The Role of Pain-related Fear in Sexual Pain

The overarching goal of this work is to identify the mechanisms underpinning sexual pain in
women. Women with sexual pain exhibit higher vaginal pain sensitivity and lower levels of
sexual desire and arousal compared to pain-free women. As a result of pain, sexual
intercourse is avoided. Previous work in this area has examined a wide variety of
interventions for sexual pain but has not examined how vaginal pain sensitivity and resulting
sexual dysfunction may be mediated by pain-related fear. The study team proposes that a
standardized exposure intervention that directly targets pain-related fear will in turn
reduce vaginal pain sensitivity and translate to clinically meaningful changes in sexual
function. The study team will assign women with sexual pain to receive a home-based,
patient-controlled exposure intervention or standardized home-based home program. The
specific aims of this proposal are: 1) To evaluate the extent to which pain-related fear
mediates vaginal pain sensitivity in women with sexual pain; 2) To evaluate the extent to
which graded exposure translates to changes in sexual function and partner dynamics. The
completion of this work will provide us with a better understanding of the mechanisms
underpinning sexual pain and specifically, how pain-related fear influences vaginal pain
sensitivity and sexual function.

Inclusion Criteria:

- Females with sexual pain >= 6 months

- Appropriate to use vaginal dilators

- The ability to read English and understand the informed consent form and screening
questions

- The ability and willingness to follow all requirements of the study including
following all directions and completion of daily pain reports

- Signed informed consent

- Are sexually active (have had intercourse at least twice in the last 30 days)

- Pain-related fear of intercourse greater than 50 on the numerical fear rating scale

Exclusion Criteria:

- Physical, psychological and medical issues, encountered during routine care that are
felt insufficient for trial participation (physician discretion), such as poor mental
status or neurological deficit limiting participation physically or cognitively
(Mini-mental state exam less than 20).

- Women with sexual pain who are not sexually active (have not had intercourse at least
twice in the last 30 days)

- Participants who use narcotic pain medication

- Participants diagnosed with a major depressive disorder

- Participants who exhibit signs and symptoms of infection, malignancy, or other
conditions identified by a member of the study team that may be contraindications to
the use of dilators

- Unable to readily access computer with Internet for reporting on daily fear levels and
dilator size

- Pain-related fear of intercourse less than 50 on the numerical fear rating scale

- Women who are pregnant

- Participants who report a history of sexual abuse or trauma.