Pain tolerance and thresholds in women with dyspareunia: Do pain and sex primes have differential effects?

Dyspareunia, defined as recurrent pain in the genital/pelvic region during sexual intercourse, is one of the most common types of female sexual dysfunction, affecting approximately 15% of women between the ages of 18 and 24. Women with dyspareunia display similar cognitive and emotional styles evidenced in other chronic pain conditions (e.g. hypervigilance for pain information, catastrophization, and negative affect); however, dyspareunia is a unique pain disorder in that it directly involves sexual functioning. This pairing of pain and sex raises the issue of conditioning. Is it possible that because intercourse is painful for women with dyspareunia, the presentation of any sexual stimuli would evoke similarly negative reactions as do pain stimuli (e.g. fear, avoidance, negative affect or decreased sexual responding)? The primary purpose of this study was investigate the extent to which sexual stimuli might have become conditioned to affect pain perception. We attempted to do this by trying to tease apart the impact of sexual and pain primes on the experience of experimentally-induced pain in women with dyspareunia in comparison to controls. Sixty no-dysfunction control women and 38 women with dyspareunia were randomly assigned to be exposed to pain or sex primes prior to the administration of a cold-pressor test assessing pain threshold and tolerance. A secondary aim of the study was to compare sexual function and cognitive-affective variables such as pain catastrophization, somatosensory amplification and overall mental health between women with dyspareunia and non-pain controls. The relationship between pain threshold and tolerance and cognitive-affective variables were also explored. Results indicated that overall, women with dyspareunia had lower pain threshold and tolerance levels than no-dysfunction women; however, there was no effect of priming condition on pain perception, nor any interaction as a function of condition and group. Women with dyspareunia displayed lower levels of sexual function and higher levels of pain catastrophization than controls. For all women, pain tolerance and threshold were related to pain catastrophization. For women with dyspareunia, pain characteristics such as reported sexual pain intensity, distress, and duration were significantly correlated with sexual function and pain catastrophization variables. Results are interpreted to indicate that women with dyspareunia display a general sensory dysregulation and heightened levels of pain-related fear, similar to other chronic pain conditions. Dyspareunia may thus best be conceptualized as a pain disorder that interferes with sexual function. Our findings further highlight that sex and pain may not be one and the same for women with dyspareunia and that current Cognitive Behavioral Therapy protocols are well advised in (1) encouraging women to engage in non-penetrative sexual activity to increase sexual function; and (2) targeting maladaptive cognitions related to pain to help women cope with and ultimately decrease their pain experience