Vulvar vestibulitis syndrome is a highly prevalent and under-investigated pain syndrome. It is believed to be the most common form of dyspareunia, or painful intercourse, in pre-menopausal women. Despite the fact that pain is its defining characteristic, its conceptualization as a sexual dysfunction remains the predominant view. The first chapter of this thesis reviews support for a re-conceptualization of vulvar vestibulitis as a pain disorder, and contends that the pain component must be measured as it is in chronic pain patients, both objectively and subjectively. This paper is followed by a study in which tactile and pain thresholds in genital and non-genital body areas of 13 women with vulvar vestibulitis syndrome and 13 non-affected women were measured, while data about the intensity and unpleasantness of these sensations were collected. Results indicated that women with vulvar vestibulitis have decreased tactile and pain thresholds in both genital and non-genital body areas, as well as higher unpleasantness ratings in response to painful stimuli than controls, replicating data from the chronic pain literature. The third paper presents a pain conceptualization of vulvar vestibulitis according to classification criteria used by the International Association for the Study of Pain, and introduces the development of a vulvalgesiometer, a standardized method of genital pain measurement. Data collected with the vulvalgesiometer are presented in the fourth paper, a study in which 14 women with vulvar vestibulitis and 14 control women participated. Women with vulvar vestibulitis had significantly lower pain thresholds, higher pain unpleasantness ratings, and used adjectives similar to those reported during intercourse in response to painful stimulation. The vulvalgesiometer was used to elicit genital tactile and pain sensation in the two groups while brain activation patterns were measured via functional magnetic rdsonance imaging, the focus of the fifth paper. Results demonstrated that women with vulvar vestibulitis have augmentations of brain activity in the processing of both painful and non-painful genital stimulation as compared with non-affected women. Overall, findings from these studies suggest that the pain of vulvar vestibulitis can be reliably measured and that the pain perspective has important implications for both research and treatment of urogenital pain problems.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.19503 |
| Date | January 2003 |
| Creators | Pukall, Caroline |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (Department of Psychology) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 002021263, Theses scanned by McGill Library. |
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