High levels of anxiety have been found in women with dyspareunia,28-30 who seem to experience severe pain during sexual intercourse.31 The pathophysiological factors that regulate this phenomenon are unknown. An interesting hypothesis suggests that a strong relationship exists between anxiety and hypervigilance in patients with anxiety and SD, with attention being allocated to threatening stimuli during sexual intercourse.32-34
Recent studies have significantly increased the understanding of pain perception and have demonstrated that a complex series of spinal, midbrain, and cortical structures are involved in pain perception.35 Pain perception can be roughly divided into a lateral, somatosensory system involved in discrimination of pain location and intensity,36 and a medial system that mediates the anticipatory, fearful, affective quality of pain through limbic structures.37 Dysfunctions of these limbic structures, including the hippocampal cortex, may be involved in SDs in which pain represents the prevalent symptom.38 Patients with chronic pelvic pain have often been found to have a history of sexual trauma or abuse. Moreover, similar alterations in limbic structure have been demonstrated both in patients with chronic pelvic pain and in survivors of trauma.39 This may suggest that pain represents not only a symptom of SD but also a symptom of a more specific anxiety disorder such as PTSD.
Persecution Live 