Multiple studies have examined the potential etiologic role of psychosexual factors (45-51). Women with VVS experience greater psychological distress and sexual dissatisfaction than healthy controls (46). Although some investigators propose that the syndrome has a purely psychogenic origin (52), others dispute this, pointing to evidence of pain relief by surgical excision of affected portions of the vestibule (53). Studies of the prevalence of psychological distress fail to distinguish whether such impairment is predisposing, precipitating, perpetuating, or simply the result of having an unmitigated pain syndrome. Qualitative research, which examines patients' commentary as an adjunct to standardized psychological profiling, suggests that sexual dysfunction and psychological distress are the consequences of, rather than the cause of, VVS. For example, when asked about the impact of the disease, VVS sufferers reported dramatic negative effects on sexuality, intimate relationships, and psychological well-being, which bore no correlation with how they rated such factors prior to symptom onset (49). Changes associated with disease onset included reduced sexual interest, satisfaction, and willingness to engage in sexual or noncoital intimacy, along with high levels of frustration and increased symptoms of clinical depression. Therefore, optimal treatments must address both physical and psychological sequelae of VVS.
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