Transcript of VPS Podcast 9 - Psychosexual interventions for vulval pain: a presentation given by Kate Moyle

As a psychosexual therapist, I consider that function and dysfunction are part of the same phenomena, and are just at different ends of the spectrum. It feels important that the problem can’t be either completely psychological or emotional, or completely physical: the two are very intertwined. That’s a lot of what we’re talking about today: the questions about mental health earlier - I think that this division of one or the other means that we’re really struggling to get to the root and a better solution for what’s going on.

If I was to break a leg, I’ve no doubt that people would be sympathetic to the fact that I was less able to walk. But vulval pain disorders are generally invisible and so if I have one, it’s much harder for people to relate to, especially given that sex is openly not discussed, but yet seems to be on the side of every bus. It seems crazy that we live in a hypersexualised culture, but are on our own when it comes to talking about real everyday sex and its problems. Sexual problems are rarely located solely in our genitals and contribution stems from personal history, thinking, emotion, relationships and life stresses. I think this is what everyone was saying this morning when they were saying how important it is to take a personal history from everyone to learn about you as the individual and therefore what you’re suffering with, the pain that you’re dealing with and how best to find a solution for you. Arousal is tied into our emotions too and when the mind is too stressed out and distracted to focus on sex, the body can’t get excited either. Anxiety takes both men and women out of the mindset needed to have sex and when we’re focused on whether we’ll perform well, we can’t enjoy what we’re doing.

So, how does this apply to vulval pain disorders? Sexual arousal produces changes in the body that occur in more than just our genitals. It often triggers the desire to reach out and touch, both metaphorically and physically. Our senses are a gateway to how we experience the outside world and feeling stimulated to a sexual charge is not that different to, for example, feeling hungry. But sometimes, the urge to act on that act is interrupted, for example, by a vulval pain disorder, and the anxiety about the pain or discomfort that it may cause. Attempted sex can lead to increased pain, and no surprise then if we want to avoid sex as a result. On top of this, communication about the problem breaks down between a couple, and this can lead to further disharmony within the relationship. Quite often, the person we’re having sex with can be the most difficult one for us to talk to about it, especially if we’re struggling to manage it ourselves and are dealing with the sexual frustration of that partner. Talking with your partner about anxiety can ease some of your worries. Trying to reach a solution together might actually bring you closer as a couple and improve your sexual relationship. For those not in a relationship, it may be difficult to know how to open up discussion about doing things differently and avoid repetition of painful experiences.

What I’m going to put up now is a slide about the cycle of sexual dysfunction, which happens really easily. Prime example - some of the cases we were discussing earlier. A traumatic event can cause sexual dysfunction to happen almost immediately and the negative emotional response from that is so strong because it’s our body’s way of protecting ourselves from pain. So, as soon as the negative emotional response goes into the anxiety or fear of recurrence, the increased likelihood of recurrence is a lot higher. Sexual performance anxiety can lead to this downward spiral, and you become so anxious about sex that you can’t perform, which leads to even more sexual performance anxiety. In vulval pain disorders, where pain is partially or wholly out of the control of sufferers, this can be a lot more complicated, and trying to use medical interventions alongside the ones that we heard earlier, we’re getting there, but we’re not quite there yet. What makes it increasingly difficult, as I’m sure most of you agree, those of you I’ve spoken to earlier, is that you’ve had numerous appointments, procedures, investigations - diagnosis has been a really tricky and long-winded process, and so that really has an impact on someone’s personal feelings about what’s going on. However, what I’m trying to talk about is if we can introduce a positive sexual experience - how we can get the cycle working to benefit you, and as strange as it may sound, taking penetrative sex partially perhaps out of the equation. One positive experience could initiate a positive cycle and they have a reinforcing and encouraging effect. Obviously the opposite is true for negative experiences, reducing our desire to repeat them.