Genital Pain and Sexual Functioning: Effects on Sexual Experience, Psychological Health, and Quality of Life
Authors: Nimbi Filippo Maria , Rossi Valentina , Tripodi Francesca , Luria Mijal , Flinchum Matthew , Tambelli Renata , Simonelli Chiara 
Published: February 2020

Abstract

Background
Genital pain (GP) is a common symptom in women of reproductive age. The prevalence of GP is difficult to gauge as it has been underreported by both patients and clinicians and neglected in clinical studies despite wide recognition of the adverse effects to women's health.

Aim
The purpose of the present study was 3-fold: (i) to explore the self-reported presence and perception of GP and its association with sexual functioning, sexual distress, emotions, psychopathology, and quality of life (QoL); (ii) to explore if, controlling for the pain effect, women with Female Sexual Function Index (FSFI) scores indicating sexual dysfunction also reported worse outcomes regarding sexual distress, emotions, psychological health, and QoL than GP women with higher FSFI scores; and (iii) to evaluate the effects of GP duration, comparing women with GP with shorter (&lt;6 months) duration of symptoms with women with longer (≥6 months) duration of symptom of GP on sexual functioning, distress, emotions, psychopathology and QoL.

Methods
A total of 1,034 women (age ranges between 18 and 40 years) from the Italian general population completed a web survey on sexual health.

Outcomes
6 self-report questionnaires exploring different biopsychosocial factors were assessed: the FSFI, the Female Sexual Distress Scale, the Positive and Negative Affect Schedule, the Short Form McGill Pain Questionnaire adapted for GP, the Short Form 36, and the Symptom Check List-90-Revised.

Results
Women who reported GP (n = 319) indicated generally lower sexual function than women without GP (n = 648; P = .036). They reported a higher level of sexual distress (P &lt; .001), more negative emotions related to sexual experiences (P = .001), lower scores in all QoL domains (P &lt; .001), and higher levels of psychopathological symptoms (P &lt; .001). Controlling for pain effects, women whose FSFI scores indicated sexual dysfunction (n = 150) reported higher rates of sexual distress than women whose FSFI scores indicated normal sexual function (n = 169; P &lt; .001).
The scores also indicated fewer positive (P &lt; .001) and more negative emotions (P &lt; .001) related to sexuality, lower QoL (P &lt; .001) and significantly higher psychological burden (P &lt; .001). Moreover, women experiencing GP for ≥6 months reported significantly lower means on the FSFI total score (P &lt; .05; especially in the desire, satisfaction, and pain domains), distress (P &lt; .001), and emotions (P &lt; .05) than women experiencing GP duration &lt;6 months. No significant differences were found on the QoL and the psychopathological symptoms.

Clinical Implications
GP is significantly pervasive, but a high percentage of sexual problems and related emotional suffering is overlooked. Raising awareness about this issue is critical, both among clinicians and the general public.

Strengths & Limitations
The present study highlighted important characteristics of GP from a community sample; the results indicate problems related to pain experiences and their repercussions on sexual, psychological, affective health, and QoL. Major limitations are related to the use of self-report measures via a web-based study.

Conclusion
The results provide evidence of a lack of awareness regarding pain experiences as they relate to sexual functioning in women; clinicians would be advised to more fully investigate sexual functioning and psychosocial variables associated with GP during routine consultation beginning with the first onset of the symptoms.