According to a recent study published in Sexual Medicine, increased vulvar pleasure is associated with reduced pain-related anxiety.
Takeaways
- A recent study found that individuals with chronic vulvar pain conditions who reported experiencing vulvar pleasure also reported lower levels of pain-related anxiety.
- Chronic vulvar pain conditions, lasting for 3 or more months and often occurring during sexual activity, can lead to decreased sexual desire, arousal, and satisfaction.
- Despite being considered separate experiences, there is interplay between chronic vulvar pain and vulvar pleasure, as indicated by sexuality research.
- The study revealed that individuals who experienced vulvar pleasure since the onset of vulvar pain had reduced pain-related anxiety and pain catastrophizing.
- Based on their findings, the investigators recommended incorporating pleasure-based approaches into the management of chronic vulvar pain, potentially improving sexual function and reducing pain-related anxiety in affected individuals.
Chronic vulvar pain conditions, characterized by 3 or more months of persistent pain often occurring during sexual activity, lead to decreased sexual desire, arousal, and satisfaction. These conditions are usually treated through physical interventions such as topical corticosteroids, pelvic floor physical therapy, and muscular hypertonicity.
Chronic pain has been associated with pain-related anxiety, fear-avoidant behaviors, and pain catastrophizing. Additionally, chronic pain and pleasure both occur in the vulva, and while these experiences are often considered dichotomous, sexuality research has indicated interplay between them.
To evaluate the association between vulvar pleasure, vulvar pain, and sexual functions in individuals with chronic vulvar pain conditions, investigators conducted a cross-sectional study. Participants were aged 17 years or older and presented to 2 urban outpatient gynecology clinics specializing in vulvar pain conditions.
Patients completed a standard clinical-based survey, with diagnoses determined by medical history and vulvoscopy, pelvic examination, and evaluation of pelvic floor muscles and pudendal nerves. Suspected diagnoses of vulvar dermatoses were confirmed through biopsy.
Pain-related anxiety was measured in online questionnaires through the Pain Anxiety Symptoms Scale–20 (PASS-20), pain catastrophizing through the Pain Catastrophizing Scale (PCS), and sexual function through the Female Sexual Function Index (FSFI). Vulvar pleasure was also reported through a researcher-developed questionnaire.
Exclusion criteria included not currently experiencing vulvar pain, having no history of vulvar pleasure, and not experiencing vulvar pleasure since the onset of vulvar pain. There were 4 subscales in the PASS-20 for pain-related anxiety: cognitive anxiety, avoidance, fear, and physiologic anxiety.
Subscales in the PCS include rumination, magnification, and helplessness, Components of sexual function measured in the FSFI include desire, arousal, lubrication, orgasm, satisfaction, and pain. Characteristics of vulvar pleasure include duration, location, intensity, and simultaneous experience of pain and pleasure.
There were 547 patients with vulvar discomfort included in the final analysis, aged a mean 41 years. Of patients, 74.8% were in a relationship, with 92% normally engaged sexually with men, 2.2% with women, and 3.3% with men and women.
Of individuals with vulvar pain, 92.1% reported having experienced vulvar pleasure, compared to 71.9% who reported vulvar pleasure since the onset of vulvar pain. These patients had an average pleasure rating of 7 on a 10-point scale. During vaginal penetration alone, 52.4% of patients reported orgasm and 15.6% reported painful orgasm.
Feeling that vulvar pain could never be pleasurable was reported by 64.7% of patients who reported both vulvar pleasure and vulvar pain. A lack of vulva pain during pleasure was reported by 55.7% of patients.
The experience of vulvar pleasure since the onset of vulvar pain had a significant effect on sexual function, increasing the total FSFI score. Pain-catastrophizing measured through PCP total scores was also reduced by experiencing vulvar pleasure.
Patients with no current vulvar pain had significantly lower PASS-20 scores compared to patients with pain and various levels of pleasure. However, experiencing vulvar pleasure since pain onset significantly improved pain-related anxiety.
These results indicated reduced pain-related anxiety and pain catastrophizing, as well as increased sexual function, from vulvar pleasure in patients with chronic vulvar pain conditions. Investigators recommended pleasure-based strategies be incorporated into chronic vulvar pain management.
Reference
Mautz TT, Mulroy ME, Krapf JM, Goldstein AT, Pukall CF. Pleasure despite pain: Associations between experiences of vulvar pleasure, vulvar pain, and sexual function in patients with chronic vulvar pain conditions. Sex Med. 2023;11(4):qfad047. doi:10.1093/sexmed/qfad047
