Negative Affect and Somatically Focused Anxiety in Young Women Reporting Pain with Intercourse (Report‪)‬

There has been a significant shift in dyspareunia research over the past decade, from mostly uncontrolled investigations and clinical case speculations about psychosocial etiologies to more methodologically sound examinations of the properties of the pain experienced. This recent series of studies has provided evidence that the pain of dyspareunia is comparable to other types of pain in terms of severity (Meana, Binik, Khalife, & Cohen, 1997b), as well as sensory characteristics and neurological processes (Pukall, Binik, Khalife, Amsel, & Abbott, 2002; Pukall et al., 2005). No longer dismissed as a somatic manifestation of deep-seated psychic conflict, dyspareunia is now being discussed as a pain syndrome in its own right, with perhaps only an incidental connection to sex (Binik, Meana, Berkley, & Khalife, 1999; Meana et al., 1997). This momentum has culminated in an appeal to remove dyspareunia from the sexual dysfunction section of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev [DSM-IV-TR]; American Psychiatric Association, 2000) and have it subsumed under the pain disorder section (Binik, 2005). With the growing acknowledgment that dyspareunia is a "legitimate" pain, research efforts have increasingly focused on potential physiological etiologies or correlates. This is especially true in the case of what is considered to be the most common type of dyspareunia, vestibulodynia (formerly known as vulvar vestibulitis; Moyal-Barraco & Lynch, 2004). Variables of interest have included recurrent yeast infections, early contraceptive use, pelvic floor hypertonicity, inflammation, and immune system disturbances, as well as genetic variables that may predispose a woman toward developing genital pain (Bouchard, Brisson, Fortier, Morin, & Blanchette, 2002; McKay & Farrington, 1995; Reissing, Brown, Lord, Binik, & Khalife, 2005; Schover, Youngs, & Cannata, 1992; van Lankveld, Weijenborg, & ter Kuile, 1996; Witkin, Gerber, & Ledger, 2002). Fruitful though these research avenues may be, there is some concern that the pendulum in dyspareunia research may have swung too far from the psychosocial and sexual end of the spectrum (Meana, 2005). Investigations into the psychosocial correlates of dyspareunia do not, in and of themselves, signify a dismissal of dyspareunia as a serious pain condition. Many recognized pain syndromes have psychological and social disturbances associated with them. Concurrent treatment of these has long been integrated into pain management programs and been shown efficacious (Gatchel, Peng, Peters, Fuchs, & Turk, 2007).