Psychosexual ImpactGoing Beyond

Going beyond

This section is for physicians who want to explore sexual response cycle and associated exercises with their patients

Given that vulvar pain can have an impact on sexual response, it can be helpful to understand sexual response in more detail and to understand how pain can affect many aspects of sexuality.

1. You can explore the impact of vulvodynia on sexual response with your patient in several ways

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2. The Sexual Response Cycle

In the 1960s, sex researchers Masters and Johnson published their book “Human Sexual Response”, which outlined sexual responsiveness in three distinct phases:

PHASE 1

Sexual Desire


the motivation or feeling of wanting to engage in sexual activity.

PHASE 2

Sexual Arousal


physiological changes (e.g., increased heart rate, breathing rate, erections, and vaginal lubrication) along with the subjective feeling of being “turned on” or excited sexually.

PHASE 3

Orgasm


a series of muscular contractions that many people experience as pleasurable.

However, research since has suggested that many people do not move through all the phases sequentially, there may be additional phases, and that not all sexual events begin with sexual desire.

Most significantly, Dr. Rosemary Basson at the University of British Columbia  suggested that sexual desire is not necessary to begin a sexual encounter and that someone may begin at a place of sexual neutrality and experience desire in response to various cues (e.g., touch, conversation) 🔗 Basson, 2000.

You can give the following handout to your patient as a guide while watching the video. They can then fill out the blank handout to help them see how their sexual response is currently affected by vulvodynia.

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📄 Sexual Response Cycle Diagram & Blank Handout⬇


3. Click the dropdown menus below to learn more about the key components of the Basson Sexual Response Cycle:

Reasons For Sex


It may be difficult for an individual with pain (sexual and non sexual) to consider positive reasons for sexual activity. See handout below for more information.
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📄 Reasons for Sex⬇
Sexual Stimuli


People with sexual pain often forego activities that would trigger their sexual arousal (e,g,. touch to other parts of their body, kissing) in favour of “just getting intercourse over with” – this is especially common when one or both individuals in a sexual encounter favour penetrative vaginal sex

The Brain


The brain processes sexual information and it can be hampered by biological factors (e.g., medications, fatigue) or psychological factors (mood, anxiety, distractions, fear, low body image, etc.). There can be also be shame and guilt associated with vulvodynia. For example, penile vaginal sex is often considered the ‘normal’ way to have sex, resulting in those who have pain with vaginal sex feeling ‘abnormal’ and sexually ‘substandard’ further contributing to anxiety and stress. Every unsatisfying or painful encounter serves to reinforce individual’s negative associations with sexual activity and internalize beliefs about being “sexually substandard”.

Sexual Arousal


If a person becomes sexually aroused, and is able to maintain their arousal (while avoiding pain), their desire for ongoing sexual activity in the future will emerge.

Responsive Desire


Desire can emerge if the other factors in the model occur. It is not the necessary that desire be the start point of sexual activity or arousal –  which is especially important with those who have sexual pain or other complex relationships to sexuality, that diminish or inhibit desire. The intentional choice to enter into sexual activity whereby arousal, pleasure, and enjoyment become a byproduct, is often a reparative experience and can help challenge the idea of the self as damaged or substandard sexually.

Positive Outcomes


Benefits of sexual activity include emotional closeness, sexual satisfaction that may or may not include orgasms, freedom from pain, and challenging negative thoughts about ones’ self or relationship. All of these reinforce the motivation for sexual activity in the future. Thus, if an individual with pain prioritizes a sexual encounter with pain free sexual activities that elicit arousal for them personally, and not pain, they are more likely to move past the barriers to sexual pleasure and sexual relationships for those with sexual pain.

Important Considerations

It is important to remember that not everyone wishes to engage in sexual activity. Relationships and sexual partners with goals at odds with those of the person with sexual pain should be examined and aligned to prioritize pain free interactions:

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4. The Dual Control Model of Sexual Response


Another useful model of sexual response to understand is the Dual Control Model of Sexual Response. This model was developed in the 1990s by Dr. John Bancroft and Dr. Erick Janssen 🔗 Bancroft and Janssen, 2006.

This model is based on the idea that sexual response is the product of a balance between excitatory and inhibitory processes.

These excitatory and inhibitory processes are thought to work somewhat independently of one another, much like a brake pedal and a gas pedal. People have high levels of sexual inhibition and low levels of sexual excitation, or vice versa, or another combination.  
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Everyone’s accelerator is uniquely sensitive. Some common factors that can increase excitation include:

  • Love/bonding
  • Erotic cues
  • Visual sexual cues
  • Romantic behaviours

Sexual inhibition can play an important protective role in reducing sexual response incases of danger or potential danger. Some common factors that increase inhibition are:  

  • Body image concerns
  • Unwanted pregnancy
  • Inappropriate timing of a sexual encounter
  • Past negative sexual encounters
  • Feeling tired or  stressed
  • Having low mood, or experiencing anxiety

Pain is another factor that can have a powerful inhibitory effect on sexual response.

Helping patients to understand their own “accelerator” and “brakes” can be helpful for helping them to understand their own sexual response as well as the role of pain in their sexual life.

★ Option to assign journaling exercise: some patients find it helpful to journal about their own accelerators and brakes to gain more insight into their sexual response

1. Impact of Vulvodynia
on Sexual Response
2. The sexual
response cycle
3. basson sexual
response cycle
4. dual control model
of sexual response