Mautz Theodora T, Mulroy Maeve E, Krapf Jill M, Goldstein Andrew T, Pukall Caroline F
The Centers for Vulvovaginal Disorders, New York City, NY 10036, United States.
Department of Psychology, Queen's University, Kingston K7L 3N6, Canada.
Sex Med. 2023 Sep 3;11(4):qfad047. doi: 10.1093/sexmed/qfad047. eCollection 2023 Aug.
Chronic pain can occur in the vulva, one of the primary pleasure centers of the body; however, the associations between pleasurable vulvar experiences and chronic vulvar pain have not yet been explored.
The aim of this study was to investigate associations between vulvar pleasure and pain experiences in patients with chronic vulvar pain.
This was a prospective cross-sectional study of 547 patients (aged ≥17 years) presenting over 10 months to 2 urban outpatient gynecology clinics specializing in vulvar pain. Prior to the initial evaluation, patients completed online validated questionnaires of pain-related anxiety, pain catastrophizing, and sexual functioning, as well as a researcher-developed questionnaire evaluating vulvar pleasure. Patients were divided into groups based on their pleasure and pain experiences. Between-group analyses consisting of -tests, analyses of variance, and multivariate analyses of variance were conducted.
Outcomes consisted of total and subscale scores on the Pain Anxiety Symptoms Scale-20, Pain Catastrophizing Scale, Female Sexual Function Index, and a researcher-developed vulvar pleasure questionnaire.
More than 70% of patients with chronic vulvar pain had experienced vulvar pleasure since the onset of their vulvar pain, with the clitoris as the most common source of pleasure. Average vulvar pleasure intensity was rated 7 (0, no pleasure; 10, extremely pleasurable). Masturbation ranked higher in pleasurable activities than vulvar stimulation by a partner or penetrative intercourse and was the most likely activity to lead to orgasm. When compared with patients who had not experienced vulvar pleasure since the onset of their vulvar pain, patients experiencing both pain and pleasure scored lower on the Pain Anxiety Symptoms Scale-20 total ( = .026) and fear subscale ( = .016), lower on the Pain Catastrophizing Scale total ( = .002) and all subscales ( = .008-.018), and higher on the Female Sexual Function Index total and all subscales (all ≤ .001).
Incorporating strategies for cultivating vulvar pleasure in patients with chronic vulvar pain may be useful in comprehensive management approaches.
Strengths of this study include the novel examination of vulvar pleasure in a population with chronic vulvar pain and a large sample size. Limitations include the lack of a nonclinical comparator group and reliance on patient self-report.
Results suggest that greater vulvar pleasure is associated with lower pain-related anxiety, lower pain catastrophizing, and higher sexual functioning in patients with chronic vulvar pain conditions.
慢性疼痛可能发生在外阴，而外阴是人体主要的愉悦中心之一；然而，愉悦的外阴体验与慢性外阴疼痛之间的关联尚未得到探讨。
本研究旨在调查慢性外阴疼痛患者的外阴愉悦与疼痛体验之间的关联。
这是一项前瞻性横断面研究，研究对象为547名年龄≥17岁的患者，他们在10个月内前往2家专门治疗外阴疼痛的城市门诊妇科诊所就诊。在初次评估前，患者完成了关于疼痛相关焦虑、疼痛灾难化和性功能的在线有效问卷，以及一份由研究人员编制的评估外阴愉悦的问卷。患者根据其愉悦和疼痛体验进行分组。进行了包括t检验、方差分析和多变量方差分析的组间分析。
超过70%的慢性外阴疼痛患者自外阴疼痛发作以来经历过外阴愉悦，阴蒂是最常见的愉悦来源。外阴愉悦平均强度评分为7分（0分表示无愉悦；10分表示极其愉悦）。在愉悦活动中，自慰的排名高于伴侣对外阴的刺激或性交，并且是最有可能导致性高潮的活动。与自外阴疼痛发作以来未经历过外阴愉悦的患者相比，同时经历疼痛和愉悦的患者在疼痛焦虑症状量表-20总分（P = 0.026）和恐惧子量表（P = 0.016）上得分较低，在疼痛灾难化量表总分（P = 0.002）和所有子量表（P = 0.008 - 0.018）上得分较低，而在女性性功能指数总分和所有子量表上得分较高（所有P≤0.001）。
在慢性外阴疼痛患者中纳入培养外阴愉悦的策略可能有助于综合管理方法。
本研究的优点包括对慢性外阴疼痛人群中外阴愉悦的新颖研究以及大样本量。局限性包括缺乏非临床对照群体以及依赖患者自我报告。
结果表明，在慢性外阴疼痛患者中，更高的外阴愉悦与更低的疼痛相关焦虑、更低的疼痛灾难化和更高的性功能相关。
