automatic affective appraisal of sexual penetration stimuli in women with vaginismus or dyspareunia introduction current psychological views are that negative appraisals of sexual stimuli lie at the core of sexual dysfunctions it is important to differentiate between deliberate appraisals and more automatic appraisals as research has shown that the former are most relevant to controllable behaviors and the latter are most relevant to reflexive behaviors accordingly it can be hypothesized that in women with vaginismus the persistent difficulty to allow vaginal entry is due to global negative automatic affective appraisals that trigger reflexive pelvic floor muscle contraction at the prospect of penetrationaim to test whether sexual penetration pictures elicited global negative automatic affective appraisals in women with vaginismus or dyspareunia and to examine whether deliberate appraisals and automatic appraisals differed between the two patient groupsmethods women with persistent vaginismus n 24 dyspareunia n 23 or no sexual complaints n 30 completed a pictorial extrinsic affective simon task east and then made a global affective assessment of the east stimuli using visual analogue scales vasmain outcome measures the east assessed global automatic affective appraisals of sexual penetration stimuli while the vas assessed global deliberate affective appraisals of these stimuliresults automatic affective appraisals of sexual penetration stimuli tended to be positive independent of the presence of sexual complaints deliberate appraisals of the same stimuli were significantly more negative in the women with vaginismus than in the dyspareunia group and control group while the latter two groups did not differ in their appraisalsconclusion unexpectedly deliberate appraisals seemed to be most important in vaginismus whereas dyspareunia did not seem to implicate negative deliberate or automatic affective appraisals these findings dispute the view that global automatic affect lies at the core of vaginismus and indicate that a useful element in therapeutic interventions may be the modification of deliberate global affective appraisals of sexual penetration eg via counterconditioning