06 November 2006

Vaginal pain during sex

Vestibular tactile and pain thresholds in pain with vulvar vestibulitis syndrome
Pukall, et al.
Vulvar vestibulitis syndrome (VVS) is a common cause of dyspareunia** in pre-menopausal women. Little is known about sensory function
in the vulvar vestibule*, despite Kinsey's assertion that it is important for sexual sensation. We examined punctate tactile and pain thresholds
to modified von Frey filaments in the genital region of women with VVS and age- and contraceptive-matched pain-free controls. Women
with VVS had lower tactile and pain thresholds around the vulvar vestibule and on the labium minus than controls, and these results were
reliable over time. Women with VVS also had lower tactile, punctate pain, and pressure-pain tolerance over the deltoid muscle on the upper
arm, suggesting that generalized systemic hypersensitivity may contribute to VVS in some women. In testing tactile thresholds, 20% of trials
were blank, and there was no group difference in the false positive rate, indicating that response bias cannot account for the lower thresholds.
Women with VVS reported significantly more catastrophizing thoughts related to intercourse pain, but there was no difference between
groups in catastrophizing for unrelated pains. Pain intensity ratings for stimuli above the pain threshold increased in a parallel fashion with
log stimulus intensity in both groups, but the ratings of distress were substantially greater in the VVS group than in controls at equivalent
levels of pain intensity. The data imply that VVS may reflect a specific pathological process in the vestibular region, superimposed on
systemic hypersensitivity to tactile and pain stimuli.
(c) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved

Pain 96 (2002) 163-175
PII: S0304-3959(01)00442-0

* The vulvar vestibule is located posterior to the glans clitoris between the labia minora, and contains the vaginal and urethral openings
and the ducts of the Bartholin’s glands.

**Dyspareunia: Painful sexual intercourse.