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Parenti M, Degliuomini RS, Cosmi E, Vitagliano A, Fasola E, Origoni M, Salvatore S, Buzzaccarini G. Botulinum toxin injection in vulva and vagina. Evidence from a literature systematic review. Eur J Obstet Gynecol Reprod Biol 2023; 291:178-189. [PMID: 38353087 DOI: 10.1016/j.ejogrb.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 08/20/2023] [Accepted: 10/18/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Botulinum toxin (BoNT) administration has been proposed in the gynecologic field for pelvic, vulvar and vaginal disorders. On this regard, we aimed assessing the therapeutic effectiveness and safety of BoNT usage in the treatment of vaginal, vulvar and pelvic pain disorders. METHODS We searched for all the original articles without date restriction until 31.12.2021. We included all the original articles which administered botulinum toxin in the vulva or vagina of women suffering from vaginismus, dyspareunia, and chronic pelvic pain. Only English language studies and those performed in humans were eligible. We excluded all case reports and pilot study from the qualitative analysis, although we accurately evaluated them. 22 original studies were finally included in the systematic review. RESULTS Botulinum toxin injection was found to be effective in improving vulvar and vaginal dyspareunia, vaginismus, and chronic pelvic pain. No irreversible side effects were detected. Major side effects reported were transient urinary or fecal incontinence, constipation and rectal pain. The risk of bias assessment proved original articles to be of medium quality. No metanalysis could have been performed since lack of congruency in the definition of pathology and methods of botulinum toxin administration. CONCLUSION Data extraction pointed out different endpoints and different methods of analysis. Studies focus on different types of participants and use various techniques and timing. According to the best evidence available, different techniques provide evidence about positive outcomes, with the need for a standardized protocol.
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Affiliation(s)
- Michele Parenti
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy
| | - Rebecca Susanna Degliuomini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy; Italian Association of Functional and Esthetic Gynecology (AIGEF), Milan, Italy
| | - Erich Cosmi
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy
| | - Amerigo Vitagliano
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy
| | - Elena Fasola
- Italian Association of Functional and Esthetic Gynecology (AIGEF), Milan, Italy
| | - Massimo Origoni
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy; Italian Association of Functional and Esthetic Gynecology (AIGEF), Milan, Italy
| | - Giovanni Buzzaccarini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
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Banaei M, Kariman N, Ghasemi V, Roozbeh N, Jahangirifar M. Component of sexual health services for vaginismus management: A qualitative study. PLoS One 2023; 18:e0283732. [PMID: 37556497 PMCID: PMC10411750 DOI: 10.1371/journal.pone.0283732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/15/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Provision of sexual health services requires gender-sensitive management, facilities, and staff, as well as planning for gender-sensitive caregivers and education. Couples suffering from vaginismus face many types of barriers to accessing sexual health services. This qualitative study was conducted to explain the needs of sexual health services in women with primary vaginismus in Iran. METHODS This qualitative study was conducted through the participation of 20 participants including service providers, women with vaginismus and their husbands in 2022, Iran. The samples were selected using purposive sampling method and considering the maximum variation. For data collection, in-depth semi-structured individual interviews were conducted and continued until data saturation was reached. The collected data were analyzed in MAXQDA10 software using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman. RESULTS Data analysis led to the emergence of three main themes: 1) Comprehensive preventive sex education which included the three categories of sex education in the education system, premarital sex education through the health system, and sex education through the media with scientific content; 2) Efficient sexual health clinics which included three categories of therapist's skills, empowerment of sexual therapist, and structural features of sexual health clinics and cultural considerations in establishing sexual health clinics; and 3) Protocol for management and treatment of sexual problems which consisted of sexual education and counseling content, treatment requirements, and sex education approaches. CONCLUSION Based on the results of the study, comprehensive preventive sex education through the education system and the Ministry of Health can improve the attitudes of adolescents and young people. Moreover, it can take a fundamental step in solving sexual problems by providing the infrastructure necessary for the establishment of efficient sexual health clinics and protocols required to manage and treat such problems.
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Affiliation(s)
- Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nourossadat Kariman
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vida Ghasemi
- Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Nasibeh Roozbeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Maryam Jahangirifar
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Çankaya S, Aslantaş BN. Determination of Dyadic Adjustment, Marriage and Sexual Satisfaction as Risk Factors for Women with Lifelong Vaginismus: A Case Control Study. Clin Nurs Res 2021; 31:848-857. [PMID: 34519553 DOI: 10.1177/10547738211046136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to assess dyadic adjustment, marriage, and sexual satisfaction as risk factors for women with lifelong vaginismus. This is a case-control study. A total of 142 women were included in the study: 71 women with a diagnosis of lifetime vaginismus constituted the study group and 71 women without a history of vaginismus/painful sexual activity constituted the control group. Data were collected using a questionnaire and the Revised Dyadic Adjustment Scale (RDAS), the Marriage Satisfaction Scale (MSS), and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Duration of marriage (OR = 1.344), frequency of sexual intercourse (OR = 0.059), marital satisfaction (OR = 1.450), sexual satisfaction (OR = 0.901), and consensus (OR = 1.749), which is a sub-dimension of RDAS, were found to be risk factors increasing likelihood of vaginismus by 83% (χ2 = 140.191, p < .001). In addition, those with low level of education, diagnosed with a psychological disorder (anxiety, depression, etc.), who found their spouse's body disgusting, who scored lower in MAS sub-dimensions, and who received lower total score in the RDAS and its satisfaction subdimension were more likely to have vaginismus (p < .05). Duration of marriage, sexual intercourse frequency, sexual satisfaction, marital satisfaction, and consensus are important risk factors for vaginismus. It may be incomplete to consider vaginismus only as a vaginal penetration problem. Women's demographic characteristics, dyadic adjustment, and marital and sexual satisfaction should be handled in a holistic manner.
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Affiliation(s)
- Seyhan Çankaya
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
| | - Beyza Nur Aslantaş
- Department of Midwifery, Health Sciences Faculty of Selcuk University, Konya, Turkey
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YORUK N, TAŞTAN K, IŞIK M. A Comparison of the Effectiveness of Hypnotherapy and Cognitive Behavioral Therapy in the Treatment of Primary Vaginismus. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.881318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gupta A, Kansal S, Gupta N. “Common Sense” Approach to the Management of Vaginismus: A Case Series. JOURNAL OF PSYCHOSEXUAL HEALTH 2020. [DOI: 10.1177/2631831820934989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Aarzoo Gupta
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Shweta Kansal
- Mental Health and Counselling Services, Timarpur, Delhi, India
| | - Nitin Gupta
- Gupta Mind Healing and Counseling Centre, Chandigarh, India
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Yaraghi M, Ghazizadeh S, Mohammadi F, Ashtiani EM, Bakhtiyari M, Mareshi SM, Sarfjoo FS, Eftekhar T. Comparing the effectiveness of functional electrical stimulation via sexual cognitive/behavioral therapy of pelvic floor muscles versus local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus: a randomized clinical trial. Int Urogynecol J 2018; 30:1821-1828. [PMID: 30506183 DOI: 10.1007/s00192-018-3836-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/19/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Most patients suffering from vaginismus feel sinful, anxious, and incompetent, with reduced self-confidence. This study was aimed at comparing the effectiveness of the physiotherapy of pelvic floor muscles as a standard treatment and local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus. METHODS In this randomized clinical trial (RCT), the study population included women with primary vaginismus referred to the Sexual Health and Gynecologic Clinics of Imam Khomeini Hospital during 2013-2014. They were diagnosed according to DSM-5 criteria and underwent treatments with botulinum injection (intervention group) and physiotherapy as the current treatment (control group). The participants' primary and secondary outcomes were measured based on successful intercourse and sexual functioning of each group. RESULTS The results indicated that the overall standard physiotherapy, along with other measurements, such as functional electrical stimulation and desensitization, could effectively improve the patients' Female Sexual Function Index compared with botulinum treatment. At the end of the study, it was found that 20 and 26 patients out of the 30 and 28 patients in the intervention and control groups managed to have successful intercourse respectively (P = 0.014). Also, sexual dysfunction frequencies were seen to be decreased by 26.6% and 50% in the mentioned groups respectively (p = 0.008 and p < 0.001). CONCLUSIONS Considering the higher efficacy of physiotherapy procedures compared with those of the desensitization and electrical stimulation techniques, this therapeutic method should be considered the first-line treatment of vaginismus (IRCT2016061828486N1).
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Affiliation(s)
- Mansooreh Yaraghi
- Department of Gynecology and Obstetrics, Imam Khomeini Hospital, Fellowship in Pelvic Floor Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Ghazizadeh
- Department of Gynecology and Obstetrics, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Mohammadi
- Department of Dermatology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmood Bakhtiyari
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Fatemeh Sadat Sarfjoo
- Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Eftekhar
- Department of Gynecology and Obstetrics, Imam Khomeini Hospital, Fellowship in Pelvic Floor Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Maseroli E, Scavello I, Cipriani S, Palma M, Fambrini M, Corona G, Mannucci E, Maggi M, Vignozzi L. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med 2018; 14:1392-1402. [PMID: 29110807 DOI: 10.1016/j.jsxm.2017.09.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Evidence concerning the determinants of vaginismus (V), in particular medical conditions, is inconclusive. AIM To investigate, in a cohort of subjects consulting for female sexual dysfunction, whether there is a difference in medical and psychosocial parameters between women with V and women with other sexual complaints. METHODS A series of 255 women attending our clinic for female sexual dysfunction was consecutively recruited. V was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Lifelong and acquired V cases were included. OUTCOMES Patients underwent a structured interview and physical, gynecologic, laboratory, and clitoral ultrasound examinations; they completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire, the Female Sexual Distress Scale-Revised (FSDS), and the Body Uneasiness Test. RESULTS V was diagnosed in 20 patients (7.8%). Women with V were significantly younger than the rest of the sample (P < .05). No differences were found for traditional risk factors such as a history of sexual abuse, relational parameters, or gynecologic diseases or for newly investigated parameters (ie, neurologic, hormonal, and metabolic alterations). Women with V showed significantly higher histrionic-hysterical symptoms and traits (as detected by MHQ-H score; P < .05) compared with subjects with other sexual complaints. When the scores of all MHQ subscales were simultaneously introduced in a logistic model, the association between V and MHQ-H score was confirmed (P = .013). Women with V also showed higher FSFI pain and FSDS total scores, even after adjusting for age (P < .05). In an age-adjusted model, FSDS total score increased as a function of the years of duration of V (P = .032) but not as a function of its severity. All observations were confirmed in a case-control study (ratio = 1:3). CLINICAL IMPLICATIONS Our data demonstrate that some novel contributors of V should be investigated, namely histrionic-hysterical traits. This psychological comorbidity could offer valuable insights for intervention and managing complications. STRENGTHS AND LIMITATIONS This is the first study to assess the role of many metabolic and hormonal parameters as potential determinants of V. The main limitation is its exploratory and cross-sectional nature; our data need to be confirmed in larger, more systematic analyses. CONCLUSION V was associated with histrionic-hysterical traits, FSFI pain domain, and sex-related distress. A history of abuse, relational parameters, gynecologic diseases, and hormonal and metabolic alterations do not seem to play a role in the development of V. Maseroli E, Scavello I, Cipriani S, et al. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med 2017;14:1392-1402.
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Affiliation(s)
- Elisa Maseroli
- Gynecological Endocrinology Research Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Irene Scavello
- Gynecological Endocrinology Research Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sarah Cipriani
- Gynecological Endocrinology Research Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Manuela Palma
- Gynecological Endocrinology Research Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Massimiliano Fambrini
- Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - Edoardo Mannucci
- Diabetes Section, Geriatric Unit, Department of Critical Care, University of Florence, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | - Linda Vignozzi
- Gynecological Endocrinology Research Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy.
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Internet-Based Guided Self-Help for Vaginal Penetration Difficulties: Results of a Randomized Controlled Pilot Trial. J Sex Med 2017; 14:238-254. [DOI: 10.1016/j.jsxm.2016.12.232] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/06/2016] [Accepted: 12/16/2016] [Indexed: 11/23/2022]
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Muammar T, McWalter P, Alkhenizan A, Shoukri M, Gabr A, Bin AA. Management of vaginal penetration phobia in Arab women: a retrospective study. Ann Saudi Med 2015; 35:120-6. [PMID: 26336017 PMCID: PMC6074138 DOI: 10.5144/0256-4947.2015.120] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vaginal penetration phobia is a common and distressing problem world.wide. It interferes with vaginal penetrative sexual relations, and leads to unconsummated marriage (UCM). This problem may be heightened in Arab women, due to cultural taboos about pain and bleeding, that may be associated with the first coital experience after marriage. Data about this problem is scarce in Arab societies. The aim of this study was to evaluate the response of these women and their husbands to an individualized, psychotherapeutic assessment and treatment to resolve this problem. DESIGN AND SETTINGS Retrospective descriptive in a general gynecology community setting over a 6-year period. METHODS The study involved a retrospective sequential cohort of 100 Arab couples with UCM due to the woman's VPP. They were evaluated by a female gynecologist in out patient clinics. Data was collected through chart review, and telephone interviews. Final analysis was performed on 100 Arab couples, who satisfied the inclusion criteria. They were followed up to assess their response to an individualized, structured treatment protocol. The treatment combined sex education with systematic desensitization, targeting fear and anxiety as.sociated with vaginal penetration. RESULTS A total of 96% of the studied group had a successful outcome after an average of 4 sessions. Penetrative intercourse was reported by the tolerance of these women; further pregnancy was achieved in 77.8 % of the infertile couples. CONCLUSION Insufficient knowledge of sexual intercourse is a major contributor to the development of VPP in the sampled population. It appears that they respond well to an individualized, structured treatment protocol as described by Hawten 1985 (regardless of other risk factors associated with vaginismus).
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Affiliation(s)
- Tarfah Muammar
- Dr. Tarfah Muammar, MBC 62 Department of Family Medicine and Polyclinic,, King Faisal Specialist Hospital and Research Centre,, PO Box 33544, Riyadh 11211, Saudi Arabia, T: 966 11 4647272, F: 966 11 4423005,
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Molaeinezhad M, Salehi M, Borg C, Yousefy A, Latifnejad Roudsari R, Salehi P, Shafiei K, Merghati Khoei E. Marriage consummated for 32 Iranian women using therapist-aided exposure therapy: a brief report. SEXUAL AND RELATIONSHIP THERAPY 2014. [DOI: 10.1080/14681994.2014.915304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vaginismus and its correlates in an Iranian clinical sample. Int J Impot Res 2014; 26:230-4. [DOI: 10.1038/ijir.2014.16] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 02/26/2014] [Accepted: 04/07/2014] [Indexed: 11/09/2022]
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Nabil Mhiri M, Smaoui W, Bouassida M, Chabchoub K, Masmoudi J, Hadjslimen M, Chaieb N, Rebai N, Masmoudi S, Bahloul A. Unconsummated marriage in the Arab Islamic world: Tunisian experience. SEXOLOGIES 2013. [DOI: 10.1016/j.sexol.2013.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nabil Mhiri M, Smaoui W, Bouassida M, Chabchoub K, Masmoudi J, Hadjslimen M, Chaieb N, Rebai N, Masmoudi S, Bahloul A. Le mariage non consommé dans le monde arabo-islamique : l’expérience tunisienne. SEXOLOGIES 2013. [DOI: 10.1016/j.sexol.2013.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Incidence of arousal and orgasmic disorders in women with female genital mutilation/cutting. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/01.xha.0000423419.15162.b0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Vaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. Various therapeutic strategies for vaginismus, such as sex therapy and desensitisation, have been proposed, and uncontrolled case series appear promising. OBJECTIVES To assess the effects of different interventions for vaginismus. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) to August 2012. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched reference lists and conference abstracts. We contacted experts in the field regarding unpublished material. SELECTION CRITERIA Controlled trials comparing treatments for vaginismus with another treatment, a placebo treatment, treatment as usual or waiting list control. DATA COLLECTION AND ANALYSIS The review authors extracted data which we verified with the trial investigator where possible. MAIN RESULTS Five studies were included, of which four with a total of 282 participants provided data. No meta-analysis was possible due to heterogeneity of comparisons within included studies as well as inadequate reporting of data. All studies were considered to be at either moderate or high risk of bias. The results of this systematic review indicate that there is no clinical or statistical difference between systematic desensitisation and any of the control interventions (either waiting list control, systematic desensitisation combined with group therapy or in vitro (with women under instruction by the therapist) desensitisation) for the treatment of vaginismus. The drop-out rates were higher in the waiting list groups. AUTHORS' CONCLUSIONS A clinically relevant effect of systematic desensitisation when compared with any of the control interventions cannot be ruled out. None of the included trials compared other behaviour therapies (e.g. cognitive behaviour therapy, sex therapy) to pharmacological interventions. The findings are limited by the evidence available and as such conclusions about the efficacy of interventions for the treatment of vaginismus should be drawn cautiously.
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Affiliation(s)
- Tamara Melnik
- Universidade Federal de São PauloBrazilian Cochrane CentreR. Pedro de Toledo, 598São PauloSão PauloBrazil
| | - Keith Hawton
- Warneford HospitalCentre for Suicide Research, University Department of PsychiatryOxfordUKOX3 7JX
| | - Hugh McGuire
- National Collaborating Centre for Women's and Children's Health4th Floor, King's Court2‐16 Goodge StreetLondonUKW1T 2QA
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Harish T, Prasad MK, Murthy P. Successful management of vaginismus: An eclectic approach. Indian J Psychiatry 2012; 54:391-2. [PMID: 23372252 PMCID: PMC3554981 DOI: 10.4103/0019-5545.104845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- T Harish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore - 560 029, Karnataka, India. E-mail:
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Ferreira JR, Souza RP. Botulinum toxin for vaginismus treatment. Pharmacology 2012; 89:256-9. [PMID: 22507920 DOI: 10.1159/000337383] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 02/08/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND/AIMS Vaginismus is characterized by recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when penile, finger, tampon, or speculum penetration is attempted. Recent results have suggested the use of botulinum toxin for the treatment of vaginismus. Here, we assessed previously published data to evaluate the therapeutic effectiveness of botulinum toxin for vaginismus. METHODS We have carried out a systematic review followed by a meta-analysis. RESULTS Our results indicate that botulinum toxin is an effective therapeutic option for patients with vaginismus (pooled odds ratio of 8.723 with 95% confidence interval limits of 1.942 and 39.162, p = 0.005). This may hold particularly true in treatment-refractory patients because most of the studies included in this meta-analysis have enrolled these subjects in their primary analysis. CONCLUSION Botulinum toxin appears to bea reasonable intervention for vaginismus. However, this conclusion should be read carefully because of the deficiency of placebo-controlled randomized clinical trials and the quality issues presented in the existing ones.
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Affiliation(s)
- Juliana Rocha Ferreira
- Graduate Program in Health Sciences, Health Sciences Unit, Universidade do Extremo Sul Catarinense, Criciuma, SC, Brazil
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18
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Reissing ED. Consultation and Treatment History and Causal Attributions in an Online Sample of Women with Lifelong and Acquired Vaginismus. J Sex Med 2012; 9:251-8. [DOI: 10.1111/j.1743-6109.2011.02534.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
INTRODUCTION Although vaginismus is a common sexual dysfunction in Saudi Arabia, there are limited data concerning the treatment modalities associated with patients with symptoms of vaginismus. AIM This study is aimed to evaluate the presentation and different modalities of management in patients with severe refractory vaginismus in western Saudi Arabia. MAIN OUTCOME MEASURES Successful penetrative sexual intercourse suggesting that common elements of the therapies used were successful. METHODS A retrospective study of patients presenting with severe refractory vaginismus treated in Jeddah, Saudi Arabia. The subjects were 15 women with third to fourth degree vaginismus who presented to King Abdulazziz University Hospital between January 1, 2008 and January 1, 2009. RESULTS The mean age of the participants was 23 years. The mean duration of marriage before seeking medical advice was 12 months. Six patients had undergone conventional therapy successfully. The other six cases, four of which had a previous history of treatment failure, and two who were unresponsive to 4 months of conventional therapy were offered botulinum toxin type A. Five patients who received the Botox therapy had satisfactory intercourse on the same day of the treatment. One patient required a repeat injection after 2 months for recurrent vaginismus. Three of the 15 patients refused the treatment as they were already divorced and had only come in to exclude organic causes for their condition. CONCLUSIONS Vaginismus is an overlooked topic in conservative societies such as Saudi Arabia. For most patients, not knowing who to confide in or where to turn to plays a major role in the under diagnosis of vaginismus. Conventional therapy proved effective in mild and moderate cases, while botulinum toxin has a more rapid effect and was thus more effective in severe cases.
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Affiliation(s)
- Wafa M K Fageeh
- King Abdulaziz University, Obstetrics and Gynecology Department, Jeddah, Saudi Arabia.
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Abstract
Vaginismus is defined as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina, which interferes with coitus and causes distress and interpersonal difficulty. In this report, we describe the successful treatment of vaginismus in a 25-year-old lady based on a model proposed by Keith Hawton. The eclectic approach involved education, graded insertion of fingers, Kegel's exercises and usage of local anesthesia with vaginal containment along with the prescription of Escitalopram.
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Affiliation(s)
- Thippeswamy Harish
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, India
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21
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Lahaie MA, Boyer SC, Amsel R, Khalifé S, Binik YM. Vaginismus: A Review of the Literature on the Classification/Diagnosis, Etiology and Treatment. WOMENS HEALTH 2010; 6:705-19. [DOI: 10.2217/whe.10.46] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Vaginismus is currently defined as an involuntary vaginal muscle spasm interfering with sexual intercourse that is relatively easy to diagnose and treat. As a result, there has been a lack of research interest with very few well-controlled diagnostic, etiological or treatment outcome studies. Interestingly, the few empirical studies that have been conducted on vaginismus do not support the view that it is easily diagnosed or treated and have shed little light on potential etiology. A review of the literature on the classification/diagnosis, etiology and treatment of vaginismus will be presented with a focus on the latest empirical findings. This article suggests that vaginismus cannot be easily differentiated from dyspareunia and should be treated from a multidisciplinary point of view.
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Affiliation(s)
- Marie-Andrée Lahaie
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montréal, Québec, H3A 1B1, Canada
| | - Stéphanie C Boyer
- Department of Psychology, Queen's University, Kingston, K7L 3N6, Ontario, Canada
| | - Rhonda Amsel
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montréal, Québec, H3A 1B1, Canada
| | - Samir Khalifé
- Faculty of Medicine, McGill University, Montréal, Québec, H3A 1B1, Canada
| | - Yitzchak M Binik
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montréal, Québec, H3A 1B1, Canada
- Department of Psychology, Royal Victoria Hospital, Montréal, Québec, Canada
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22
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Hope ME, Farmer L, McAllister KF, Cumming GP. Vaginismus in peri- and postmenopausal women: a pragmatic approach for general practitioners and gynaecologists. ACTA ACUST UNITED AC 2010; 16:68-73. [DOI: 10.1258/mi.2010.010016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vaginismus is generally described as an involuntary contraction of the vaginal musculature, which usually results in the failure of penetration. Despite a lack of consensus as to the exact definition, prevalence rates vary between 4.2% and 42%. It is commonly diagnosed at both gynaecological and psychosexual clinics. The majority of studies and treatment options concentrate on the premenopausal age group. It is accepted that even within this age group, the diagnosis is often incorrect as symptoms can be confused with dyspareunia and other sexual pain disorders. There is no literature discussing vaginismus in the postmenopausal patient, despite evidence that an active sex life is important to the majority of women, irrespective of age. It is known that the majority of women do not report difficulties in their sex life and it may be that the older patient is more embarrassed at disclosing any such difficulties. This review aims to highlight the possible causes of vaginismus in this older age group and to aid the clinician in asking the appropriate questions, performing the appropriate examination and suggesting possible treatment options.
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Affiliation(s)
| | | | | | - Grant P Cumming
- Department of Obstetrics and Gynaecology, Dr Grays Hospital, Elgin, UK
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23
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Abstract
Vaginal spasm has been considered the defining diagnostic characteristic of vaginismus for approximately 150 years. This remarkable consensus, based primarily on expert clinical opinion, is preserved in the DSM-IV-TR. The available empirical research, however, does not support this definition nor does it support the validity of the DSM-IV-TR distinction between vaginismus and dyspareunia. The small body of research concerning other possible ways or methods of diagnosing vaginismus is critically reviewed. Based on this review, it is proposed that the diagnoses of vaginismus and dyspareunia be collapsed into a single diagnostic entity called "genito-pelvic pain/penetration disorder." This diagnostic category is defined according to the following five dimensions: percentage success of vaginal penetration; pain with vaginal penetration; fear of vaginal penetration or of genito-pelvic pain during vaginal penetration; pelvic floor muscle dysfunction; medical co-morbidity.
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Affiliation(s)
- Yitzchak M Binik
- Department of Psychology, McGill University, 1205 Dr. Penfield Ave., Montreal, QC H3A 1B1, Canada.
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Goldsmith T, Levy A, Sheiner E, Goldsmith T, Levy A, Sheiner E. Vaginismus as an independent risk factor for cesarean delivery. J Matern Fetal Neonatal Med 2009; 22:863-6. [DOI: 10.1080/14767050902994598] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Graziottin A. Dyspareunia and vaginismus: Review of the literature and treatment. CURRENT SEXUAL HEALTH REPORTS 2008. [DOI: 10.1007/s11930-008-0008-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
BACKGROUND AND PURPOSE Musculoskeletal dysfunction is a known cause of dyspareunia and a reason for referral for physical therapist management. The purpose of this case report is to describe the physical therapist management of a patient with dyspareunia and overactivity of the pelvic-floor muscles with a limited number of visits and a focus on self-management strategies. CASE DESCRIPTION This case involved a 30-year-old married woman with levator ani muscle overactivity and dyspareunia that was 1 year in duration. INTERVENTION The therapist explained the anatomy and function of the pelvic-floor muscles during intercourse, instructed the patient on how to control the levator ani muscles, and instructed her on vaginal self-dilation techniques. OUTCOMES The patient attended 3 physical therapy sessions over a period of 9 weeks. She performed vaginal self-dilation at home. She rated pain during intercourse as 0/10 on a verbal rating scale and had no remaining tenderness in the levator ani muscles at discharge. DISCUSSION Some women with dyspareunia may improve with an intervention that emphasizes education and vaginal self-dilation techniques. Future research should compare home-based and clinic-based treatments.
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Affiliation(s)
- Kimberly A Fisher
- Pelvic Floor Rehabilitation Unit, OU Pelvic and Bladder Health Clinic, 825 NE 10th, Ste 3400, Oklahoma City, OK 73104, USA.
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27
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Tulla ME, Dunn ME, Antilus R, Muneyyirci-Delale O. Vaginismus and failed in vitro fertilization. SEXUAL AND RELATIONSHIP THERAPY 2006. [DOI: 10.1080/14681990600855059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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