Provoked Vestibulodynia (PVD) is the most common form of chronic vulvar pain, affecting 12% of women in the general population. Research has demonstrated that women with PVD display both allodynia and hyperalgesia to pain at vulvar and non-vulvar sites, as well as reduced psychosocial functioning. The goal of this study was to use a multi-method approach (interview, questionnaires, sensory testing, and fMRI) to examine group differences between women with PVD (N=15) and healthy control women (N=15). Results will allow for improved understanding of the interaction between psychosocial and neurobiological underpinnings of this disorder, which can contribute to the creation of better treatment strategies. Variables included psychophysical and psychosocial measures, as well as neural activations associated with painful pressure, painful words, and psychosocial functioning. Differences between subgroups of PVD, based on temporal onset, were also examined. There were no robust group differences in neural activation during the application of pain or pain words. This finding is consistent with many studies that match groups on pain intensity ratings, as opposed to amount of pressure applied. Painful pressures and painful words resulted in greater neural activation than neutral words or touch; however, there were no group differences for the word conditions. Women with PVD reported increased psychosocial dysfunction, including higher levels of anxiety and catastrophizing. Significant correlations were found between these psychosocial variables and areas of the brain associated with pain modulation and attention (e.g., PFC). Examination of PVD subgroups revealed differences in neural correlates of anxiety and catastrophizing during painful stimulation. This finding adds to the literature suggesting that women with primary PVD experience greater dysfunction than women with secondary PVD. Overall, these studies support findings of pain processing in the general pain literature, as well as supporting PVD as a chronic pain condition. They also add to the development of a greater understanding of the interaction between psychophysical and psychosocial components of chronic pain by examining their relationship with neural activations. Future research should examine brain functioning in PVD women pre- and post-treatment as well as examining neural correlates of other psychosocial variables that contribute to the pain experience (e.g., somatization). / Thesis (Ph.D, Psychology) -- Queen's University, 2013-01-30 09:14:09.652

Provoked Vestibulodynia (PVD) is the most common form of chronic vulvar pain, affecting 12% of women in the general population. PVD is characterized by a severe burning pain in response to pressure localized to the vaginal entrance. Research examining the pain component of PVD indicates that it has much in common with other chronic pain conditions. Increased pain sensitivity has been demonstrated in other chronic pain conditions to be due in part to impairment in centrally acting endogenous pain modulation systems, such as Diffuse Noxious Inhibitory Control (DNIC). DNIC is triggered by the simultaneous application of two painful stimuli, with pain at one body site inhibiting pain at another body site. Because DNIC consists of a feedback loop that involves the spinal cord and the brain, it is thought to be dependent upon both sensory and affective pain components. In the current study, 20 women with PVD and 24 controls underwent sensory testing to determine the integrity of DNIC function. Unexpectedly, women with PVD displayed a DNIC response of greater magnitude than controls. Participants also completed measures to assess the interplay between group, DNIC, and psychosocial functioning. Women with PVD experienced decreases in psychosocial functioning; however, this reduction was not found to mediate the relationship between group and DNIC function. Findings of intact DNIC function in women with PVD do not imply that PVD is not a chronic pain condition. DNIC is a complex and dynamic process and warrants further study using different stimuli and paradigms. This study supports previous literature, while adding to the development of a greater understanding of the interaction between psychophysical and psychosocial components of chronic pain, which will allow for the creation of better assessment and treatment strategies. / Thesis (Master, Psychology) -- Queen's University, 2007-09-14 00:14:17.698

Female sexual pain is a common problem affecting women worldwide yet remains a poorly researched area of women’s sexual health. Dyspareunia and vaginismus are two types of sexual pain disorder each having psychological and physical health consequences for women and their partners. Part 1: A literature review of the qualitative research literature exploring women’s experiences of sexual pain disorders and their treatment was conducted adopting a narrative synthesis approach. Searches of psychological and medical electronic databases highlighted the paucity of research exploring women’s experiences of sexual pain disorders. Ten studies met the inclusion criteria for the review. The type of qualitative method and quality varied. Findings highlighted the complexity of women’s experiences of sexual pain. Positive experiences of treatment identified alternative benefits of treatment in addition to the traditional outcome of vaginal penetration and penetration without pain. Existing literature has focussed on dyspareunia, and further research is needed on vaginismus. Part 2: The research study used an Interpretative Phenomenological Analysis (IPA) of women’s experiences of vaginismus. Three women were interviewed about their experiences of vaginismus and the treatment they received. Interview transcripts were analysed using IPA. The findings identified the complexity of experiencing vaginismus, the struggle the women faced when trying to make sense of their vaginismus and the wider impact of these experiences on their identity. The findings highlight the value of psychological therapy with this client group and of the need to raise awareness amongst primary care professionals whom women with vaginismus are likely to consult in the first instance. Part 3: A critical appraisal of the research process is presented with focus on the experience of conducting qualitative research as a trainee clinical psychologist. A discussion of the findings is presented in the context of critical reflections on both the strengths and limitations of the study.

Provoked vestibulodynia (PVD), or recurrent vulvar pain, is a prevalent condition among women. Although research has documented that PVD is associated with sexual problems, little research has systematically examined the intimate relationships of affected women. The general purpose of the current studies was to comprehensively examine sexual and relationship functioning among women with provoked vulvar pain. In order to do so, three related studies were conducted. The first study was a systematic review of the literature examining sexual and relationship satisfaction among PVD-affected women. Secondly, an online study was conducted using both standardized and qualitative measures to examine sexual, relationship, and psychological functioning among women with self-reported provoked vulvar pain and their male partners in comparison to controls. The online study also examined associations between affected women’s pain and women and partner’s functioning. The final study was a laboratory-based study that included women with PVD and matched control women and examined psychosexual functioning, including sexual and relationship satisfaction, and vestibular pain sensitivity; additionally, this study examined potential associations between women’s pain and self-reported functioning. Overall, these studies suggest that women with provoked vulvar pain experience decreased sexual functioning, sexual satisfaction, and psychological functioning in comparison to control women, and that pain-affected partners experience decreased sexual functioning and sexual satisfaction. The findings also indicate that some aspects of women’s pain experiences are related to their self-reported functioning and to that of their partners. This research has implications for understanding the potential sexual and relationship consequences associated with provoked vulvar pain, and is among the first to comprehensively examine affected partners’ functioning. It is hoped that these studies will contribute novel information to the vulvar pain literature, and that they will encourage future research examining sexual and relationship functioning among women with provoked vulvar pain and their partners. / Thesis (Ph.D, Psychology) -- Queen's University, 2010-08-25 12:02:29.446

Provoked Vestibulodynia (PVD) is a common form of chronic genital pain, affecting approximately 12% of premenopausal women. Even though knowledge of vulvodynia has been present in the medical field for many years, it was previously thought to be of psychogenic origin and has never been thoroughly investigated for the purpose of pain classification. When investigating any pain condition, one of the most important distinctions to make is whether or not the pain is neuropathic. Even though this possibility has never been investigated in women with PVD, some have claimed that PVD pain contains elements of neuropathy, even treating this pain with medication created for neuropathic pain conditions. The purpose of this study was to use standardized measures and determine whether PVD may have a neuropathic component. Women with PVD completed an online survey assessing various pain and psychosocial variables. Their responses were compared with those of pain-free controls and women experiencing an established neuropathic pain condition, post-herpetic neuralgia (PHN). Women with PVD scored above established cut-offs on measures of neuropathic pain (NP). Further, for some NP measures there was no difference in scores between PVD and PHN women. Women with PVD also had similar psychosocial profiles as those with PHN, although women with PHN reported poorer health-related quality of life. Interestingly, the number of NP symptoms did not predict pain/psychosocial disturbance, or vary as a function of pain duration or intensity. Overall, these results lend support to the argument that PVD is a chronic pain condition. Further, these results indicate that women with PVD likely experience some form of NP. These results add to the understanding and classification of PVD, justifying further investigation, for example, via psychophysical testing and functional magnetic resonance imaging. / Thesis (Master, Psychology) -- Queen's University, 2011-09-21 16:25:34.216

Introduction: Provoked vestibulodynia is a common life impacting disease. Research hasshown higher pain intensity and anxiety levels in primary (pain present since first penetrativeattempt) provoked vestibulodynia (PVD1) compared to secondary provoked vestibulodynia(PVD2) and mixed results regarding age and female sexual functioning when comparing thegroups.Aim: The aim of this study was to further investigate the differences between PVD1 andPVD2 regarding pain intensity, sexual functioning, age and anxiety levels. The secondary aimwas to analyze how PVD group, age, anxiety and pain intensity associates with sexualfunctioning.Method: A total of 57 women from the Netherlands and Sweden were recruited via socialmedia, advertisement and regional caregivers. This study was part of a larger study oncognitive behavioral group therapy for women with provoked vestibulodynia. Data wasextracted from a survey assessing intensity of pain, sexual functioning, age and anxiety levels.A t-test was used to compare the PVD1 and PVD2 groups and a multivariate regressionanalysis was used to analyze the variables association with sexual functioning.Results: No statistically significant differences were found regarding pain intensity, sexualfunctioning, age and anxiety levels between PVD1 and PVD2. Decreased sexual functioningwas significantly related to higher age and pain intensity.Conclusion: We found no significant differences between PVD1 and PVD2. Increased ageand higher pain intensity seems to associate with lower sexual functioning. Longitudinalstudies with a greater sample size are needed for further investigation.

Provoked vulvodynia (PVD) is a disorder characterized by intense vulvar pain, most often reported as raw, burning, or stinging tissue. Current treatment options for PVD are insufficient and narrow in focus, as they predominantly address the physical pain associated with the disorder. Current publications regarding cognitive behavioral therapy and mindfulness treatment indicate that both therapies are highly effective. Mindfulness and cognitive behavioral therapies are noninvasive, efficacious long term, and provide a comprehensive biopsychosocial approach. The aim of this study is to educate nurse practitioners regarding these treatment options, which manage the physical as well as psychosocial aspects of PVD.

Although Provoked Vestibulodynia has a great impact on women’s relationships, including their partners, research has predominantly focused on the women. This thesis aimed to expand the knowledge regarding psychosexual health of the partner. Depressive symptoms, anxiety, sexual distress, and domains of sexual function (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall sexual satisfaction) were investigated through descriptive comparisons, correlations, and regression analyses. The sample consisted of male partners (N=53) of women with PVD, aged 20-50 years. Baseline data from a larger RCT was compared with data from external studies. Results showed that PVD partners reported similar levels of depressive symptoms and anxiety as comparison groups. However, PVD partners expressed higher levels of sexual distress, and lower levels of sexual function than comparison groups. Several domains of sexual function predicted overall sexual satisfaction, whereas depressive symptoms did not explain levels of sexual distress. However, depressive symptoms co-occurring with poorer overall sexual satisfaction and orgasmic function, explained higher sexual distress. We conclude that partners have a perceived impaired sexual health. Their impairment is localised to sexuality and not generalised to the rest of their lives. Partner involvement is integral in the treatment of PVD and should be investigated in future research.

Vaginismus is a sexual pain disorder, where spasm of musculature of the outer third of the vagina interferes with intercourse. Vaginismus exists in two forms: total vaginismus, where intercourse is impossible, and the more seldom described partial vaginismus, in which intercourse is possible but painful. The aim of the thesis was to develop a useful definition of partial vaginismus for both clinical and scientific purposes; to describe the prevalence of partial vaginismus among women with superficial coital pain; to report on symptoms and clinical findings in women with partial vaginismus; and to present treatment results for women with vaginismus. In a clinical sample of 224 women with superficial coital pain, we found a great overlap of the clinical diagnoses of partial vaginismus (PaV) and vulvar vestibulitis (VVS) (nowadays called provoked vestibulodynia); 102 women had both PaV and VVS. All women with VVS had vaginismus. Partial vaginismus was more common in all our samples than total vaginismus. sEMG of pelvic floor muscles was found to be of no value in distinguishing women with partial vaginismus with or without vulvar vestibulitis (PaV+/-VVS) (n=47) from each other or from an asymptomatic group (n=27). Women with PaV+/-VVS (n=53) reported not only burning pain but also itch during a standardized penetration situation (sEMG of pelvic floor muscles), while asymptomatic women (n=27) did not. In most cases, the appearance of burning pain preceded the appearance of itch. In a retrospective interview study, 24 women with PaV+/-VVS reported pain after intercourse more often than pain during penetration at the onset of the problem. When the women ceased having intercourse, both symptoms were equally common. Intensity of pain during penetration increased dramatically from very low at onset of the problem to very high when the women ceased having intercourse, while intensity of pain after intercourse was already high at onset of the problem and increased to very high when the women ceased having intercourse. Pain after intercourse in women with PaV+/-VVS was described as burning and/or smarting and lasted in mean for two hours, while pain during penetration was described with words like sharp/incisive/bursting and lasted for one minute. At long-term follow-up (more than three years) of a group of women treated with cognitive behaviour therapy for vaginismus (n=59, response rate 44/59 on a questionnaire), a majority were able to have and enjoy intercourse. The proportion of women with positive treatment outcome was, however, associated to the definition of treatment outcome. An ability to have intercourse at end of therapy was maintained at follow-up. Every tenth women with vaginismus healed spontaneously after thorough assessment. Conclusion: Partial vaginismus was more common in our studies than total vaginismus, and all women with vulvar vestibulitis had partial vaginismus. Women with PaV+/-VVS reported not only burning pain during standardized penetration but also itch. When the problem started in women with PaV+/-VVS, pain after intercourse was more common than pain during penetration. Pain after intercourse was described as longlasting and burning and/or smarting, while pain during penetration was described as short and sharp/incisive/bursting. Long-term follow-up results of a series of women treated with CBT for vaginismus show good treatment outcome.

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