Understanding sexual pain: A cognitive-motivational account

Sexual pain or dyspareunia is a prevalent and disabling health problem in women. It is generally defined as a recurrent or persistent pain during sexual activities, involving vaginal penetration or tactile stimulation of the vulva and vestibule. In many patients, the pain is also elicited by nonsexual activities and is comparable to other pain syndromes in terms of severity, sensory characteristics, and neurological processes. As yet, little is known about the etiology of sexual pain because current research is complicated by a number of factors. First, dyspareunia encompasses multiple pain conditions with varying etiologies, causing nosological confusion. Second, evidence on causal factors is inconclusive because there are no controlled experimental studies that allow discerning cause and effect. Third, research has put more emphasis on physical markers – including neurogenic pelvic inflammation, neurochemical influences, central and peripheral sensitization, and increased vulva–vaginal innervations – rather than considering psychosocial variables that may exacerbate and maintain sexual pain problems. Pain is, however, a multidimensional experience that needs to be addressed in all its dimensions, including biomedical as well as psychosocial aspects. Because much less is known about the psychological and relational determinants of sexual pain, this review focuses specifically on the role of cognitive-motivational factors in relation to pain. Such cognitive-motivational perspective is likely to inform both research and clinical practice.