History of Sexual and Physical Abuse in Women with Dyspareunia: Association with Pain,Psychosocial Adjustment,and Sexual Functioning

AimDyspareunia is a women's sexual health problem that still often goes undiagnosed despite its high prevalence and its detrimental impact on sexual, relationship, and psychological adjustment. Although sexual and physical abuse may constitute risk factors for the development of dyspareunia, the effects of past abuse on current pain and associated sexual and psychosocial impairments have never been examined. Thus, the aim of this study is to determine the relation between a history of sexual and physical abuse and a series of pain, psychological, dyadic, and sexual functioning variables in a sample of women with dyspareunia.MethodsA hundred and fifty-one women took part in the study via health professional referrals and advertisements in local newspapers. Each participant underwent a standardized gynecological examination and a structured interview in order to confirm the diagnosis of dyspareunia. They also completed self-report questionnaires investigating past sexual and physical abuse, in addition to current pain, psychosocial adjustment, and sexual functioning. Dependent measures included: (i) The Brief Symptom Inventory; (ii) the Sexual History Form; and (iii) the Locke-Wallace Marital Adjustment Scale. Pain was assessed via the McGill Pain Questionnaire and a visual analogue scale.ResultsResults revealed that a history of sexual abuse involving penetration was associated with poorer psychological adjustment and sexual functioning. Additionally, findings showed that women who perceived a link between their dyspareunia and their past sexual abuse reported worse sexual functioning than those who did not. Finally, the experience of sexual abuse was not associated with pain intensity and physical abuse was not associated with any of the outcome measures.ConclusionsFindings suggest that the presence of a sexual abuse history in women with dyspareunia is associated with increased psychological distress and sexual impairment, although there is no relation between a history of physical abuse and these outcomes. Leclerc B, Bergeron S, Binik YM, and Khalifé S. History of sexual and physical abuse in women with dyspareunia: Association with pain, psychosocial adjustment and sexual functioning.     

Childbirth Fear: Relation to Birth and Care Provider Preferences

Introduction

The purpose of this study was to assess how preferences for place of birth and mode of birth relate to different dimensions of childbirth fear and whether there is an association between Canadian women's prenatal fear of childbirth and the type and quality of prenatal care they received.

Methods

A link to an online survey was posted on Canadian pregnancy and birth websites; 409 women completed the survey that included sociodemographic questions, questions about the current pregnancy and previous pregnancy experiences (if applicable), and the Childbirth Fear Questionnaire, a validated 40‐item scale that measures 9 dimensions of childbirth fear.

Results

Women under physician care and those with a preference for cesarean birth were generally more fearful of pain associated with vaginal birth, fear of loss of sexual pleasure and attractiveness, and fear of harm to themselves or their infant. Conversely, women under the care of midwives and women who preferred to give birth vaginally were more fearful of interventions. Women who preferred a cesarean birth were significantly more likely to report that fear of childbirth interfered with daily functioning, compared to women who preferred a vaginal birth. Satisfaction with care was associated with lower scores on the Childbirth Fear Questionnaire full and subscales, especially among midwifery clients.

Discussion

At present there are no guidelines in Canada or the United States for the treatment and/or referral of pregnant women who suffer from childbirth fear. Until such guidelines are developed, findings from the current study can help maternity care providers identify and address specific fears among women in their care and understand how different fear domains relate to care provider choice, satisfaction with care, and women's preferences for place and mode of birth.     

“Universal Precautions”: Perinatal Touch and Examination after Childhood Sexual Abuse

Background: Childhood sexual abuse is a common experience of Australian women with 1 woman in 3 reporting unwanted sexual activity, and 1 in 10 reporting attempted or penetrative sexual abuse before 16 years of age. The objective of this study was to explore women's responses to perinatal professional touch and examination of themselves and their babies. Methods: Eighteen women were interviewed using an in‐depth semistructured qualitative method. Interviews were recorded and transcribed. The interviews were coded and thematically analyzed, using NVivo to assist with data management. To ensure rigor, four initial interviews were coded by a second researcher and discrepancies resolved. Results: Two key themes were identified by childhood sexual abuse survivors as important in improving service provision: safety issues for survivors and their babies in the clinical encounter and ways of making service provision safer. Conclusions: Childhood sexual abuse survivors experienced pain, dissociation, fear, blame, helplessness, and guilt in their encounters with health care practitioners. These experiences led to the development of a set of “Universal Precautions” for perinatal professionals responding to women and their children.     

Sexual function and satisfaction in adults based on the definition of child sexual abuse

IntroductionThe literature shows a discrepancy in the association between child sexual abuse (CSA) and adult sexual function. One of the proposed explanations for this discrepancy is the different ways in which CSA is assessed. While some studies explicitly ask potential participants whether they are sexual abuse survivors, others ask whether participants experienced specific unwanted sexual behaviors.AimThis study investigated the differences between women who self-identified as CSA survivors, women who experienced similar unwanted sexual experiences but did not identify as CSA survivors (NSA), and women with no history of sexual abuse (control). CSA was defined as unwanted touching or penetration of the genitals before the age of 16.MethodsA sample of 699 college students anonymously completed a battery of questionnaires on sexuality and sexual abuse history.Main Outcome MeasuresSexual function was measured with the Female Sexual Function Index (FSFI), and sexual satisfaction was measured with the Sexual Satisfaction Scale-Women. History of CSA was measured with a modified version of Carlin and Ward's childhood abuse items.ResultsDifferences emerged between women who experienced sexual abuse before age 16 and women who never experienced sexual abuse (control) on the personal distress subscale of the Sexual Satisfaction Scale. The CSA group (N = 89) reported greater sexual distress compared to the NSA (N = 98) group, and the NSA group reported more distress than the control group (N = 512). No significant group differences were observed in the FSFI. Characteristics of the abuse that predicted whether women identified as CSA survivors included vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse. These abuse characteristics were associated with sexual satisfaction but not with sexual function.ConclusionsDifferences in levels of sexual satisfaction between women with and without a history of CSA were associated with the type of CSA definition adopted. It remains unexplained why the CSA group showed more personal distress about their sexuality but not more sexual dysfunction. Rellini A, and Meston C. Sexual function and satisfaction in adults based on the definition of child sexual abuse.     

Dyspareunia in a Survivor of Childhood Sexual Abuse

Dyspareunia is a frequent chief concern encountered by midwives and other women's health care providers. There are many possible etiologies for dyspareunia, including a history of childhood sexual abuse, and approaching assessment in a holistic manner is necessary to identify the etiology. This case report presents evidence on the importance of screening a woman who presents with dyspareunia in a therapeutic manner to facilitate disclosure of sexual abuse. Best practices for screening for sexual violence, along with recommendations for providing gynecologic care to survivors, are offered. By understanding the long‐term sequelae of sexual abuse and through screening all women, midwives and other women's health care providers can facilitate healing and treatment for survivors.     

Women's lived experience of fear of childbirth

Objective

to describe women's lived experience of fear of childbirth.

Design

a qualitative study using a phenomenological approach and a lifeworld perspective. Data were collected via tape-recorded interviews.

Setting

Sahlgrenska University Hospital, Göteborg, Sweden in 2003.

Participants

eight pregnant women (24–37 gestational weeks) seeking help within an outpatient clinic for women with severe fear of childbirth. Two of the women were primiparous.

Findings

four constituents were identified: feeling of danger that threatens and appeals; feeling trapped; feeling like an inferior mother-to-be and on your own. The essential structure was described as ‘to lose oneself as a woman into loneliness’.

Key conclusions

fear of childbirth affects women in such a way that they start to doubt themselves and feel uncertain of their ability to bear and give birth to a child. Previous birth experience was central to the multiparous women. They described their experiences of suffering in relation to the care they received during childbirth. This mainly concerned pain and negative experiences with staff.

Implications for practice

pregnant women who fear childbirth are an exposed group in need of much support during pregnancy and childbirth. The encounter between the woman and the midwife can be a way of breaking down the feeling of loneliness and restoring the woman's trust in herself as a childbearing woman.     

Fear during labor: the impact of sexual abuse in adult life

Our aim was to study the occurrence of extreme fear during labor and its association with previous sexual abuse in adult life. All postpartum women (n = 414) in two municipalities in Norway participated in a questionnaire study. Self-reported fear during labor was categorized as “no fear/some fear/extreme fear”. Sexual abuse was measured by the Abuse Assessment Screen (AAS). Three percent of the women reported extreme fear during labor, 13% some fear and 84% no fear. In total, 12% had been sexually abused as an adult. Among the women with extreme fear during labor, however, one third had a history of sexual abuse in adult life (crude odds ratio 3.7; 95% CI: 1.0–3.7). When controlling for depression in pregnancy, duration of labor and mode of delivery, the adjusted odds ratio for extreme fear during labor was 4.9 (95% CI: 1.2–19.1). The results suggest that women with a history of sexual abuse in adult life have an increased risk of extreme fear during labor.     

Vaginismus,Dyspareunia and Abuse History: A Systematic Review and Meta-analysis

BackgroundGenito-pelvic pain/penetration disorder, which consists of a combination of vaginismus and dyspareunia, is considered a new diagnosis in the latest version of the Diagnostic and Statistical Manual of Mental Disorders. Although the etiology of this diagnosis is not well known, a history of abuse has been suggested to be a primary factor in the emergence of this disorder.AimThis systematic review and meta-analysis aimed to determine the association of abuse history with vaginismus and dyspareunia diagnosis.MethodsRelated keywords were used to search articles in PubMed, PsycArticles, PsycINFO, Scopus, Web of Science, and the Turkish scientific information database (TRDizin). All articles published in English and Turkish until August 2020 were systematically reviewed. A total of 14 case-control studies, including 1428 participants, were included in the final analysis. The fixed-effects model was used to pool odd ratios (ORs) and 95% confidence intervals (CIs) of the studies. Heterogeneity was evaluated using the I² statistic.OutcomesCase-control studies that reported vaginismus or dyspareunia outcomes in individuals with or without a history of abuse.ResultsA significant relationship was found between a history of sexual (1.55 OR; 95% CI, 1.14–2.10; 12 studies) and emotional abuse (1.89 OR; 95% CI, 1.24–2.88; 3 studies) and the diagnosis of vaginismus. A significant relationship was found between sexual abuse and dyspareunia (1.53 OR; 95% CI, 1.03–2.27; 6 studies). No statistically significant relationship was observed between physical abuse, vaginismus, and dyspareunia. No significant difference was found between sexual or physical abuse in terms of assessment methods for the diagnosis of vaginismus and dyspareunia.Clinical ImplicationsThis systematic review and meta-analysis points out that in the assessment of vaginismus patients, the risk of sexual and emotional abuse and in the assessment for dyspareunia patients, the risk of sexual abuse should be questioned and addressed in its treatment.Strenght and LimitationsThe strength of the current meta-analysis is the inclusion of all forms of abuse, and studies published in Turkish and English with a broad and reproducible search strategy. The limitations of this meta-analysis are the exclusion of sources and design other than journal articles and case-control studies, including studies both childhood and adult abuse, which in some studies were not differentiated, having potential language and recall bias.ConclusionThe study analysis suggests an association of vaginismus with sexual and emotional abuse and dyspareunia with sexual abuse. However, both disorders showed no association with physical abuse. S. Tetik, ÖY. Alkar, Vaginismus, Dyspareunia, and Abuse History: A Systematic Review and Meta-analysis. J Sex Med 2021;18:1555–1570.     

Assessment of sexual dysfunction and determination of its risk factors in the Republic of Korea

Objective

To assess sexual function among women via self-evaluation of female sexual dysfunction (FSD) and to determine risk factors for FSD among Korean women.

Methods

A preliminary questionnaire-based study in Ansan, Korea, enrolled 935 women between January and December 2010. Participants completed the Female Sexual Function Index and a self-administered survey. Participants were divided into 2 groups: in the recognized group (RG), women were aware of their sexual problems; in the unrecognized group (URG), women were not.

Results

The prevalence of FSD was 46.1% (n = 431). The prevalence of recognized FSD was 21.5% (n = 201), whereas that of unrecognized FSD was 24.6% (n = 230) Younger women showed a significantly more positive attitude toward sex compared with older individuals (P < 0.001). Sexual desire, sexual arousal, dyspareunia, lubrication, and sexual satisfaction were factors of sexual dysfunction in the RG. In the URG, sexual arousal, sexual desire, orgasm, dyspareunia, and sexual satisfaction were identified as significant factors.

Conclusion

Women in the RG had positive attitudes toward sex, whereas those in the URG had negative attitudes. Women who were unsatisfied with their sexual life did not express a need for treatment. The sociocultural background of Korean women should be considered in the diagnosis and treatment of FSD.     

Age of sexual debut and central introital dyspareunia

Objectives

Analysis of characteristics of patients with introital central dyspareunia. Is late coitarche (age at first sexual intercourse) a risk factor for introital dyspareunia?

Study design

145 women attending a vulvo-vaginitis clinic in secondary and tertiary care center in Tienen and Leuven, Belgium, with central introital pain during sexual intercourse.

Results

The mean age of the study group was 32 years, and 5% were 60 years of age or older. Of the patients, 51% had primary and 49% secondary dyspareunia. Before referral, two-thirds of the patients had already tried several types of therapy, including psychiatric help in 16% of cases. The study group of patients with central introital dyspareunia had a coitarche at a mean of 18.3 years. 72% of the dyspareunic women with coitarche later than 18 had to regularly interrupt intercourse because of pain, compared with 52% of women with coitarche before 18 (p < 0.05). A strong correlation was found between the age of sexual debut and the necessity to interrupt intercourse attempts due to pain (p < 0.001). Frequency of intercourse was also found to be inversely related to coitarche.

Conclusion

Women with introital dyspareunia had their sexual debut at a later age than otherwise comparable women. Late coitarche is inversely related to frequency of attempted intercourse and to the necessity to interrupt intercourse due to pain, suggesting a relation between coitarchal age and severity of dyspareunia. A possible explanation is increased fibrosis and stiffening of the hymenal remnants at the posterior vulvar commissural due to increasing age in primary, and repeated injury by sexual contacts in secondary, central introital dyspareunia patients.     

Predictors of Task‐Persistent and Fear‐Avoiding Behaviors in Women with Sexual Pain Disorders

IntroductionDyspareunia and vaginismus are the most common sexual pain disorders (SPDs). Literature suggests that many women with dyspareunia continue with intercourse despite pain (task persistence), whereas many women with vaginismus avoid penetrative activities that may cause pain (fear avoidance). Both forms of sexual pain behavior may maintain or aggravate complaints.AimThis study examined (i) whether women with SPD differ from pain‐free controls in motives for sexual intercourse, sexual autonomy, maladaptive beliefs regarding vaginal penetration, and partner responses to pain; and (ii) which of these factors best predict whether women with SPD stop or continue painful intercourse (attempts).MethodsWomen with superficial dyspareunia (n = 50), women with lifelong vaginismus (n = 20), and pain‐free controls (n = 45) completed questionnaires.Main Outcome MeasuresFor Aim 1, the main outcome measures were (i) motives for intercourse; (ii) sexual autonomy; (iii) maladaptive beliefs regarding vaginal penetration; and (iv) partner responses to pain. For Aim 2, sexual pain behavior (to continue or discontinue with painful intercourse) was the outcome measure.Results(i) Women with dyspareunia exhibited more mate guarding and duty/pressure motives for intercourse and were less sexually autonomous than controls. (ii) Symptomatic women had more maladaptive penetration‐related beliefs than controls, with women with vaginismus reporting the strongest maladaptive beliefs. (iii) Partners of women with dyspareunia self‐reported more negative responses to pain than those of women with vaginismus. (iv) The factors that best predicted sexual pain behavior were the partner responses to pain and the woman's maladaptive beliefs regarding vaginal penetration.ConclusionsOur findings reveal support for task persistence in women with dyspareunia and fear avoidance in women with lifelong vaginismus. As such, it is important to consider these distinct types of responding to sexual pain when treating SPD. Brauer M, Lakeman M, van Lunsen R, and Laan E. Predictors of task‐persistent and fear‐avoiding behaviors in women with sexual pain disorders. J Sex Med 2014;11:3051–3063.     

Experiences of midwifery care in English prisons

Background

In the United Kingdom (UK), all prisoners must receive healthcare equivalent to that available in the community. However, evidence suggests that equality in healthcare provision for perinatal women in UK prisons is not always achieved. The aim of this research was to examine pregnant women prisoners' and custody staffs' experiences and perceptions of midwifery care in English prisons.

Methods

A qualitative approach based on institutional ethnography was used to research women's experiences in three English prisons over a period of 10 months. In total, 28 women participated in audio-recorded, semi-structured interviews. Ten staff members were interviewed, including six prison service staff and four health care personnel. Ten months of prison fieldwork enabled observations of everyday prison life. NVivo was used for data organization with an inductive thematic analysis method.

Results

Women's experiences included: disempowerment due to limited choice; fear of birthing alone; and a lack of information about rights, with a sense of not receiving entitlements. Some women reported favorably on the continuity of midwifery care provided. There was confusion around the statutory role of UK midwifery.

Discussion

Experiences of perinatal prisoners contrast starkly with best midwifery practice—women are unable to choose their care provider, their birth companions, or their place of birth. In addition, a reliance upon “good behavior” in return for appropriate treatment may be detrimental to the health, safety, and well-being of the pregnant woman and her unborn baby.

Conclusion

Prison is an adverse environment for a pregnant woman. This study provides key insights into imprisoned women's experiences of midwifery care in England and shows that midwives play an essential role in ensuring that perinatal prisoners receive safe, high-quality, respectful care.     

Sexual Communication,Dyadic Adjustment,and Psychosexual Well‐Being in Premenopausal Women with Self‐Reported Dyspareunia and Their Partners: A Controlled Study

IntroductionAlthough research that takes into account partner and relationship factors in dyspareunia is slowly emerging, little is known about how these couples communicate about their sexuality. Additionally, partner psychosexual adjustment has not been examined in a controlled fashion.AimThis study aimed to compare dyadic sexual communication, dyadic adjustment, psychological adjustment, and sexual well‐being of women with self‐reported dyspareunia and their partners with those of pain‐free control women and their partners.MethodsPremenopausal women (n = 38; mean [M] age = 24.92) with self‐reported dyspareunia, their partners (n = 38; M age = 26.71), as well as pain‐free control women (n = 44; M age = 25.86) and their partners (n = 44; M age = 27.95) completed an online survey measuring dyadic sexual communication, dyadic adjustment, anxiety, depression, sexual functioning, and sexual distress.Main Outcome MeasuresAssessments of women and men's (i) dyadic sexual communication; (ii) dyadic adjustment; (iii) anxiety; (iv) depression; (v) sexual functioning; and (vi) women's sexual distress were the main outcome measures.ResultsCompared with pain‐free controls, women with dyspareunia reported significantly poorer dyadic sexual communication, a difference not found between partners of women with dyspareunia and control partners. Compared with partners of control women, those of women with dyspareunia reported significantly more impaired sexual functioning. No differences in dyadic adjustment were found between women with dyspareunia and pain‐free control women, or between their respective partners. Finally, compared with control women, those with dyspareunia reported significantly more impaired psychological and sexual well‐being.ConclusionsFindings suggest that dyspareunia impacts not only the psychosexual adjustment of affected women but also that of their partners. It seems relevant to include both members of the couple in future research and treatment for dyspareunia. Pazmany E, Bergeron S, Verhaeghe J, Van Oudenhove L, and Enzlin P. Sexual communication, dyadic adjustment, and psychosexual well‐being in premenopausal women with self‐reported dyspareunia and their partners: A controlled study. J Sex Med 2014;11:1786–1797.     

Culture and Sexuality: Cognitive–Emotional Determinants of Sexual Dissatisfaction Among Iranian and New Zealand Women

Background

Several studies have demonstrated that culture plays a fundamental role in individuals' beliefs, attitudes, and values toward sexuality, and influences their ability to enjoy sex. It follows that culture may influence sexual satisfaction or dissatisfaction.

Prospective Cohort of Deep Dyspareunia in an Interdisciplinary Setting

Introduction

Deep dyspareunia is a common symptom in women, including in half of women with endometriosis, but little is known about its response to treatment and predictors of persistent deep dyspareunia over time.

A community-based participatory research approach to explore community perceptions of the quality of maternal–newborn health services in the Dominican Republic

Objective

to understand both men's and women's beliefs and attitudes regarding public maternity and newborn services, care and quality.

Design

qualitative, cross-sectional, retrospective study with an observation arm, using community-based participatory research as both the mechanism of enquiry and catalyst for change.

Setting

four urban neighbourhoods in the Dominican Republic, selected in collaboration with the Provincial Medical Public Health Director and the partnering local public hospital.

Participants

adolescent women (15–20 years of age), adult women (21–49 years of age) and adult men (>19 years of age) from the four neighbourhoods were recruited to participate in focus sessions, personal interviews and/or antenatal observations. A total number of 137 participants were recruited: 27 males, 51 adolescent females and 59 adult females. The attrition rate was 17% (n=23). Dominican and US midwives and nurses, as well as community leaders, comprised the research team.

Measurements and findings

following informed consent, self-reported demographics and obstetric history were collected. Twelve focus groups and 12 individual interviews were recorded and transcribed, then qualitatively analysed for content and interpretation of salient themes. Antenatal observations were performed by community leaders to identify patterns of antenatal health-care delivery and utilisation. The main over-riding theme uncovered by the research was ‘no me hace caso’, or that women and men accessing the maternal health system did not feel valued. The significant amount of time required to receive care was interpreted by the participants as a lack of respect. Finally, the idea of ‘cuña’ emerged, in which participants noted special treatment for those with social connections to health-care providers. Presentation to the hospital was challenging but resulted in hospital volunteers joining the community volunteer group to collaborate on improving services.

Key conclusions and implications

this study, conducted in the Dominican Republic, illustrates international collaboration between university researchers, maternity service providers and community members. Community-based participatory research may be an effective mechanism to unite community members and health providers in the common mission to improve maternal–newborn health services.     

Sexual Functioning After Childhood Abuse: The Influence of Post-Traumatic Stress Disorder and Trauma Exposure

Background

Impairments in sexual functioning and sexual satisfaction are very common in women who have experienced childhood sexual abuse (CSA). A growing body of literature suggests a high prevalence of sexual distress in patients with post-traumatic stress disorder (PTSD). However, the influence of sexual trauma exposure per se and the influence of PTSD symptoms on impairments in sexual functioning remain unclear.

To lube or not to lube: experiences and perceptions of lubricant use in women with and without dyspareunia

IntroductionThere are few studies examining the relationship between lubricant use and sexual functioning, and no studies have examined this relationship in women with dyspareunia. Vaginal dryness is a prevalent complaint among women of all ages. There is an association between vaginal dryness and painful intercourse; therefore, women with dyspareunia represent a particularly relevant sample of women in which to investigate lubricant use.AimThe aim of this study was to examine differences between women with and without dyspareunia in self‐reported natural lubrication and attitudes toward and use of personal lubricants.MethodsRespondents completed an online survey including questions on demographics, gynecological/medical history, sexual functioning, and lubricant use and attitudes.Main Outcome MeasuresThe main outcome measures used were the Female Sexual Function Index (FSFI) and questions regarding attitudes toward and use of lubricants.ResultsControls scored higher on the lubrication subscale of the FSFI than women with dyspareunia (P < 0.001). Women with dyspareunia reported greater frequency of lubricant use during sexual activity over the last year (P < 0.01). They were also more likely to use lubricant prior to penetration (P < 0.05). The most common use for controls was to enhance sexual experiences. This was also a common answer for women with dyspareunia; however, in this group, the most common reason was to reduce/alleviate pain. Lubricants were rated as less effective among women with dyspareunia vs. controls across all reported reasons for use. Nevertheless, lubricant use was still rated as being moderately effective in alleviating pain for women with dyspareunia.ConclusionsWomen with dyspareunia have more difficulty with natural lubrication; it is consequently not surprising that they reported using lubricant more frequently than control women. Women with dyspareunia reported using lubricants more often than controls to try to prevent or alleviate pain and reported this as being a moderately effective strategy, suggesting that it may be a useful tool for some women with dyspareunia. Sutton KS, Boyer SC, Goldfinger C, Ezer P, and Pukall CF. To lube or not to lube: Experiences and perceptions of lubricant use in women with and without dyspareunia. J Sex Med 2012;9:240–250.     

Effects of Aversive Classical Conditioning on Sexual Response in Women With Dyspareunia and Sexually Functional Controls

IntroductionIn dyspareunia—a somatically unexplained vulvovaginal pain associated with sexual intercourse—learned pain-related fear and inhibited sexual arousal are supposed to play a pivotal role. Based on research findings indicating that enhanced pain conditioning is involved in the etiology and maintenance of chronic pain, in the present study it was hypothesized that enhanced pain conditioning also might be involved in dyspareunia.AimTo test whether learned associations between pain and sex negatively affect sexual response; whether women with dyspareunia show stronger aversive learning; and whether psychological distress, pain-related anxiety, vigilance, catastrophizing, and sexual excitation and inhibition were associated with conditioning effects.MethodsWomen with dyspareunia (n = 36) and healthy controls (n = 35) completed a differential conditioning experiment, with one erotic picture (the CS⁺) paired with a painful unconditional stimulus and one erotic picture never paired with pain (the CS⁻).Main Outcome MeasuresGenital sexual response was measured by vaginal photoplethysmography, and ratings of affective value and sexual arousal in response to the CS⁺ and CS⁻ were obtained. Psychological distress, pain cognitions, and sexual excitation and inhibition were assessed by validated questionnaires.ResultsThe two groups showed stronger negative affect and weaker subjective sexual arousal to the CS⁺ during the extinction phase, but, contrary to expectations, women with dyspareunia showed weaker differential responding. Controls showed more prominent lower genital response to the CS⁺ during acquisition than women with dyspareunia. In addition, women with dyspareunia showed stronger expectancy for the unconditional stimulus in response to the safe CS⁻. Higher levels of pain-related fear, pain catastrophizing, and sexual inhibition were associated with weaker differential conditioning effects.ConclusionsPairing of sex with pain negatively affects sexual response. The results indicate that a learned association of sex with pain and possibly deficient safety learning play a role in dyspareunia.Both S, Brauer M, Weijenborg P, Laan E. Effects of Aversive Classical Conditioning on Sexual Response in Women With Dyspareunia and Sexually Functional Controls. J Sex Med 2017;14:687–701.