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Dewitte M, Meulders A. Fear Learning in Genital Pain: Toward a Biopsychosocial, Ecologically Valid Research and Treatment Model. JOURNAL OF SEX RESEARCH 2023; 60:768-785. [PMID: 36648251 DOI: 10.1080/00224499.2022.2164242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Although fear learning mechanisms are implicated in the development, maintenance, exacerbation, and reduction of genital pain, systematic research on how fear of genital pain emerges, spreads, persists, and reemerges after treatment is lacking. This paper provides an overview of the literature on pain-related fear, integrates the ideas on learning and sexual arousal responding, and specifies the pathways through which compromised learning may contribute to the development and persistence of genital pain. In order to refine theories of genital pain and optimize treatments, we need to adopt a biopsychosocial framework to pain-related fear learning and uncover potential moderators that shape individual trajectories. This involves examining the role of physiological processes, subjective experiences, as well as partner and relational cues in fear acquisition, excessive generalization and impaired safety learning, extinction of fear, counterconditioning, and return of fear. Recent methodological advances in fear conditioning and sex research are promising to enable more symptom-specific and ecologically valid experimental paradigms.
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Affiliation(s)
- Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University
| | - Ann Meulders
- Department of Clinical Psychological Science, Maastricht University
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Lopez-Brull A, Perez-Dominguez B, Hernandez-Sanchez S, Rodriguez-Rodriguez AM, Nahon I, Blanco-Diaz M. Psychometric Properties of the Translated Spanish Version of the Vaginal Penetration Cognition Questionnaire: A Preliminary Work for Validation. Healthcare (Basel) 2023; 11:healthcare11101482. [PMID: 37239768 DOI: 10.3390/healthcare11101482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: To develop an instrument in Spanish to assess beliefs and feelings about vaginal penetration and assess its psychometric properties. (2) Methods: This study translated and adapted the Vaginal Penetration Cognition Questionnaire into Spanish, and a total of 225 women who suffered from Genito-Pelvic Pain/Penetration Disorder were included in the study. The psychometric properties, including construct, convergent and discriminant validity, test-retest reliability, and internal consistency of the translated version were assessed. (3) Results: The Spanish version of the Vaginal Penetration Cognition Questionnaire is a valid, reliable, and consistent tool to assess beliefs and thoughts about vaginal penetration in women suffering from Genito-Pelvic Pain/Penetration Disorder. The exploratory factor analysis yielded four domains that explained 62.5% of the variance. Convergent and discriminant validity was also confirmed. Test-retest reliability was high, with an intraclass correlation coefficient value of 0.90, a standard error of measurement of 4.21, and a minimal detectable change of 11.66 points. Every domain also showed good internal consistency levels, with Cronbach's α values ranging from 0.84 to 0.89. (4) Conclusion: The Spanish version of the Vaginal Penetration Cognition Questionnaire is a valid, reliable, and consistent tool to assess vaginal penetration cognition in women suffering from Genito-Pelvic Pain/Penetration Disorder.
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Affiliation(s)
- Aida Lopez-Brull
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Borja Perez-Dominguez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Sergio Hernandez-Sanchez
- Department of Pathology and Surgery, Physiotherapy Area, Center for Translational Research in Physiotherapy, Miguel Hernandez University, 03202 Elche, Spain
| | | | - Irmina Nahon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra 2617, Australia
| | - Maria Blanco-Diaz
- Department of Physiotherapy, University of Oviedo, 33003 Oviedo, Spain
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Maldonado M, Nardi AE, Sardinha A. The Role of Vaginal Penetration Skills and Vaginal Penetration Behavior in Genito-Pelvic Pain/Penetration Disorder. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:816-828. [PMID: 36951274 DOI: 10.1080/0092623x.2023.2193587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Vaginal penetration skills and behavior are considered different aspects of vaginal penetration. Nevertheless, these terms are used interchangeably in most genito-pelvic pain/penetration disorder (GPPPD) intervention studies, possibly impacting the assessment and selection of intervention outcomes. This is the first theoretical essay on the relevance of nonsexual vaginal penetration skills in understanding and treating GPPPD symptoms, mainly for patients with vaginismus complaints. We aim to provide avenues for further empirical research and new perspectives for assessing, preventing, and treating GPPPD symptoms. We highlight the conceptual boundaries, overlaps, and commonalities between vaginal penetration skills and vaginal penetration behavior and the implications for measuring and selecting GPPPD treatment outcomes. We then briefly explain vaginal penetration skills as a self-learning process and review the impact of fear, anxiety, and cognitive factors on GPPPD symptoms. We also outline the role of the nonsexual genital self-exploration skills in later penetration behavior and offer implications for a new GPPPD patient-centered treatment approach.
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Affiliation(s)
- Mariana Maldonado
- Sexual Dysfunction Nucleus in the Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Antonio Egidio Nardi
- Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Aline Sardinha
- Sexual Dysfunction Nucleus in the Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Banaei M, Kariman N, Ozgoli G, Nasiri M, Roozbeh N, Zare F. Sexual function among women with vaginismus: a biopsychosocial approach. J Sex Med 2023; 20:298-312. [PMID: 36755511 DOI: 10.1093/jsxmed/qdac049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/11/2022] [Accepted: 12/08/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Vaginismus is known as a type of sexual pain disorder. Regarding the multifactorial nature of vaginismus, the biopsychosocial model is one of the best models to describe this sexual disorder. AIM The present research was conducted to study the determinants of sexual function in women with and without vaginismus based on the biopsychosocial model. METHODS This case-control study was conducted in Iran on 420 women with and without primary vaginismus who met the inclusion criteria. All eligible people were included in the research once their eligibility was verified and their informed permission was acquired; convenience and purposive sampling techniques were used continually. Data collection tools included the demographic and obstetric information form and multiple published scales and questionnaires. Structural equation modeling with LISREL 9.2 software (Scientific Software International) was used to evaluate the determinants of the sexual function of vaginismus. OUTCOMES Participants rated their determinants of sexual function based on the biopsychosocial model. RESULTS The mean ages of the case and control groups were 27.67 and 28.44 years, respectively. The direct, indirect, and total effects of the dimensions of sexual health on sexual function and the diagnostic score of vaginismus of the women with vaginismus were significant (P < .001). Furthermore, based on the results, the diagnostic score of vaginismus in women with vaginismus was significantly affected by the direct, indirect, and cumulative impacts of vaginal penetration cognition and fear of sex (P = .016, P = .005). Women with and without vaginismus were able to accept the models' excellent fit. CLINICAL IMPLICATIONS This study helps inform health planners and policy makers about the sexual function of women with vaginismus, the factors related to this disorder, and the multidimensional nature of this sexual problem. STRENGTHS AND LIMITATIONS This study attempted to offer a more comprehensive and complete view of present knowledge via surveying different aspects of sexual health and by means of valid and reliable tools and path analysis. The study's merits include the use of the biopsychosocial model to evaluate sexual function in women with vaginismus, the use of a variety of questionnaires to compare women with and without vaginismus, and the size of the sample. The research was limited by the fact that electronic sampling was conducted because of the COVID-19 epidemic. CONCLUSION Based on the findings of the present study for the group of women with vaginismus, the direct, indirect, and overall effects of the majority of dimensions of sexual health were significantly correlated with sexual function and vaginismus.
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Affiliation(s)
- Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, 7916613885, Iran
| | - Nourossadat Kariman
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 1996835119, Iran
| | - Giti Ozgoli
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 1996835119, Iran
| | - Maliheh Nasiri
- Department of Biostatistics, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 1996835119, Iran
| | - Nasibeh Roozbeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, 7916613885, Iran
| | - Fatemeh Zare
- Midwifery Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 6135715794, Iran
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Pithavadian R, Chalmers J, Dune T. The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231199383. [PMID: 37771119 PMCID: PMC10540594 DOI: 10.1177/17455057231199383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND There is low social awareness of vaginismus despite it being a relatively common female sexual dysfunction that makes vaginal penetration painful, difficult, and/or impossible. While existing literature on vaginismus has had a clinical focus on the affected genitalia, there is a lack of research on women's help-seeking experiences of vaginismus from their perspective. OBJECTIVES This integrative review's objective was to explore: women's help-seeking experiences of vaginismus, and how such help-seeking experiences impact their sense of self. DESIGN Cooper's five-step integrative review approach was followed to develop a research question, a search strategy, selection criteria, and data evaluation, analysis, and presentation. DATA SOURCES AND METHODS A systematic search of the literature was completed in the following seven databases in January 2023: PsycINFO, ProQuest Central, PubMed, Scopus, CINAHL, Cochrane, and Embase. Out of the 373 articles found through database searches and additional citation searching, 22 studies were included in this review for meeting the eligibility criteria of having an empirical design, being written in English, and examining women's help-seeking experiences for vaginismus and its impact on their sense of self. RESULTS Thematic analysis was used to summarize the findings from the included studies which were informed by 1671 participants. Help-Seeking Process, Medical Management, Help-Seeking and Sense of Self, and Holistic Care Recommendations from the Findings emerged as four major themes with corresponding subthemes. CONCLUSION This review indicates that women continue to face difficulties in seeking and receiving help for vaginismus even through the healthcare system. However, the studies did not explicitly discuss how women's help-seeking for vaginismus impacted their sense of self. This highlights an epistemological gap on how women's help-seeking for their vaginismus impacts their sense of self, which can affect their treatment responses. Recommendations are provided for future healthcare and research to improve health outcomes for women with vaginismus.
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Affiliation(s)
- Rashmi Pithavadian
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Jane Chalmers
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Tinashe Dune
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Psychological Science at Australian College of Applied Professions, Sydney, NSW, Australia
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McEvoy M, McElvaney R, Glover R. Understanding vaginismus: a biopsychosocial perspective. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2021.2007233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria McEvoy
- Department of Psychology, Waterford Institute of Technology, Waterford, Ireland
| | - Rosaleen McElvaney
- Department of Psychotherapy, Dublin City University, Dublin, Ireland
- Department of Psychotherapy, Children’s Health at Connolly, Dublin, Ireland
| | - Rita Glover
- Department of Psychotherapy, Dublin City University, Dublin, Ireland
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Yükselay Ö, Gıca Ş, Yalçın M, Guleç MY, Güleç H. Investigation of auditory P50 sensory gating with sexual visual stimuli in patients with vaginismus. Neurophysiol Clin 2021; 51:251-257. [PMID: 33814257 DOI: 10.1016/j.neucli.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of the study was to investigate sensory information processing induced by visual sexual stimuli and to assess its relationship with sexual behaviors and symptoms in patients with vaginismus. METHODS Twenty-one patients with vaginismus and 20 controls were included in the study. The sociodemographic information and sexual life history of the patients with vaginismus and controls were examined and electrophysiological measurements related to auditory P50 sensory gating were obtained using a double click paradigm during by sexual/horror visual stimulation, which was thought to be related to the pathophysiology of the disease. RESULTS P50 suppression ratios during visual sexual stimuli were lower in vaginismus group compared to the control group. There was no difference in P50 suppression ratios during visual horror stimuli when the two groups were compared. The P50 suppression of the vaginismus group with visual sexual stimuli was found to be lower than P50 suppression with visual horror stimuli. A positive moderate correlation was found between the duration of foreplay and P50 suppression ratio during visual sexual stimuli in vaginismus group. CONCLUSION Our study revealed that patients with vaginismus had sensory gating impairment during visual sexual stimuli. Increase in the duration of foreplay in vaginismus patients may improve sensory gating impairment by affecting sensory gating functions.
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Affiliation(s)
- Özge Yükselay
- University of Health Sciences, Van Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Şakir Gıca
- Necmettin Erbakan University, Meram Medical Faculty, Department of Psychiatry, Konya, Turkey.
| | - Murat Yalçın
- University of Health Sciences, Erenköy Mental and Nervous Diseases Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Medine Yazıcı Guleç
- University of Health Sciences, Erenköy Mental and Nervous Diseases Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Hüseyin Güleç
- University of Health Sciences, Erenköy Mental and Nervous Diseases Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
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Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021; 18:770-782. [PMID: 33757773 DOI: 10.1016/j.jsxm.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite a growing body of research on psychosocial factors in Genito-Pelvic Pain/Penetration Disorder (GPPPD) during sexual intercourse, there are few studies examining adolescent and young adult women's experiences with painful sex and the effects of religiosity, sexual education, and sex guilt. AIM The purpose of the study was to examine the occurrence of GPPPD among sexually active female college students, including psychosocial factors of religiosity and religious practice, sexual education, sex guilt, and sexual distress. METHODS Data were collected from 974 college women from a university in the Northeastern U.S. We limited our sample to sexually active women (n = 593, 60.9%; mean age: 18.96) who responded to the questionnaire item, "In general, do you feel pain with sexual intercourse?" Participants completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Revised Mosher Sex Guilt Scale, Abbreviated Santa Clara Strength of Religious Faith Questionnaire, 10-item Gender Role Beliefs Scale, and measures on sexual wellness and practice and sexual education experiences. Data were analyzed using standard bivariate and regression analyses as well as path analysis. MAIN OUTCOME MEASURES Women were asked, "In general, do you feel pain with sexual intercourse?" and categorized into one of three pain groups: occasional (10%-25% of the time), frequent (50% or more), and no pain (less than 10%). RESULTS GPPPD with sex was prevalent among young college women, with 113 (19.1%) reporting frequent pain and 143 (24.1%) occasional pain (control n = 337, 56.8%). Numerous statistically significant factors were identified, including frequency of sex, ability to orgasm, sensations during intercourse, presence of a steady sexual partner, expectations of painful sex, sex guilt, and sexual distress. Sex guilt acted as full mediator between religiosity and painful sex. IMPLICATIONS Healthcare providers should proactively initiate conversations with young female patients about painful intercourse to identify issues and normalize language on pain with sex. Educators are urged to teach evidence-based information on pain-free and guilt-free sexual experiences inside and outside religious contexts. CONCLUSION Painful sex affects adolescent and young adult women at a similar rate as non-college adult women and while religiosity does not directly impact young women's GPPPD, religiosity does lead to painful sex if it causes sex guilt. Further research is needed into the mechanisms of religion-based sexual shaming and among religiously conservative women who practice abstinence until marriage. Azim KA, Happel-Parkins A, Moses A, et al. Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021;18:770-782.
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Do women with vaginismus have a lower threshold of pain? Eur J Obstet Gynecol Reprod Biol 2021; 258:189-192. [PMID: 33450709 DOI: 10.1016/j.ejogrb.2020.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Vaginismus and dyspareunia are together categorized as a genito-pelvic pain and penetration disorder. We aimed to evaluate the threshold of pain and the pain sensitivity in women with vaginismus. STUDY DESIGN In this prospective case-control study; 32 women with vaginismus and 29 healthy women were enrolled. Sociodemographic Information Form, Female Sexual Function Index (FSFI), Pain Beliefs Questionnaire (PBQ), Revised Fibromyalgia Impact Questionnaire (FIQR), The Lamont Scale of Vaginismus were applied. Threshold of pain was measured with algometer in terms of Newton (N). RESULTS The pain thresholds vaginismus and control group were as follows; left posterior superior iliac crest (40.3 N, 84.9 N respectively;p < 0.001), right posterior superior iliac crest (42.9 N, 76.1 N respectively;p = 0.007), left lateral trochanter (42.0 N, 69.8 N respectively; p = 0.015), right lateral trochanter (43.8 N, 75.3 N respectively; p = 0.003), left anterior superior iliac spine (29.2 N, 51.2 N respectively; p = 0.003), left insertion of gracilis muscle (27.3 N, 45.2 N respectively; p = 0.038), left medial vastus muscle (37.0 N, 52.4 N respectively; p = 0.025) and the pain thresholds were significantly lower in the vaginismus patients. CONCLUSION Women with vaginismus have a lower threshold of pain, and the pain threshold decreases in higher grades of vaginismus. The pain may aggravate the avoiding behavior of women from sexual intercourse.
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Turan Ş, Usta Sağlam NG, Bakay H, Gökler ME. Levels of Depression and Anxiety, Sexual Functions, and Affective Temperaments in Women With Lifelong Vaginismus and Their Male Partners. J Sex Med 2020; 17:2434-2445. [PMID: 32981852 DOI: 10.1016/j.jsxm.2020.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Depression and anxiety levels, sexual dysfunctions, and affective temperament characteristics of women with lifelong vaginismus (LLV) and their male partners may have important effects on the development, maintenance, and exacerbation of LLV. AIM We aimed to investigate depression and anxiety levels, sexual dysfunctions, and affective temperament characteristics of both women with LLV and their male partners. METHODS 56 women with LLV, their 56 male partners, and 44 couples with no complaints of any sexual function as a control group were included in this study. Dyadic data were analyzed using the Actor-Partner Interdependence Model. OUTCOMES The Beck Depression Inventory, Beck Anxiety Inventory, Golombok Rust Inventory of Sexual Satisfaction, and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire Scale were completed by all participants. RESULTS Women with LLV had higher levels of anxiety and depression and had more sexual dysfunctions except for avoidance than those of female controls. Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire Scale scores were significantly higher in women with LLV for depressive (odds ratio [OR] = 1.27, 95% CI = 1.09-1.49), cyclothymic (OR = 1.31, 95% CI = 1.15-1.49), anxious (OR = 1.22, 95% CI = 1.09-1.38), and irritable (OR = 1.22, 95% CI = 1.04-1.42) temperament than in female controls. It was found that anxiety levels of male partners of women with LLV were higher than those of male controls and that they experienced less sexual satisfaction. Depressive (OR = 1.31, 95% CI = 1.07-1.61) and cyclothymic (OR = 1.18, 95% CI = 1.04-1.34) temperament scores were significantly higher in male partners of women with LLV than in male controls. The Actor-Partner Interdependence Model analyses show that hyperthymic temperament in male partners of women with LLV and anxious and depressive temperament in women with LLV have a negative effect on their own sexual functions. In terms of partner effect, it was found that men with hyperthymic temperament had a negative effect on the sexual functions of women with LLV and men with depressive temperament had a positive effect. CLINICAL IMPLICATIONS The individual characteristics of both the women and their male partners have an impact on LLV. STRENGTHS & LIMITATIONS The sample size was relatively small to assess affective temperaments. The inclusion of male partners in the study contributed to our understanding of couples with LLV. CONCLUSION Our results indicate that affective temperaments detected in women with LLV (depressive, cyclothymic, anxious and irritable) and their male partners (depressive and cyclothymic) have an effect on the development, maintenance, and exacerbation of LLV, and affective temperaments have an effect on both their own and partner's sexual functions. Turan Ş, Usta Sağlam NG, Bakay H, et al. Levels of Depression and Anxiety, Sexual Functions, and Affective Temperaments in Women With Lifelong Vaginismus and Their Male Partners. J Sex Med 2020;17:2434-2445.
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Affiliation(s)
- Şenol Turan
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | | | - Hasan Bakay
- Department of Psychiatry, Nizip State Hospital, Gaziantep, Turkey
| | - Mehmet Enes Gökler
- Department of Public Health, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Anğın AD, Gün İ, Sakin Ö, Çıkman MS, Eserdağ S, Anğın P. Effects of predisposing factors on the success and treatment period in vaginismus. JBRA Assist Reprod 2020; 24:180-188. [PMID: 32301599 PMCID: PMC7169926 DOI: 10.5935/1518-0557.20200018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective There are many predisposing factors associated with vaginismus, but there is lack of data in the literature regarding which and how of these factors influence the success rate of treatment. Our aim is to investigate the effects of factors that are considered as predisposing factors for vaginismus on treatment prognosis and success rate, with cognitive-behavioral therapy and desensitization exercises after sexual therapy. Methods Patients with vaginismus were divided into three groups. Group 1: patients who successfully completed vaginal penetration exercises after sexual therapy and experienced vaginal sexual intercourse; Group 2: patients who started penetration exercises but could not reach success; Group 3: patients who discontinued treatment before starting exercises. Demographic and sexual parameters were compared between the groups. Results There were statistically significant differences between the groups in terms of history of vaginismus in relatives (4.3%, 23% and 35.7%, p=0.047, respectively), the unsuccessful therapy history (69%, 61% and 21.4%, p=0.014, respectively), and anal and/or oral sex ratios (47.8%, 7.7% and 57.1%, p=0.019, respectively). Mean number of sessions were significantly higher in patients saying, “It is my fault” than among those perceiving it as a common problem (10.6±2.9 ve 7.5±5.7, p=0.042, respectively), and in patients with sexual disorder in their male partners than those not having any problem (13.3±3.7 ve 8.2±3.7, p=0.013, respectively). Conclusion Patients are more resistant to treatment if they have a history of vaginismus among relatives or when one of the couple say, it is his or her fault.
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Affiliation(s)
- Ali Doğukan Anğın
- University of Health Sciences, Dr Lütfi Kırdar Kartal Training and Research Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - İsmet Gün
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Önder Sakin
- University of Health Sciences, Dr Lütfi Kırdar Kartal Training and Research Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Muzaffer Seyhan Çıkman
- University of Health Sciences, Dr Lütfi Kırdar Kartal Training and Research Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Süleyman Eserdağ
- Hera Women's Health Center, Sexual Dysfunction and Gynecology Clinic, İstanbul, Turkey
| | - Pınar Anğın
- Ümraniye Training and Research Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Padoa A, McLean L, Morin M, Vandyken C. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med Rev 2020; 9:64-75. [PMID: 32238325 DOI: 10.1016/j.sxmr.2020.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/30/2019] [Accepted: 02/02/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Overactive pelvic floor (OPF) muscles are defined as muscles that do not relax, or may even contract, when relaxation is needed, for example, during micturition or defecation. Conditions associated with OPF are multifactorial and include multiple possible etiologies and symptom complexes. The complex interplay between biological and psychosocial elements can lead to the persistence of OPF symptoms along with psychological and emotional distress. OBJECTIVES (1) To review and contextualize, from a pathophysiologic perspective, the evidence for OPF, (2) to provide an overview of common clinical presentations and comorbidities of OPF, and (3) to discuss the effect of OPF on sexual function in men and women. METHODS Review of the updated literature on the pathophysiology of OPF was carried out. OPF-associated conditions were overviewed, with special emphasis on the impact on sexual function in men and women. RESULTS Individuals with suspected OPF often present with a combination of gastrointestinal, gynecological, musculoskeletal, sexual, and urological comorbidities, mostly accompanied by psychoemotional distress. In both women and men, sexual function is significantly impaired by OPF and genitopelvic pain penetration disorders are often the primary manifestation of this condition. Women with OPF report less sexual desire, arousal, and satisfaction; more difficulty reaching orgasm; lower frequencies of intercourse; more negative attitudes toward sexuality; and more sexual distress than women without sexual pain. The most frequently reported sexual dysfunctions in men with OPF include erectile dysfunction, premature ejaculation, and ejaculatory pain. CONCLUSION The complex pathophysiology of OPF involving multisystemic comorbidities and psychosocial factors emphasize the importance of a biopsychosocial assessment for guiding effective and personalized management. Padoa A, McLean L, Morin M, et al. "The Overactive Pelvic Floor (OPF) and Sexual Dysfunction" Part 1: Pathophysiology of OPF and Its Impact on the Sexual Response. Sex Med 2021;9:64-75.
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Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Yitzhak Shamir (formerly Assaf Harofe) Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Linda McLean
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Melanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Center of the Centre hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, QC, Canada
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Sexual Disgust: Evolutionary Perspectives and Relationship to Female Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00219-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Farnam F. The complexities and challenges of sexual dysfunctions diagnosis
in females: A case report. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2019. [DOI: 10.29252/pcnm.9.2.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women. J Sex Med 2019; 16:1068-1077. [PMID: 31155386 DOI: 10.1016/j.jsxm.2019.04.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To date, few studies have investigated the prevalence of sexual pain in the context of the new diagnostic concept of genito-pelvic pain/penetration disorder (GPPPD). AIM To evaluate the prevalence of GPPPD and its associated factors. METHODS This was a population-based, cross-sectional study of 590 healthy married women age 18-70 years conducted between May and October 2017 in Tehran, Iran. MAIN OUTCOME MEASURES Research tools included demographic characteristics checklist, factors affecting GPPPD, sexual distress and self-reporting of pain during intercourse, 2 standard questionnaires on depression (Patient Health Questionnaire 9) and Binik's guideline for the diagnosis of GPPPD. RESULTS 196 women (33%) reported pain or fear in answer to self-report questions. Administration of Binik's guideline yielded a GPPPD prevalence of 16% (n = 94 women); however, this number decreased to 62 women (10.5%) when sexual distress was taken into account; thus, the final prevalence of GPPPD was considered to be 10.5%. However, if the threshold in Binik's guideline was lowered to also include those reporting "somewhat" pain in addition to the group reporting "moderate" and "quite a bit or always," then the prevalence of GPPPD increased to 25.8%. The results of backward logistic regression identified a strong aversion to looking at or touching the genitalia (odd ratio [OR] = 4.3), low sexual satisfaction (OR = 3.1), and severe depression (OR = 6.6) as independent risk factors for a diagnosis of GPPPD and secure financial status (OR = 0.3) and a high level of marital satisfaction (OR = 0.2) as protective factors against a diagnosis of GPPPD. CLINICAL IMPLICATIONS Reliable diagnosis of GPPPD is crucial. Application of validated tools may mitigate the overestimation of GPPPD prevalence. Simultaneously, clinicians' judgment is essential in assessing a reasonable threshold and preventing underestimation that leads to the exclusion of women suffering from pain. STRENGTHS & LIMITATIONS The present study is one of the few evaluating the prevalence of GPPPD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) definition and Binik's guideline. The study also aims to point out some new perspectives on merging the 2 concepts of vaginismus and dyspareunia. Study limitations include the evaluation of factors affecting GPPPD based on self-reporting and possible recall bias. CONCLUSION Further research is needed to determine the appropriate threshold for a diagnosis of GPPPD. We suggest that a woman with mild to moderate pain or fear of vaginal penetration is under sexual distress and cannot be neglected. In addition, problems may arise following the DSM-5 merging of the 2 disorders of vaginismus and dyspareunia, owing to the significant prevalence and distress of lifelong vaginismus in some cultures. Alizadeh A, Farnam F, Raisi F, et al. Prevalence of and Risk Factors for Genito-Pelvic Pain/Penetration Disorder: A Population-Based Study of Iranian Women.J Sex Med 2019;16:1068-1077.
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Tourrilhes E, Veluire M, Hervé D, Nohuz E. [Obstetric outcome of women with primary vaginismus]. Pan Afr Med J 2019; 32:160. [PMID: 31303929 PMCID: PMC6607310 DOI: 10.11604/pamj.2019.32.160.16083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/12/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Dysfonction importante, le vaginisme est un problème tant individuel que du couple qui peut altérer la relation sexuelle. Il peut influencer le pronostic obstétrical. Le but de cette étude était de déterminer si les caractéristiques cliniques du vaginisme ont une incidence sur le processus de l’accouchement. Méthodes Etude rétrospective multicentrique incluant des patientes affectées par un vaginisme primaire, ayant donné naissance à terme à un premier enfant vivant, entre 2005 et 2015. Résultats Sur les 19 patientes inclues dans l’étude, nous avons constaté 9 grossesses prolongées, 14 mises en travail spontanées (dont 8 à terme atteint), 3 césariennes en dehors du travail et 2 déclenchements artificiels. Parmi les 16 femmes ayant eu un travail, nous avons dénombré 4 césariennes, 5 accouchements par voie basse avec forceps et 7 par voie basse spontanée. Parmi les 12 accouchements par voie basse, 9 épisiotomies ont été pratiquées, 7 femmes ont présenté des déchirures périnéales spontanées seules ou associées à une épisiotomie, aucune lésion périnéale de type 3 ou 4, ni de périnées intacts n’ont été recensés. Le poids moyen des nouveau-nés était de 3380g±332 (2870g-3970g, 47e percentile). Conclusion La proportion d’accouchements dystociques et la morbidité périnéale étaient notablement élevées, ce qui parait comparable avec la plupart des données de la littérature. Il est possible que les composantes psychologiques et comportementales du vaginisme, (mécanisme de peur-évitement, anxiété) aient favorisé les grossesses prolongées, les césariennes, les dystocies mécaniques et les lésions périnéales. Des études complémentaires sont nécessaires afin de mieux cerner le vaginisme et ses implications obstétricales.
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Affiliation(s)
- Elise Tourrilhes
- Service de Gynécologie Obstétrique, Centre Hospitalier de Fougères, Fougères, France
| | - Marie Veluire
- Service de Gynécologie Obstétrique, Hôpital Privé d'Athis-Mons, Caron, 91200 Athis Mons, France
| | - David Hervé
- Service de Gynécologie Obstétrique, Hôpital Privé d'Athis-Mons, Caron, 91200 Athis Mons, France
| | - Erdogan Nohuz
- Université Clermont-Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France.,Service de Gynécologie Obstétrique, Centre Hospitalier de Thiers, Route du Fau, 63300 Thiers, France
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Outcome of Medical and Psychosexual Interventions for Vaginismus: A Systematic Review and Meta-Analysis. J Sex Med 2018; 15:1752-1764. [DOI: 10.1016/j.jsxm.2018.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 01/02/2023]
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Vieira-Baptista P, Lima-Silva J, Pérez-López FR, Preti M, Bornstein J. Vulvodynia: A disease commonly hidden in plain sight. Case Rep Womens Health 2018; 20:e00079. [PMID: 30245974 PMCID: PMC6142188 DOI: 10.1016/j.crwh.2018.e00079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 01/16/2023] Open
Abstract
•Vulvodynia affects at least 6% of women, and can be found at any age and in all ethnic groups.•The diagnosis is one of exclusion but is very often missed.•Women with vulvodynia are frequently misdiagnosed as having vaginismus.•Failure to make the diagnosis often leads to irrelevant or deleterious examinations and treatments.
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Affiliation(s)
- Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Portugal
- Unidade de Tracto Genital Inferior, Serviço de Ginecologia e Obstetrícia, Centro Hospitalar de São João, Porto, Portugal
| | - Joana Lima-Silva
- Unidade de Tracto Genital Inferior, Serviço de Ginecologia e Obstetrícia, Centro Hospitalar de São João, Porto, Portugal
| | - Faustino R. Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza, Faculty of Medicine, Lozano-Blesa University Hospital, Zaragoza, Spain
| | - Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Spoelstra SK, Weijmar Schultz WCM, Reissing ED, Borg C, Broens PM. The distinct impact of voluntary and autonomic pelvic floor muscles on genito-pelvic pain/penetration disorder. SEXUAL AND RELATIONSHIP THERAPY 2018. [DOI: 10.1080/14681994.2018.1442568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Symen K. Spoelstra
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Willibrord C. M. Weijmar Schultz
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elke D. Reissing
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Charmaine Borg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Paul M.A. Broens
- Department of Surgery, Anorectal Physiology Laboratory, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Jebelli F, Maaroufi M, Maracy MR, Molaeinezhad M. Effectiveness of eye movement desensitization and reprocessing (EMDR) on the sexual function of Iranian women with lifelong vaginismus. SEXUAL AND RELATIONSHIP THERAPY 2017. [DOI: 10.1080/14681994.2017.1323075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- F. Jebelli
- Department of Psychiatry, School of Medicine, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M. Maaroufi
- Department of Psychiatry, School of Medicine, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M. R. Maracy
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M. Molaeinezhad
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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McLean L, Brooks K. What Does Electromyography Tell Us About Dyspareunia? Sex Med Rev 2017; 5:282-294. [PMID: 28330675 DOI: 10.1016/j.sxmr.2017.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Emergent evidence suggests that pelvic floor muscle (PFM) dysfunction contributes to dyspareunia, the experience of pain on vaginal penetration. Electromyography (EMG) is a valuable tool for the assessment of neuromuscular control and could be very useful in enhancing our understanding of PFM involvement in sexual function and in conditions such as dyspareunia. However, PFM EMG must be interpreted within the context of the many factors that can influence findings. AIM To outline the main factors to consider when evaluating PFM EMG for female sexual function and dyspareunia and to synthesize the literature in which EMG has been acquired and interpreted appropriately in this context. METHODS Standards for the acquisition and interpretation of EMG were retrieved and consulted. An exhaustive search of four electronic databases (Embase, CINAHL, PubMed, and PsycLit) and hand searching references from relevant articles were performed to locate articles relevant to PFM involvement in sexual function and in dyspareunia in which EMG was used as a primary outcome. Study outcomes were evaluated within the context of the appropriate application and interpretation of EMG and their contribution to knowledge. MAIN OUTCOME MEASURES A synthesis of the evidence was used to present the current state of knowledge on PFM involvement in sexual function and in dyspareunia. RESULTS Few standards documents and no practice guidelines for the acquisition and interpretation of PFM EMG are available. Some cohort studies with small samples of women have described the role of the PFMs in female sexual function. The literature on PFM involvement in dyspareunia also is limited, with outcomes suggesting that higher than normal tonic activation and higher than normal reflex responses might be present in the superficial PFM layer and might be characteristic features of dyspareunia. The data are less clear on the involvement of the deep layer of the PFMs in dyspareunia. CONCLUSION Guidelines for the application and interpretation of PFM EMG in the context of sexual function and dyspareunia are needed. When interpreted within the context of their strengths and limitations, EMG data have contributed valuable information to our understanding of PFM involvement in dyspareunia. The literature to date suggests that the superficial PFMs might have higher than normal tone and exaggerated responses to tactile or penetrative provocation in at least some women with dyspareunia. McLean L, Brooks K. What Does Electromyography Tell Us About Dyspareunia? Sex Med Rev 2017;5:282-294.
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Affiliation(s)
- Linda McLean
- School of Rehabilitation Science, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
| | - Kaylee Brooks
- School of Kinesiology, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Gammoudi N, Affes Z, Mellouli S, Radhouane K, Dogui M. The diagnosis value of needle electrode electromyography in vaginismus. SEXOLOGIES 2016. [DOI: 10.1016/j.sexol.2016.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Vieira-Baptista P, Lima-Silva J. Is the DSM-V Leading to the Nondiagnosis of Vulvodynia? J Low Genit Tract Dis 2016; 20:354-5. [DOI: 10.1097/lgt.0000000000000250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Berger MH, Messore M, Pastuszak AW, Ramasamy R. Association Between Infertility and Sexual Dysfunction in Men and Women. Sex Med Rev 2016; 4:353-365. [PMID: 27872029 DOI: 10.1016/j.sxmr.2016.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/13/2016] [Accepted: 05/15/2016] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The relation between infertility and sexual dysfunction can be reciprocal. Causes of sexual dysfunction that affect fertility include erectile dysfunction, Peyronie's disease (abnormal penile curvature), low libido, ejaculatory disorders in men, and genito-pelvic pain/penetration disorder (GPPPD) and low sexual desire in women. AIM To review the association between infertility and sexual dysfunction and discuss current management strategies to address sexual disorders in couples with infertility. METHODS Peer-reviewed publications from PubMed published from 1980 through February 2016 were identified that related to sexual dysfunction and infertility in men and women. MAIN OUTCOME MEASURES Pathophysiology and management approach of erectile dysfunction, Peyronie's disease, low libido, ejaculatory disorders in men, and GPPPD and low sexual desire in women and how each etiology contributes to sexual dysfunction and infertility in the couple. RESULTS Treating the infertile couple with sexual dysfunction involves addressing underlying conditions such as psychogenic erectile dysfunction, low testosterone, Peyronie's disease in men, and GPPPD and low sexual desire in women. Psychogenic erectile dysfunction can be successfully treated with phosphodiesterase inhibitors. Low testosterone is often identified in men with infertility, but testosterone therapy is contraindicated in men attempting conception. Men with Peyronie's disease have a new treatment option to address their penile curvature-collagenase Clostridium histolyticum injection directly into the penile plaque. GPPPD is a broad disorder that includes vulvodynia and vaginismus and can be treated with topical lubricants and moisturizers. We must address psychosocial factors in women with low sexual desire. Flibanserin and transdermal testosterone (off-label) are novel therapies for women with low sexual desire. CONCLUSION Sexual dysfunction in a couple with infertility is a complex issue. Management of infertility and sexual dysfunction should involve appropriate medical therapy and addressing the psychosocial concerns of the couple.
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Affiliation(s)
- Michael H Berger
- Department of Urology, University of Miami-Miller School of Medicine, Miami, FL, USA
| | - Marisa Messore
- Center for Women's Sexual Health and Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami-Miller School of Medicine, Miami, FL, USA.
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Abstract
PURPOSE OF REVIEW The purpose of this review was to assess recent research (the last 18 months) and its impact on understanding sexual pain disorders relevant to daily clinical practice. RECENT FINDINGS It has been highlighted that sexual pain is related to the number of tender points, pressure pain threshold, more deliberate fear and less global positive affective associations with sexual stimuli, episiotomy, attachment styles, drug abuse and the influence of ambivalence over emotional expression in couples.The efficacy of a multidisciplinary vulvodynia programme of treatment, another type of therapy based on the fear-avoidance and pain self-efficacy model and a novel cognitive-behavioral couple therapy has been stated. SUMMARY There is a gradual advance in the knowledge of sexual pain disorder etiology. At the same time different therapeutics strategies have been increasing, but it is necessary to introduce guidelines on the basis of the evidence to approach with efficacy this severe disorder. VIDEO ABSTRACT http://links.lww.com/YCO/A31.
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Flink IK, Thomtén J, Engman L, Hedström S, Linton SJ. Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale. Scand J Pain 2015; 9:74-80. [PMID: 29911654 DOI: 10.1016/j.sjpain.2015.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
Background and purpose Recurrent vulvar pain is a common and debilitating condition which has received remarkably little attention in pain research. For instance, little is known about how these women cope with sexual activities, and there are no structured assessment tools. The purpose of this study was to explore coping strategies in this group, with a view to develop a measure to assess how women with vulvar pain cope with sexual activities. Methods The current study is based on a subsample from a longitudinal study about vulvar pain in a student sample consisting of women between 18 and 35 years old (N = 964). Only data from the ones reporting recurrent vulvar pain during the last six months (N = 289) were used in the analyses. First, the CHAMP Sexual Pain Coping Scale (CSPCS) was created, with the aim of assessing how women with vulvar pain cope with sexual activities. The scale was inspired by previous research on women with vulvar pain as well as well-known coping strategies in other pain populations. Second, the psychometric properties of the scale were explored by analyzing the factor structure and internal reliability. Third, validity features were examined in terms of criterion validity and construct validity. Results The analyses supported a three-factor solution, embracing the strategies endurance, avoidance and alternative coping. The internal reliability of the subscales turned out to be good, and the criterion validity was supported for all three subscales. The construct validity was clearly supported for the endurance and the avoidance subscales, but not for the alternative coping subscale. Conclusions The findings support the CSPCS as an instrument for assessing how women with vulvar pain cope with sexual activities. The strategies endurance, avoidance and alternative coping correspond with findings from earlier research. Endurance reflects a tendency to engage in and continue with sexual activities despite pain, while attempting to minimize or suppress thoughts of pain. Avoidance, on the other hand, involves efforts to stay away from sexual activities, in particular vaginal penetration, because of fear of pain. Alternative coping refers to endeavours to find alternative sexual activities that do not necessarily involve vaginal penetration. Even though this first study indicates that the CSPCS may be psychometrically sound, more studies are needed to confirm the psychometric properties and clinical application of this instrument. In particular, the construct validity of the alternative coping subscale needs to be further evaluated. Implications A valid instrument for assessing strategies for coping with sexual activities in this population has important clinical implications, since it provides a method that may enhance assessment procedures, be used in research, and stimulate the development of treatment.
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Affiliation(s)
- Ida K Flink
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Johanna Thomtén
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden.,Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Linnéa Engman
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Stina Hedström
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Steven J Linton
- Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
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Lahaie MA, Amsel R, Khalifé S, Boyer S, Faaborg-Andersen M, Binik YM. Can Fear, Pain, and Muscle Tension Discriminate Vaginismus from Dyspareunia/Provoked Vestibulodynia? Implications for the New DSM-5 Diagnosis of Genito-Pelvic Pain/Penetration Disorder. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1537-1550. [PMID: 25398588 DOI: 10.1007/s10508-014-0430-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 10/07/2014] [Accepted: 10/23/2014] [Indexed: 06/04/2023]
Abstract
Fear has been suggested as the crucial diagnostic variable that may distinguish vaginismus from dyspareunia. Unfortunately, this has not been systematically investigated. The primary purpose of this study, therefore, was to investigate whether fear as evaluated by subjective, behavioral, and psychophysiological measures could differentiate women with vaginismus from those with dyspareunia/provoked vestibulodynia (PVD) and controls. A second aim was to re-examine whether genital pain and pelvic floor muscle tension differed between vaginismus and dyspareunia/PVD sufferers. Fifty women with vaginismus, 50 women with dyspareunia/PVD, and 43 controls participated in an experimental session comprising a structured interview, pain sensitivity testing, a filmed gynecological examination, and several self-report measures. Results demonstrated that fear and vaginal muscle tension were significantly greater in the vaginismus group as compared to the dyspareunia/PVD and no-pain control groups. Moreover, behavioral measures of fear and vaginal muscle tension were found to discriminate the vaginismus group from the dyspareunia/PVD and no-pain control groups. Genital pain did not differ significantly between the vaginismus and dyspareunia/PVD groups; however, genital pain was found to discriminate both clinical groups from controls. Despite significant statistical differences on fear and vaginal muscle tension variables between women suffering from vaginismus and dyspareunia/PVD, a large overlap was observed between these conditions. These findings may explain the great difficulty health professionals experience in attempting to reliably differentiate vaginismus from dyspareunia/PVD. The implications of these data for the new DSM-5 diagnosis of Genito-Pelvic Pain/Penetration Disorder are discussed.
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Macey K, Gregory A, Nunns D, das Nair R. Women's experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study. BMC WOMENS HEALTH 2015; 15:49. [PMID: 26091883 PMCID: PMC4475318 DOI: 10.1186/s12905-015-0201-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/18/2015] [Indexed: 12/03/2022]
Abstract
Background Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes ‘performance-based’ sexuality which may be detrimental. Despite this, little has been done to seek women’s views about their treatment. This study set out to explore women’s experiences of vaginismus treatment with vaginal trainers, and to use their voices to propose guidelines for improving treatment. Methods 13 women who had used vaginal trainers for vaginal penetration difficulties diagnosed as vaginismus were recruited through a specialist clinic, university campuses, and online forums. The women took part in semi-structured individual interviews (face-to-face/telephone/Skype), which were audio-recorded, transcribed verbatim and analysed using Thematic Analysis. Results Four superordinate themes were elicited and used to draft ‘better treatment’ guidelines. Themes were: (1) Lack of knowledge, (2) Invalidation of suffering by professionals, (3) Difficult journey, and (4) Making the journey easier. This paper describes themes (3) and (4). Difficult Journey describes the long and arduous ‘Journey into treatment’, including difficulties asking for help, undergoing physical investigations and negotiating ‘the system’ of medical referrals. It also describes the sometimes demoralising process of ‘being in treatment’, which includes emotional and practical demands of treatment. Making the journey easier highlights the importance of and limits to ‘partner support’. ‘Professional support’ comprises personal qualities of professionals/therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. ‘Peer support/helping each other’ describes the importance of supportive vaginimus networks and sharing tips with other women. Conclusions Accessing effective treatment for vaginal penetration difficulties is difficult. The practical and emotional demands of using vaginal trainers may be underestimated by professionals, resulting in inadequate provision of support and information in practice. At times vaginal trainers may be prescribed to women who are unlikely to benefit from this treatment in isolation. Core communication skills like non-judgemental listening are important for supporting women through treatment. However professionals also need greater specialist knowledge, which in turn requires more detailed research. New ways to disseminate specialist knowledge and suggestions for further research are discussed. Electronic supplementary material The online version of this article (doi:10.1186/s12905-015-0201-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kat Macey
- Clinical Psychology, University of Nottingham, Nottingham, UK. .,Clinical Psychology, Division of Psychiatry & Applied Psychology, University of Nottingham, YANG Fujia Building, B Floor, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK.
| | - Angela Gregory
- Chandos Clinic, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - David Nunns
- Division of Obstetrics & Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Roshan das Nair
- Clinical Psychology, University of Nottingham, Nottingham, UK. .,Dept. of Clinical Psychology & Neuropsychology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Kimmes JG, Mallory AB, Cameron C, Köse Ö. A treatment model for anxiety-related sexual dysfunctions using mindfulness meditation within a sex-positive framework. SEXUAL AND RELATIONSHIP THERAPY 2015. [DOI: 10.1080/14681994.2015.1013023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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