Sex, intimacy and sexual pain remain private topics which may result in a reluctance to participate. In an attempt to overcome this barrier, healthcare professionals (HCP) working in the field of sexual health will be recruited to invite their patients to participate in the study. Purposive sampling [46, 47] will be used and women who meet the inclusion criteria will be included. The estimated number of patients seen per annum by healthcare professionals consulted indicated a population size of 200 women. In order for the survey results to be statistically valid a minimum of 132 completed questionnaires are required. The margin of error was set at 5% and the confidence level at 95%. With an estimated response rate of 25% for online surveys, a total of 528 participants would have to be invited to achieve the required sample size. Inclusion criteria are (i) females from the age of 18 and (ii) a diagnosis of GPPPD. Exclusion criteria are (i) previous treatment for SPD; (ii) diagnosis affecting the neurological system e.g. Multiple Sclerosis; (iii) cancer-related diagnosis; and (iv) pregnant at time of completing questionnaire.
Sensory processing patterns will be measured by 163 items on the Adolescent/Adult Sensory History (AASH) questionnaire . Reliability of the AASH’s total score is 0.85 and concurrent validity 0.78 (p<.001) [48–50]. The AASH is relatively new but has already been used in a few studies [51, 52]. This self-report questionnaire identifies dysfunction in five key areas, namely, sensory discrimination, sensory modulation, postural ocular skills, praxis/motor coordination and social-emotional functioning  as well as functional problems related to these areas. Additionally, it describes overall sensory processing which is also broken down into sub-sections based on sensory modalities (e.g. touch and taste). It uses a five point Likert-type scale and can be used by individuals aged 13 to 95 years. The questionnaire takes 15 to 20 minutes to complete.
The AASH provides a total score, reflecting the functioning in overall sensory processing. This is followed by sub-scores for the sensory section, sensory modulation, sensory discrimination, functional problems and motor/social sections respectively. Each sub-score also consists of separate modalities which identify problems in specific areas.
While the original instrument allows for a small number of questions not to be completed, the online questionnaire will only proceed to the next section if all items have been completed, thus attempting to minimise incomplete questionnaires which cannot be included for analysis.
Levels of anxiety will be assessed by the Hospital Anxiety and Depression Scale’s (HADS) subscales for Anxiety (HADS-A). This self-administered subscale consists of seven questions for anxiety, with a four-point (0 to 3) ordinal response format. The instrument takes between two to five minutes to complete. The HADS-A has a correlation score of 0.80 and the validity has been described as good to very good . Cut-off scores are available for quantification, for example a score of 8 or more for anxiety has a specificity of 0.78 and a sensitivity of 0.9, and for depression a specificity of 0.79 and a sensitivity of 0.83 [54, 55].
Cut-off scores existed for the following diagnostic categories: normal (score 0 to 7), borderline (8 to 10) and clinical/abnormal (score 11 to 21).
Potential participants will receive an e-mail from the HCP containing information regarding SPD and a link to a secure online questionnaire on the Research electronic data capture (REDCap) platform. Participation in both phases will be completely voluntary and participants can withdraw from the study without any detriment at any time. Informed consent will be obtained electronically prior to completing the demographic information (age, gender, additional diagnosis, highest qualification, marital status, number of children & age, sexual history, province) and online questionnaires (AASH & HADS). Data can be submitted anonymously or an e-mail address can be provided should participants wish to be considered for phase two of the study. Each online questionnaire will receive a unique identification number. All identifying data, including consent regarding participation in phase two and e-mail addresses, will be kept securely, separate from the questionnaires. Once a questionnaire has been scored and SPD identified, the questionnaire number will be compared with the list of participants who gave consent to be contacted regarding participation in phase two.
Ethical clearance has been obtained from the Human Ethics Research Committee at the University of the Witwatersrand (Certificate Number M170829).
Nominal data and ordinal data will be assigned a numeric value to each possible answer within REDCap software. The raw data will be exported from REDCap to Excel and imported into Statistica analytics software program. Nominal and ordinal data will be analysed using descriptive statistics including ranges, means and medians for each section of the demographic questionnaire. Categorical data will be analysed descriptively, using frequency tables and percentages.
The responses to the AASH will entered into the AASH-Scoring Program©. Individual reports providing raw scores, z-scores and interpretation of scores will be generated. Standardised scores will be divided into three categories, namely typical performance, mild (frequently demonstrates functional difficulties in some areas of sensory, motor or social/emotional processing) and definite difficulties (performance is well outside typical performance and almost always result in functional difficulties). A diagnosis of mild difficulty requires further investigation or assessment and a diagnosis of definite difficulty requires intervention. A combined score will be obtained for each item by combining the mild and definite difficulty percentages indicating the percentage of participants who fell outside the parameters of typical functioning.
Results obtained on the AASH and HADS (only anxiety items will be computed as the presence of depression is beyond the scope of the current study) will be transferred to Excel for each participant and then to an Excel summary sheet for each instrument. Data will be cleaned and imported into Statistica software program for descriptive analysis.