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  • Review Article
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A psychosocial approach to female genital pain

Nature Reviews Urology volume 15, pages 25–41 (2018)Cite this article

Subjects

Key Points

  • Genital pain is heterogeneous and multifactorial, including different pain syndromes that involve a dynamic interplay between biological, psychological, and sociorelational variables

  • Research and clinical practice lack standardized diagnostic methods and are complicated by nosological, methodological, aetiological, and treatment confusion, which precludes uniform conclusions, causes diagnostic delay, and interferes with treatment selection

  • Although the focus of research has been on biological factors, psychosocial approaches are becoming more popular, particularly when trying to understand how genital pain is maintained and exacerbated

  • A comprehensive assessment protocol and methodologically sound research to evaluate the efficacy and effectiveness of various interventions (across treatment modalities) are lacking

  • Research and clinical efforts should be directed at developing and evaluating multimodal treatments that target biopsychosocial aspects of genital pain; this approach requires multidisciplinary teams and collaboration across disciplines

Abstract

Genital pain is a prevalent, complex, and disabling health concern in women. Efforts to study this chronic pain condition have been complicated by the fact that genital pain is heterogeneous and exists at the intersection of different biopsychosocial disciplines. Thus, organization of theoretical ideas and empirical findings across research areas is required to improve our understanding of how biopsychosocial factors affect the development and maintenance of the pain, the reporting of symptoms, and the choice of treatment. In the past, the study of physical markers has received the most research attention; an assimilation of the psychosocial variables underlying genital pain is, therefore, particularly needed to inform the field about the rapidly growing literature and stimulate interdisciplinary work. Current research lacks specificity, fails to capture the unique features of different pain conditions, and yields conflicting evidence, which makes it difficult to draw uniform conclusions. Although considerable advances have been made, confusion remains at the nosological, aetiological, theoretical, methodological, and treatment levels. This lack of consensus has important theoretical and clinical implications because inconsistent criteria and empirical disagreement can lead to misdiagnoses and interfere with the development of sound theoretical models and effective treatments to manage female genital pain and its physical and psychological sequelae.

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Figure 1: An information processing model of sexual arousal.
Figure 2: The fear–avoidance model of chronic pain.

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Authors and Affiliations

  1. Department of Clinical Psychological Science, Maastricht University, Universiteitssingel, 40, Maastricht, 6229 ER, The Netherlands

    Marieke Dewitte

  2. Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, Groningen, 9712 TS, The Netherlands

    Charmaine Borg

  3. Department of Obstetrics and Gynaecology, Rambam Medical Center, 8 Ha'aliyah Hashniyah Street, Haifa, 3109601, Israel

    Lior Lowenstein

Authors
  1. Marieke Dewitte
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  2. Charmaine Borg
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  3. Lior Lowenstein
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All authors researched data for the article and took part in discussions of content M.D. wrote the manuscript. All authors reviewed and edited the article before submission.

Corresponding author

Correspondence to Marieke Dewitte.

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The authors declare no competing financial interests.

PowerPoint slides

Glossary

Quantitative sensory testing (QST).

A noninvasive, painless technique that essentially determines the sensation and pain thresholds for cold and warm temperatures and the vibration sensation threshold by stimulating the skin and comparing the results to normative values.

Allodynia

An increased pain response after normal, nonpainful stimulation.

Hyperalgesia

Increased sensitivity to painful stimulation.

Self-efficacy

The confidence in one's ability to successfully accomplish a task, achieve intended results, and exert influence over events that affect one's life.

Sexual script

The scenario each couple develops over time to guide their sexual interactions.

Bodyscan meditation

One of the most effective exercises to develop mindfulness. During bodyscan meditation attention is directed at various parts of the body, thereby focusing on the physical sensations in the present moment with an open and compassionate attitude.

Sensate focus

A set of sexual exercises in which both partners touch each other in hierarchical steps (starting with nongenital touching, over genital touching, towards penetration) without regard for sexual response or pleasure for oneself or one's partner.

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Dewitte, M., Borg, C. & Lowenstein, L. A psychosocial approach to female genital pain. Nat Rev Urol 15, 25–41 (2018). https://doi.org/10.1038/nrurol.2017.187

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