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

So, how do we find that sexually pleasurable experience? It’s probably useful to first understand something about sexual arousal. Looking at the following image [she indicates a slide], which shows us the sexual arousal circuit from the British Medical Journal, we can understand that sexual arousal can be broken or interrupted at three break points. It’s useful to understand in the way that Lucia [Lucia Berry, an earlier speaker at the workshop] was saying earlier, for you as an individual, what type of pain you’re dealing with, or perhaps the cause of that - when it arrived, how it started.

Put simply, sexual arousal can be thought of as an electrical circuit. It can start anywhere. It depends on the point of stimulation, so that could be emotional, it could be psychological, it could be physical. However, like a circuit, it can also be broken at any of these points. Where there is a pain, there’s Break Point 1 here on the bottom [indicates the slide of the sexual arousal circuit]. As we experience pain, it shuts down our response to sexual arousal. In basic terms, in appropriate stimulation of the body, there is a spinal reflex, which is interpreted by the brain and moderated by our emotions, and that decides how that physical stimulation is interpreted. If it is interpreted as painful, or potentially threatening, stress hormones like adrenaline are released to prepare our body for ‘fight or flight’. Of course, our partner isn’t a threat, but as a result of the pain, we may react to them negatively, which is why this response is so counter-productive to intimacy.

The second point occurs in the emotional area here [indicates the slide again] where anxiety, fear, anger or even resentment can cause a break in arousal. The final break is mind, where we are too preoccupied for our mind to become relaxed, and therefore aroused, so this is up here [indicates the slide]. This can occur in the form of distraction, memories of negative experiences, and expectation of failure. Clearly these points can overlap, and the part that I’m focusing on is the top two. I’m not a medical doctor, so that is why, for example, psychosexual therapists a lot of the time will liaise with your medical team or you will be referred from a clinician or a doctor, and they will be trying to focus on this bit: a lot about the talks we’ve heard this morning, whether it’s a medical intervention, an operation, medications etc. Then these are the bits where I’m trying to help with, I suppose, a lot of the anxiety, the anger, the grief etc.

Obviously, this is all happening really quickly. It’s not necessarily conscious, and although we can’t change how we feel, or what our reactions are, we can try and change how we respond, and this is where therapy can sometimes be helpful. Our reactions are the result of lots of components, such as our health, our personal history and our previous sexual experiences.

Psychosexual therapy for a vulval pain disorder would aim to help us understand what’s happening. We do this by talking through, mapping out and trying to explore the interaction and what’s going on. There’s been a bit of mention of cognitive behavioural therapy today – some of those elements I use in my work. Basically you’re trying to look at the basic top event, and then reprocess the thoughts, see what’s going on in the thinking, see if it can be done differently, or if things can be looked at in another way. I’m fully aware that standing up here, that seems very easy for me to say to a group of people that have been struggling with this and struggling with getting diagnoses and speaking to people about what’s going on, and not finding it that easy to get a message from anyone or an answer from anyone.

I’m trying to desensitise some of the instant fight or flight reactions that occur as a result of that pain. In a way, the body is doing what it’s made to do, and it’s defending itself against a stimulus that creates discomfort, but this inhibits closeness with our partner, and if that closeness is likely to lead to painful sex, then we’re not going to want to pursue it.