Abstract
Vaginismus and dyspareunia have been typically classified as sexual dysfunctions. In practice and research, this conceptualization has led to a focus on sexual and interpersonal issues after biological causes were excluded. Although this approach has been very useful, it has not led to significant theoretical or therapeutic progress in the last 20 years. We propose a reconceptualization of vaginismus and dyspareunia as pain disorders that interfere with sexuality rather than as sexual disorders characterized by pain. This reconceptualization focuses the clinician and researcher on the central phenomenon—pain. It also suggests new approaches to research and treatment. Data from diagnostic, etiologic, and therapeutic studies will be presented to illustrate these points.
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REFERENCES
American College of Obstetricians and Gynecologists. (1995). ACOG technical bulletin: Sexual dysfunction. International Journal of Gynecology and Obstetrics, 51, 265–277.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed. Revised). Washington, DC: Author.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Bergeron, S., Binik, Y. M., Khalifé, S., Meana, M., Berkley, K. J., & Pagidas, K. (1997). The treatment of vulvar vestibulitis syndrome: Toward a multimodal approach. Sexual and Marital Therapy, 12, 305–311.
Bergeron, S., Binik, Y. M., Khalifé, S., & Pagidas, K. (1996). Vulvar vestibulitis syndrome: A critical review. Clinical Journal of Pain, 13, 27–42.
Bergeron, S., Binik, Y. M., Khalifé, S., Pagidas, K., & Glazer, H. (2001a). Reliability and validity of the diagnosis of vulvar vestibulitis syndrome. Obstetrics and Gynecology, 98, 45–51.
Bergeron, S., Binik, Y. M., Khalifé, S., Pagidas, K., & Glazer, H. (2001b). A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain, 91, 297–306.
Bergeron, S., Binik, Y. M., Khalifé, S., Pagidas, K., & Glazer, H. (2001c). [A two and a half year follow-up of “A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis”]. Unpublished raw data.
Binik, Y. M., Bergeron, S., & Khalifé, S. (2000). Dyspareunia. In S. R. Leiblum & R. C. Rosen (Eds.), Principles and practice of sex therapy (pp. 154–181). New York: Guilford.
Binik, Y. M., & Koerner, N. (1998). [Catastrophization and vestibular pain during the cotton swab test]. Unpublished raw data.
Binik, Y. M., Meana, M. Berkley, K., & Khalifé, S. (1999). Dyspareunia: Is the pain sexual or is the sex painful? Annual Review of Sex Research, 210–236.
Heiman, J. R., & Meston, C. M. (1997). Empirically validated treatment for sexual dysfunction. Annual Review of Sex Research, 8, 148–194.
Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: Prevalence, predictors and outcomes. Journal of the American Medical Association, 281, 537–545.
Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Boston: Little, Brown.
Meana, M., & Binik, Y. M. (1994). Painful coitus: A review of female dyspareunia. Journal of Nervous and Mental Disease, 182, 264–272.
Meana, M., Binik, Y. M., Khalifé, S., Bergeron, S., Pagidas, K., & Berkley, K. J. (1997). Dyspareunia: More than bad sex. Pain, 71, 211–212.
Meana, M., Binik, Y. M., Khalifé, S., & Cohen, D. (1997a). Biopsychosocial profile ofwomen with dyspareunia. Obstetrics and Gynecology, 90, 583–589.
Meana, M., Binik, Y. M., Khalifé, S., & Cohen, D. R. (1997b). Dyspareunia: Pain symptomatology, biopsychosocial correlates and classification. Journal of Nervous and Mental Disease, 185, 561–569.
Meana, M., Binik, Y. M., Khalifé, S., & Cohen, D. (1998). Affect and marital adjustment in women's rating of dyspareunic pain. Canadian Journal of Psychiatry, 43, 381–385.
Meana, M., Binik, I., Khalife, S., & Cohen, D. (1999). Psychosocial correlates of pain attributions in women with dyspareunia. Psychosomatics, 40, 497–502.
Merskey, H., & Bogduk, N. (Eds.). (1994). Classification of chronic pain (2nd ed.). Washington, DC: IASP Press.
O'Donohue, W. O., Dopke, C. A., & Swingen, D. N. (1997). Psychotherapy for female sexual dysfunction: A review. Clinical Psychology Review, 17, 537–566.
Pukall, C. F., Binik, Y. M., Khalifé, S., Amsel, R., & Abbott, F. V. (2002). Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain, 96, 163–175.
Rapkin, A. J. (1995). Gynecological pain in the clinic: Is there a link with the basic research? In G. F. Gebhart (Ed.), Visceral pain: Progress in pain research and management (Vol. 5, pp. 469–488). Seattle, WA: International Association for the Study of Pain Press.
Reissing, E., Binik, Y. M., & Khalifé, S. (1999). Does vaginismus exist? A critical review of the literature. Journal of Nervous and Mental Disease, 187, 261–274.
Reissing, E. D., Binik, Y. M., Khalifé, S., Cohen, D., & Amsel, R. (2002). Vaginal spasm, pain and behaviour: An empirical investigation of the reliability of the diagnosis of vaginismus. Manuscript submitted for publication.
Reissing, E. D., Binik, Y. M., Khalifé, S., Cohen, D., & Amsel, R. (in press). Etiological correlates of vaginismus; Sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. Journal of Sex and Marital Therapy.
Steege, J. F., Metzger, D. A., & Levy, B. L. (Eds.). (1998). Chronic pelvic pain: An integrated approach. Toronto: Saunders.
van der Velde, J., & Everaerd, W. (1999). Voluntary control over pelvic floor muscles in women with and without vaginistic reactions. International Urogynaecology Journal and Pelvic Floor Dysfunction, 10, 230–236.
van der Velde, J., & Everaerd, W. (2001). The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat inwomen with and without vaginismus. Behaviour Research and Therapy, 39, 395–408.
Wesselman, U., Burnett, A. L., & Heinberg, L. J. (1997). The uro-genital and rectal pain syndromes. Pain, 73, 269–294.
World Health Organization. (1992). Manual of the international statistical classification of diseases, injuries, and causes of death (10th ed.). Geneva: Author.
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Binik, Y.M., Reissing, E., Pukall, C. et al. The Female Sexual Pain Disorders: Genital Pain or Sexual Dysfunction?. Arch Sex Behav 31, 425–429 (2002). https://doi.org/10.1023/A:1019892125163
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DOI: https://doi.org/10.1023/A:1019892125163