Psychophysiology of the Sexuality of Women with Lifelong Vaginismus: A Matched Controlled Thermography and Survey Investigation of Sexual Function, Behaviour, and Physiological Arousal

Vaginismus is defined as a persistent difficulty with vaginal entry, despite a woman’s expressed wish, due to muscle tension, avoidance, and/or pain (Basson et al., 2003). The disorder is classified as a sexual dysfunction; however, there is a paucity of literature on the sexual response, sexual function, and sexual behaviour of women with vaginismus. This thesis research was designed to investigate the differential aspects of sexual health in women with lifelong vaginismus, compared to women with lifelong dyspareunia (pain with intercourse) and women with pain-free intercourse. In the first study, 45 women viewed erotic films, of which one set depicted penetration and the other did not. Physiological sexual arousal was assessed via thermography. Subjective responses to films were assessed with questionnaires. Despite significantly greater negative emotions and lower mental sexual arousal in response to erotic stimuli, women with vaginismus showed genital arousal comparable to the comparison groups. In the second study, 174 women completed an online survey. Women with vaginismus reported more sexual difficulties than the no-pain group and a restricted range of lifetime sexual behaviours and lower frequency of intercourse attempts/experiences than the comparison groups. Women with vaginismus and dyspareunia reported more anxiety during sexual activity and a restricted sexual behaviour repertoire in the previous year and month compared to the no-pain group. Women with vaginismus endorsed more negative cognitions related to penetration, specifically concerns about losing control of their body and the situation. The findings suggest that sexual function difficulties and restricted behavioural repertoire may be associated with negative emotions and maladaptive cognitions. Women with vaginismus may avoid encounters that could lead to intercourse. Alternatively, the negative response to sexual stimuli may be indicative of a more global negative response to sexuality beyond intercourse. The negative penetration-related cognitions, negative responses to sexual stimuli, anxiety during sexual activity, and reduced range and frequency of sexual behaviours of women with vaginismus provide support for the Fear-Avoidance Model of Vaginismus. The impairment in sexual functioning supports the need to move beyond the singular treatment focus of making intercourse possible to an approach that addresses overall sexual rehabilitation