Moderators of the Relationship Between Pain and Pain-Related Sexual Disability in Women with Provoked Vestibulodynia Symptoms.

BACKGROUND: Previous studies have demonstrated the deleterious effects of pain anxiety (ie, the degree to which one fears pain), stress, and solicitous partner responses (ie, expressions of sympathy and attention to one's partner's pain) on pain and pain-related disability, but little is known about whether these variables moderate the robust pain-pain-related disability relationship in individuals with provoked vestibulodynia (PVD). AIM: We investigated whether pain anxiety, stress, and solicitous partner responses moderated the relationship between penetrative pain and pain-related sexual disability in women with PVD symptoms. METHODS: Participants with PVD symptoms (N = 65, age range = 18-73 years) completed an online survey assessing pain anxiety (Pain Anxiety Symptoms Scale-20), perceived stress (Perceived Stress Scale), solicitous partner responses (WHYMPI Solicitous Responses Scale), penetrative pain (Female Sexual Function Index), and pain-related sexual disability (Pain Disability Index). Moderated regression analyses were performed using pain anxiety, stress, and solicitous partner responses as moderators of the relationship between penetrative pain, and pain-related sexual disability. OUTCOMES: Outcomes in the current study included the moderating effect of pain anxiety, perceived stress, and solicitous partner responses on the relationship between penetrative genital pain and pain-related disability in sexual behavior. RESULTS: Higher genital pain from penetrative intercourse and higher pain anxiety significantly predicted higher pain-related sexual disability, but perceived stress was not significantly related to sexual disability. Solicitous partner responses were significantly positively correlated with pain-related sexual disability. None of the moderators significantly moderated the pain-pain-related sexual disability relationship. CLINICAL IMPLICATIONS: For women with PVD, pain anxiety and solicitous partner responses to their pain may exacerbate their pain-related sexual disability, signifying that pain anxiety and solicitous partner responses represent important targets of therapeutic intervention for women with PVD. STRENGTHS AND LIMITATIONS: The present study extended past research on the relationships between psychological and behavioral factors and pain in women with PVD symptoms by demonstrating the deleterious relationship between pain anxiety, solicitous responses, and pain-related sexual disability. However, the study was correlational in nature, which precludes conclusions about the effect of pain anxiety, and solicitous partner responses on pain-related sexual disability. CONCLUSION: High pain anxiety and frequent solicitous partner responses to an individual's pain predicted higher pain-related sexual disability, suggesting that it may be possible to improve the quality of life of PVD sufferers through interventions that aim to decrease pain anxiety, and solicitous partner responses, in addition to interventions that aim to decrease pain per se. Maunder L, Dargie E, Pukall C. Moderators of the Relationship Between Pain and Pain-Related Sexual Disability in Women with Provoked Vestibulodynia Symptoms. J Sex Med 2022;19:809-822.

The Clinical Utility of the Vulvar Pain Assessment Questionnaire: A Pilot Study.

OBJECTIVE: The aim of the study was to document treatment-seeking experiences of women with chronic vulvar pain, comfort communicating about pain, and test the clinical utility of the screening version of the Vulvar Pain Assessment Questionnaire, screening version (VPAQscreen). MATERIALS AND METHODS: Patients scheduled for an appointment with the Program in Vulvar Health at Oregon Health and Science University were invited to complete the VPAQscreen and answer descriptive questions about previous treatment-seeking experiences and communication with health care providers. Clinicians provided provisional diagnoses based on VPAQscreen summaries, final diagnoses based on gynecological examination, and commented on alignment with clinical observations. Patients gave feedback on the accuracy and helpfulness of the VPAQscreen summary, characteristics of the questions asked, and whether their comfort communicating increased. RESULTS: Participants reported previously seeing approximately 5 medical doctors and 2 other health care providers and perceived them as lacking knowledge of vulvar pain syndromes. Providers indicated that VPAQscreen summaries aligned with clinical presentations and suggested provisional diagnoses with more than 80% accuracy. Participants reported that VPAQscreen summaries were helpful and accurate in summarizing symptoms. Most reported that the number, range, and readability of VPAQscreen questions were good or excellent. More than half reported that completing the VPAQscreen increased comfort when speaking with their Oregon Health and Science University physician. CONCLUSIONS: Patients with vulvar pain often endure a lengthy process of consulting multiple clinicians before securing care. The VPAQscreen was more than 80% accurate in predicting diagnosis at this specialty clinic and was useful in assisting patients with expressing symptoms. The applicability of the VPAQscreen in general practice is unknown, although it shows promise.

Self-Reported Neuropathic Pain Characteristics of Women With Provoked Vulvar Pain: A Preliminary Investigation.

BACKGROUND: Provoked vestibulodynia (PVD) is a common chronic genital pain condition affecting approximately 12% of premenopausal women. Although parallels have been drawn between PVD and neuropathic pain (NP), no studies have examined self-reported NP characteristics in PVD. AIM: To explore pain symptoms that resemble NP reported by those with PVD and compare responses with those with an established NP condition. METHODS: Women with provoked vulvar pain (PVP; n = 65) completed online questionnaires designed to assess characteristics of NP. Responses were compared with those of women with postherpetic neuralgia (PHN; n = 30). OUTCOMES: In addition to a range of descriptive questions, participants completed the McGill Pain Questionnaire, the Self-Complete Leeds Assessment of Neuropathic Signs and Symptoms (S-LANSS), the Neuropathic Pain Symptom Inventory (NPSI), and the Pain Quality Assessment Scale (PQAS). RESULTS: PVP exhibits some neuropathic characteristics, typically evoked pain (as opposed to the more constant pain of PHN) indicative of allodynia and hyperalgesia. Specifically, women with PVP scored, on average, higher than the NP cutoff on the S-LANSS, and there were no significant differences between women with PVP and those with PHN on some NPSI subscales. However, women with PHN reported more NP symptoms on the PQAS, S-LANSS, and other NPSI subscales. CLINICAL IMPLICATIONS: Validated NP questionnaires could be of particular use for health care professionals who need a more efficient way to assess symptoms of patients with PVP and should be included in future studies investigating the mechanisms and treatment of this pain. STRENGTHS AND LIMITATIONS: This study takes a unique approach to the examination of PVP by using multiple validated NP measures to compare pain characteristics with those of a group of participants with PHN, an established NP condition. However, it is limited by self-reported data not confirmed with clinical examination, small size of the PHN group, and the severity of the pain experienced in the PVP group. CONCLUSION: Women with PVP report some symptoms suggestive of NP characteristics, and future research should use NP measures in addition to physical examinations to further investigate the mechanisms that maintain this pain condition. Dargie E, Gilron I, Pukall CF. Self-Reported Neuropathic Pain Characteristics of Women With Provoked Vulvar Pain: A Preliminary Investigation. J Sex Med 2017;14:577-591.

The Vulvar Pain Assessment Questionnaire: Factor Structure, Preliminary Norms, Internal Consistency, and Test-Retest Reliability.

BACKGROUND: The Vulvar Pain Assessment Questionnaire (VPAQ) was developed to assist in the assessment and diagnosis of chronic vulvar pain (vulvodynia). AIM: To further establish the psychometric properties of the VPAQ by examining factor structure, test-retest reliability, internal consistency, and scale normative data, and to gather feedback from those with vulvar pain about the usefulness and accessibility of the questionnaire. METHODS: 182 participants completed a confidential online study and 70 participated again at time 2 (4 weeks later). OUTCOMES: Participants were asked to complete the full VPAQ, which assesses pain characteristics, effects on various parts of their lives, coping strategies used, and romantic partner factors. Additional questions captured sociodemographics and feedback about the instrument. RESULTS: Exploratory structural equation modeling indicated that the previously established subscales, except the coping scale, had adequate model fit, and all items loaded significantly onto relevant factors. Pearson product moment correlations (r = 0.57-0.96) established strong 4-week test-retest reliability for most subscale scores, and Cronbach α indicated overall acceptable to high internal consistency (α = 0.56-0.95). Preliminary norms for the scales are supplied. Approximately half the participants reported an increase in their comfort level in discussing a range of topics after completing the VPAQ. Most participants reported that the length, readability, and range of VPAQ questions were "good" or "excellent." CLINICAL IMPLICATIONS: The results of this study provide further justification for using the VPAQ scales in clinical and research settings, preliminary norms for a vulvar pain population, and suggestions for interpretation. STRENGTHS AND LIMITATIONS: This study established the psychometric properties of the VPAQ scales using multiple methods at 2 time points and gathered feedback from participants. However, data were collected online so diagnoses could not be confirmed and more than half the initial sample did not complete the survey at time 2. CONCLUSION: The results of this study suggest that most VPAQ subscales (except the coping subscale) have moderate to strong psychometric properties and that the VPAQ is user friendly. Dargie E, Holden RR, Pukall CF. The Vulvar Pain Assessment Questionnaire: Factor Structure, Preliminary Norms, Internal Consistency, and Test-Retest Reliability. J Sex Med 2017;14:1585-1596.

Provoked Vestibulodynia: Diagnosis, Self-Reported Pain, and Presentation During Gynaecological Examinations.

OBJECTIVE: To explore factors associated with the diagnosis of provoked vestibulodynia (PVD) through (1) self-reported pain characteristics and (2) Friedrich's criteria (vestibular pain during sexual activity/gynaecological examination). We also identified cases in which incorrect diagnoses were assigned and explored group differences in gynaecological examination presentation and associations with self-reported pain. METHODS: Data were extracted from nine studies conducted in our research laboratory. Information obtained during a telephone interview and a standardized gynaecological examination was compiled for 106 participants with vulvar pain and 106 pain-free control participants, matched for age, hormonal contraceptive use, and parity. RESULTS: Cohen's kappa (0.78) indicated substantial agreement (87.3%) between the telephone interview group categorization and diagnosis after the gynaecological examination. A discriminant function analysis yielded one significant function: Friedrich's first two criteria correctly classified 84.2% of cases, accounting for 76.0% of group membership variance. Of note, those in the other genital pain group were most likely to have received an incorrect diagnosis following the telephone interview (P < 0.001). Paired-samples t tests showed that those with pain reported lower pain intensity during the gynaecological examination than during intercourse (P < 0.001) and that intercourse pain was not necessarily related to pain during the examination. However, many participants (72.8%) indicated that the pain elicited during the cotton swab test was similar to the pain they felt with intercourse. CONCLUSION: These results support the use of a targeted clinical interview and the evaluation of vestibular pain during sexual activity and the gynaecological examination for diagnosing PVD. Caution should be exercised when a patient presents with genital pain symptoms other than those typically observed in PVD. Furthermore, the cotton swab test may underestimate the degree of pain regularly experienced.

Women in "Sexual" Pain: Exploring the Manifestations of Vulvodynia.

This study explored the sexual and pain histories and pain presentations of women with forms of chronic vulvar pain (i.e., vulvodynia). One hundred and seventy-seven women with five subtypes of vulvodynia completed an online questionnaire. Groups were similar across several domains: participants experienced pain for many years during sexual and nonsexual activities, and pain was rated as moderate to severe. However, several differences emerged when considering pain development, number of sexual partners, and treatment seeking. This study illustrates how severe vulvodynia pain can be, regardless of subtype. However, not all vulvodynia sufferers are alike, and distinctions between research and clinical practice are highlighted.

Go long! Predictors of positive relationship outcomes in long-distance dating relationships.

Little is known about long-distance dating relationships. This study aimed to investigate differences between long-distance dating relationships and geographically close relationships and to explore predictors of relationship quality. Participants were 474 women and 243 men in long-distance dating relationships and 314 women and 111 men in geographically close relationships. Few differences existed between long-distance dating relationships and geographically close relationships, while individual and relationship characteristics predicted relationship quality. These results indicate that individuals in long-distance dating relationships are not at a disadvantage and that relationship and individual characteristics predict relationship quality. This knowledge could be a powerful tool for helping those in long-distance dating relationships.

Multidisciplinary Treatment for Provoked Vestibulodynia: Treatment Trajectories, Predictors, and Moderators of Sexual Distress and Pain.

OBJECTIVES: Multidisciplinary treatment programs for provoked vestibulodynia (PVD) are recommended, yet few have been evaluated. This study examined women's symptom trajectories over time, as well as baseline demographic, psychosocial and pain characteristics as predictors/ moderators of sexual pain and distress following treatment at a clinic using multidisciplinary concurrent methods. We also examined the impact of baseline variables on the probability of having low sexual distress scores following treatment. MATERIALS AND METHODS: Women attending a multidisciplinary treatment program for PVD were invited to complete questionnaires before, following, and at 6 and 18 months after program completion. Questionnaires included the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), State-Trait Anxiety Inventory (STAI), Pain Catastrophizing Scale (PCS), Painful Intercourse Self-Efficacy Scale (PISES), and Pain Vigilance and Awareness Questionnaire (PVAQ). Linear mixed-effects models evaluated the FSDS and FSFI pain subscale as criterion variables, and the other baseline variables as predictors and moderators. RESULTS: Significant improvements in sexual distress and pain were observed over time. No significant moderators were identified, but higher baseline levels of FSFI desire and arousal predicted greater improvements in sexual distress. Similarly, higher baseline levels of desire predicted greater improvements in pain. Among women distressed at baseline and with 6 month FSDS scores, 25% (n=35) were no longer sexually distressed at 6 months; higher baseline levels of desire were associated with greater probability of having low sexual distress at 6 months. DISCUSSION: Although global improvements were observed, women with poorer baseline sexual functioning were less likely to improve after multidisciplinary treatment.

Provoked Vestibulodynia: A Comparative Examination of Mental Health, Sleep, Sexual Functioning, and Relationship Adjustment.

OBJECTIVES: Provoked vestibulodynia (PVD) is an idiopathic vulvar pain condition characterized by burning pain at the vaginal opening in response to contact or pressure. Previous research has established some of the psychosocial difficulties experienced by these patients, but direct comparisons with other pain conditions are needed. The purpose of this study was to compare women with PVD to those with postherpetic neuralgia and pain-free control participants. MATERIALS AND METHODS: Participants were invited to complete an anonymous online survey consisting of sociodemographic questions and a range of validated measures. RESULTS: Women with PVD and postherpetic neuralgia (PHN) did not differ in terms of pain catastrophizing or pain anxiety, but women with PHN reported greater pain disability than those with PVD. Participants in both pain groups reported significantly more symptoms of stress, depression, anxiety, and sleep disturbances than pain-free controls; women with PHN reported more symptoms of depression than those with PVD, with no other differences between pain groups. Groups did not differ on relationship adjustment, but participants with PVD reported poorer sexual functioning than the other groups. DISCUSSION: These results indicate that women with PVD and PHN experience similar mental health difficulties, but women with PHN experience more severe impact on their day-to-day functioning and mood. These results support the classification of PVD as a chronic pain condition, as both the pain groups differed from pain-free control participants on a range of measures. Finally, the presence of mental health difficulties and poorer sexual functioning highlights the importance of conducting biopsychosocial pain assessments.

The Vulvar Pain Assessment Questionnaire inventory.

Millions suffer from chronic vulvar pain (ie, vulvodynia). Vulvodynia represents the intersection of 2 difficult subjects for health care professionals to tackle: sexuality and chronic pain. Those with chronic vulvar pain are often uncomfortable seeking help, and many who do so fail to receive proper diagnoses. The current research developed a multidimensional assessment questionnaire, the Vulvar Pain Assessment Questionnaire (VPAQ) inventory, to assist in the assessment and diagnosis of those with vulvar pain. A large pool of items was created to capture pain characteristics, emotional/cognitive functioning, physical functioning, coping skills, and partner factors. The item pool was subsequently administered online to 288 participants with chronic vulvar pain. Of those, 248 participants also completed previously established questionnaires that were used to evaluate the convergent and discriminant validity of the VPAQ. Exploratory factor analyses of the item pool established 6 primary scales: Pain Severity, Emotional Response, Cognitive Response, and Interference with Life, Sexual Function, and Self-Stimulation/Penetration. A brief screening version accompanies a more detailed version. In addition, 3 supplementary scales address pain quality characteristics, coping skills, and the impact on one's romantic relationship. When relationships among VPAQ scales and previously researched scales were examined, evidence of convergent and discriminant validity was observed. These patterns of findings are consistent with the literature on the multidimensional nature of vulvodynia. The VPAQ can be used for assessment, diagnosis, treatment formulation, and treatment monitoring. In addition, the VPAQ could potentially be used to promote communication between patients and providers, and point toward helpful treatment options and/or referrals.