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Psychological and cognitive factors In accordance with current chronic pain models, there is much more to the experience of dyspareunia than the pain and its possible physiological underpinnings. This point is illustrated by a recent functional magnetic resonance imaging study of women with vulvar vestibulitis, demonstrating that both sensory and affective brain areas are activated in response to painful genital stimulation. These findings are consistent with results from other pain imaging studies and support the multidimensional conceptualization of dyspareunia proposed in this chapter. Factors such as psychological distress, anxiety, depression, low sexual selfesteem, harm avoidance, somatization, shyness, and pain catastrophization have been found in women with vulvar vestibulitis. Whether they precede or develop subsequent to the pain remains to be elucidated; however, it is crucial to investigate the role of these factors in the maintenance of dyspareunia as negative affect has been shown to modulate pain intensity. Negative affect is also associated with an increase in attention towards pain stimuli, otherwise known as hypervigilance, which in turn can increase perceived pain intensity. In a recent study, hypervigilance for pain stimuli was examined in women with vestibulitis and matched control women. Results indicated that women with vulvar vestibulitis syndrome reported hypervigilance to coital pain and exhibited a selective attentional bias towards pain stimuli, an effect mediated by anxiety and fear of pain. These results suggest that anxiety and fear-mediated hypervigilance represent important factors for pain perception in vulvar vestibulitis. Furthermore, hypervigilance to pain stimuli could exacerbate sexual impairment in women suffering from dyspareunia by distracting attentional resources away from erotic cues, a cognitive bias that has been associated with impaired sexual arousal. The role of sexual arousal in vulvar sensation has not yet been established; however, many theoretical models posit arousal as a key factor in preparing the female reproductive system for the “trauma” of coitus. Therefore, hypervigilance to pain stimuli in women with VVS may result in both a heightened awareness of pain and a distraction away from sexual stimuli, resulting in impaired sexual arousal which may further aggravate the pain experience. Relationship factors The examination of relationship factors has been quite limited despite the tremendous impact dyspareunia has on intimate relationships. Seventy-four percent of vestibulitis sufferers report that the pain impacts their relationships, although they do not typically report significant levels of dyadic distress. In addition, high dyadic adjustment is related to decreased pain severity in women with dyspareunia, whereas psychosocial attributions for the pain are associated with dyadic distress, suggesting an interaction between pain coping style and relationship adjustment. Further research is currently underway to clarify the complex relationship among pain severity, relationship adjustment, and coping styles in this population of women.
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About The Author David Crawford is the CEO and owner of a Top Male Enhancement company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2010 David Crawford of Best Male Enhancement This article may be freely distributed if this resource box stays attached.
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