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Engman L, Ter Kuile MM, Linton SJ, Ekholm E, Tuijnman-Raasveld CC, Flink IK. An initial proof of concept: A replicated single-case study of a CBT group treatment with partner involvement for vulvodynia. Cogn Behav Ther 2022; 51:503-519. [PMID: 35960277 DOI: 10.1080/16506073.2022.2086907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Vulvodynia is common and has an immense impact on affected women and their partners. Psychological factors have been found to contribute to pain maintenance and exacerbation, and treatments addressing psychological factors have yielded positive results. This study employed a replicated single-case experimental design to examine a cognitive behavioral therapy (CBT) group treatment with partner involvement in vulvodynia. Repeated measures of pain intensity related to pain-inflicting behaviors were collected weekly throughout baseline and treatment phases. Associated outcomes were measured pre-, post- and at two follow-up assessments. Participants were 18-45-year-old women, in a stable sexual relationship with a man, experiencing vulvodynia. Five women completed the treatment consisting of 10 group sessions and 3 couple sessions. Data were analyzed through visual inspection and supplementary nonparametric calculations. The study showed promising results of the CBT treatment in alleviating pain intensity in connection to specific pain-inflicting behavior since three out of five participants showed improvements. For the participants who improved, sexual function, pain catastrophizing, avoidance, and endurance behavior changed during treatment and were maintained at follow-ups. These results warrant further study of the CBT treatment, in larger, and controlled formats.
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Affiliation(s)
- Linnéa Engman
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Moniek M Ter Kuile
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Steven J Linton
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Elin Ekholm
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | | | - Ida K Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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Suvaal I, Hummel SB, Mens JWM, van Doorn HC, van den Hout WB, Creutzberg CL, Ter Kuile MM. A sexual rehabilitation intervention for women with gynaecological cancer receiving radiotherapy (SPARC study): design of a multicentre randomized controlled trial. BMC Cancer 2021; 21:1295. [PMID: 34863145 PMCID: PMC8642903 DOI: 10.1186/s12885-021-08991-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sexual problems are frequently reported after treatment with radiotherapy (RT) for gynaecological cancer (GC), in particular after combined external beam radiotherapy and brachytherapy (EBRT+BT). Studies demonstrate that psychosexual support should include cognitive behavioural interventions and involvement of the patient's partner, if available. Therefore, we developed a nurse-led sexual rehabilitation intervention, including these key components. The intervention was previously pilot-tested and results demonstrated that this intervention improves women's sexual functioning and increases dilator compliance. The objective of the current study is to investigate the (cost-)effectiveness of the intervention compared to optimal care as usual (CAU). We expect that women who receive the intervention will report a statistically significant greater improvement in sexual functioning and - for women who receive EBRT+BT - higher compliance with dilator use, from baseline to 12 months post-RT than women who receive optimal care as usual (CAU). METHODS/DESIGN The intervention is evaluated in the SPARC (Sexual rehabilitation Programme After Radiotherapy for gynaecological Cancer) study, a multicentre, randomized controlled trial (RCT). The primary endpoint is sexual functioning. Secondary outcomes include body image, fear of sexual activity, sexual-, treatment-related- and psychological distress, health-related quality of life and relationship satisfaction. A cost-effectiveness analysis (CEA) will be conducted in which the costs of the intervention will be related to shifts in other health care costs and the impact on patient outcome. The study sample will consist of 220 women with GC treated with RT in specialized GC treatment centres (N = 10). Participants are randomized to either the intervention- or CAU control group (1:1), and within each centre stratified by type of radiotherapy (EBRT+BT vs. EBRT only) and having a partner (yes/no). All women complete questionnaires at baseline (T1) and at 1, 3, 6, and 12 months post-RT (T2, T3, T4 and T5, respectively). DISCUSSION There is a need to improve sexual functioning after RT for GC. This RCT will provide evidence about the (cost-)effectiveness of a nurse-led sexual rehabilitation intervention. If proven effective, the intervention will be a much needed addition to care offered to GC survivors and will result in improved quality of life. TRIAL REGISTRATION ClinicalTrials.gov, NCT03611517 . Registered 2 August 2018.
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Affiliation(s)
- Isabelle Suvaal
- Department of Gynaecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Susanna B Hummel
- Department of Gynaecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Jan-Willem M Mens
- Department of Radiotherapy, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Helena C van Doorn
- Department of Gynaecology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Moniek M Ter Kuile
- Department of Gynaecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC, Leiden, the Netherlands
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Melles R, Dewitte MD, Ter Kuile MM, Bonnemayer C, Peters MML. The Vaginal Pressure Inducer: A New Device to Test the (Un)pleasurableness and Tolerance of Vaginal Pressure and the Influence of Sexual Stimuli. J Sex Marital Ther 2018; 44:189-200. [PMID: 28686528 DOI: 10.1080/0092623x.2017.1342728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To better understand the impact of sexual stimuli on genital pain, a new instrument was developed: the Vaginal Pressure Inducer (VPI). We administered gradually increasing vaginal pressure with the VPI to sexually functional women as they watched a neutral, erotic, or explicit sex film. Women had higher unpleasantness thresholds in a sexual context compared to a nonsexual context. Moreover, ratings of pleasurableness were higher in the sexual compared to neutral context and most so during the explicit sexual film. These results provide initial support for the suitability of the VPI to study determinants of pleasant and unpleasant appraisal of vaginal pressure.
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Affiliation(s)
- Reinhilde Melles
- a Department of Psychiatry and Psychology , Maastricht University Medical Center , Maastricht , The Netherlands
| | - Marieke D Dewitte
- b Faculty of Psychology and Neuroscience , Maastricht University , Maastricht , The Netherlands
| | - Moniek M Ter Kuile
- c Department of Psychosomatic Gynaecology and Sexology , Leiden University Medical Center , Leiden , The Netherlands
| | - Charlie Bonnemayer
- b Faculty of Psychology and Neuroscience , Maastricht University , Maastricht , The Netherlands
| | - Madelon M L Peters
- b Faculty of Psychology and Neuroscience , Maastricht University , Maastricht , The Netherlands
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Flink IK, Engman L, Ter Kuile MM, Thomtén J, Linton SJ. Coping with pain in intimate situations: Applying the avoidance-endurance model to women with vulvovaginal pain. Scand J Pain 2017; 17:302-308. [PMID: 28927649 DOI: 10.1016/j.sjpain.2017.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Chronic vulvovaginal pain is strikingly common and has a serious impact on women's lives. Nevertheless, there are few longitudinal studies focusing on mechanisms involved in the pain development. One area of interest is how women cope with sexual activities and how this affects their pain. In this study, avoidance and endurance coping behaviors were explored as possible mediators of the relation between catastrophizing and pain, cross-sectionally and longitudinally. METHODS 251 women (18-35 years old) with vulvovaginal pain were recruited in university settings and filled out questionnaires about their pain, catastrophizing and coping behaviors at two occasions, with five months in between. Multiple mediation models were tested, exploring avoidance and endurance as mediators of the relation between catastrophizing and pain. RESULTS The results showed that avoidance was an influential mediator of the link between catastrophizing and pain. Using multiple mediation models we found that although the indirect effects of both avoidance and endurance were significant cross-sectionally, only avoidance was a significant mediator in the combined model exploring associations over time. CONCLUSIONS This study indicates that the strategies women with vulvovaginal pain use for coping with sexual activities are important for the course of pain. Avoidance and, to a lesser degree, endurance strategies were identified as important mediators of the effects of catastrophizing on pain. When exploring the links over time, only avoidance emerged as a significant mediator. IMPLICATIONS In this longitudinal study, catastrophizing was linked to vulvovaginal pain, via avoidance and endurance of sexual activities. Hence, targeting catastrophizing early on in treatment, as well as addressing coping, may be important in clinical interventions.
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Affiliation(s)
- Ida Katrina Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden.
| | - Linnéa Engman
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
| | - Moniek M Ter Kuile
- Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna Thomtén
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Steven J Linton
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
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Roumen FJME, Zimmerman Y, van Wijck A, Ter Kuile MM, Onghena P, Coelingh Bennink HJT. Mood disturbances during combined oral contraceptive use and the effect of androgen supplementation. Results of a double-blind, placebo-controlled, single-case alternation design pilot study. EUR J CONTRACEP REPR 2017; 22:147-151. [PMID: 28256915 DOI: 10.1080/13625187.2017.1286313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the effect of androgen supplementation in healthy combined oral contraceptive (COC) users who experience mood disturbances during COC-use only. METHODS Six women with mood disturbances during COC-use only, received COC with co-treatment of 50 mg dehydroepiandrosterone (DHEA) during three cycles and placebo during another three cycles in an individualized random order. Daily mood rating was measured by a single item: 'In what kind of mood have you been in the past 24 h?' The results were analysed using a randomisation test for single-case experimental designs. RESULTS The p values for the alternation design randomisation tests on the raw data of the six healthy individuals varied between 0.21 and 1, indicating that the average daily mood ratings of the active treatment DHEA are not statistically significantly larger than the average daily mood ratings of placebo. The combined p value of the subjects using a DRSP-containing pill was 0.97, and of the subjects using an LNG-containing pill was 0.65, indicating no statistically significant treatment effect for any of the pill types. CONCLUSIONS In this single-case alternation design study, concomitant treatment with DHEA for intermittent periods of 4 weeks did not result in improvement of mood disturbances related to COC-use, but had also no side-effects.
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Abstract
This paper reports on the feasibility and preliminary effects of a decision aid (DA) about female fertility preservation (FP). We conducted a pilot multicentre randomized controlled trial of women with breast cancer aged 18-40 who were randomized to brochures or the DA. Over 18 months, 62 women were eligible, of which 42 were invited by their healthcare provider (74%) to participate in the study. A total of 36 women signed up for participation and 26 (72%) were randomized to brochures (n = 13) or the DA (n = 13). In both groups, many women (87%) read the brochures and eight women used all available brochures. In the intervention group, 7/13 women logged in to the DA. Women who received brochures had slightly less decisional conflict, whereas knowledge improved in both groups. Our results indicate that both brochures about FP and a detailed DA have beneficial effects with regard to knowledge, but the DA seemed to introduce slightly more decisional conflict (DC) than the brochures. Although we encountered challenges with recruitment, our design and measurements seem feasible and the effects of the information materials seem promising, hence justifying conducting a larger study.
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Affiliation(s)
- Mirjam M Garvelink
- a Department of Gynaecology , Leiden University Medical Centre , Leiden , The Netherlands
| | - Moniek M Ter Kuile
- a Department of Gynaecology , Leiden University Medical Centre , Leiden , The Netherlands
| | - Leoni A Louwé
- a Department of Gynaecology , Leiden University Medical Centre , Leiden , The Netherlands
| | - Carina G J M Hilders
- b Department of Gynaecology , Reinier de Graaf Hospital , Delft , The Netherlands
| | - Anne M Stiggelbout
- c Department of Medical Decision Making , Leiden University Medical Centre , Leiden , The Netherlands
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Kremer MEB, Derikx JPM, Peeters A, Ter Kuile MM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. Sexual function after treatment for sacrococcygeal teratoma during childhood. J Pediatr Surg 2016; 51:534-40. [PMID: 26460155 DOI: 10.1016/j.jpedsurg.2015.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/29/2015] [Accepted: 09/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Children treated for sacrococcygeal teratoma (SCT) may suffer from sexual dysfunction later in life because of the extended pelvic surgery performed, however, structured evaluations have not been performed yet. METHODS The Female Sexual Function Index (FSFI), the International Index of Erectile Function (IIEF) and the Body Image Questionnaire (BIQ) were sent to patients (≥18years) treated for SCT in the Dutch pediatric surgical centers after 1970. RESULTS Forty-five of 76 patients returned the questionnaires; 28 women (median age 27.3years, range 18.3-41.0) and seven men (median age 22.0years, range 19.1-36.5) were eligible for analysis. The FSFI and IIEF results were compared to healthy controls. Female patients scored significantly lower on the desire (p=0.014), arousal (p=0.013) and lubrication domain (p=0.019). FSFI total-scores of female patients were significantly lower compared to controls [median 30.5 (IQR 28.6-31.4) vs. median 32.4 (IQR 30.6-33.45) p≤0.001] but were above the threshold value for sexual dysfunction. Males reported normal erectile function and penetration ability with normal ejaculation. Females had significant lower BIQ results compared to males; BIQ-cosmesis scores were moderately correlated to the FSFI-desire score (r=-0.37, p=0.028). CONCLUSION SCT resection in girls may result in diminished sexual function at adult age with worse self-perceived body image. The possibility of sexual complaints should be integrated in the surveillance strategies for these patients.
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Affiliation(s)
- Marijke E B Kremer
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joep P M Derikx
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Moniek M Ter Kuile
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, the Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam (Emma Children's Hospital AMC and VU Medical Center), Amsterdam, the Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric, Radboud University Medical Center, Nijmegen, the Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L W Ernest van Heurn
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
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Vermeer WM, Bakker RM, Kenter GG, Stiggelbout AM, Ter Kuile MM. Cervical cancer survivors' and partners' experiences with sexual dysfunction and psychosexual support. Support Care Cancer 2015; 24:1679-87. [PMID: 26412245 PMCID: PMC4766206 DOI: 10.1007/s00520-015-2925-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/23/2015] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of the study was to assess experiences with sexual dysfunctions, psychosexual support, and psychosexual healthcare needs among cervical cancer survivors (CCSs) and their partners. METHODS Semi-structured interviews were conducted with CCSs (n = 30) and their partners (n = 12). RESULTS Many participants experienced one or more sexual dysfunctions often causing feelings of distress. Most participants reported having been asked about their sexual functioning, although attention for sexual functioning was often limited and medically oriented. Considering sexuality a taboo topic hampered some participants to seek help. Many participants desired information about treatment consequences for sexual functioning, practical advice on dealing with dysfunctions, and reassurance that it is common to experience sexual dysfunction. A website was generally considered a useful and accessible first resource for information about sexual functioning after cancer. CONCLUSIONS Sexual dysfunctions are often distressing. Many patients and partners experience psychosexual healthcare needs, but the provided information and care is generally limited. Psychosexual support should go beyond physical sexual functioning and should take aspects such as sexual distress, relationship satisfaction, and the partner perspective into account. Additionally, offering more practical and reassuring information about sexuality after cervical cancer would be valuable for both CCSs and their partners.
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Affiliation(s)
- Willemijn M Vermeer
- Departments of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands.
| | - Rinske M Bakker
- Departments of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Gemma G Kenter
- Centre for Gynecological Cancer Amsterdam, Amsterdam, The Netherlands
| | - Anne M Stiggelbout
- Departments of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Moniek M Ter Kuile
- Departments of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
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Ter Kuile MM, Melles RJ, Tuijnman‐Raasveld CC, de Groot HE, van Lankveld JJ. Therapist‐Aided Exposure for Women with Lifelong Vaginismus: Mediators of Treatment Outcome: A Randomized Waiting List Control Trial. J Sex Med 2015; 12:1807-19. [DOI: 10.1111/jsm.12935] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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10
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Bel LGJ, Vollebregt AM, Van der Meulen-de Jong AE, Fidder HH, Ten Hove WR, Vliet-Vlieland CW, Ter Kuile MM, de Groot HE, Both S. Sexual Dysfunctions in Men and Women with Inflammatory Bowel Disease: The Influence of IBD-Related Clinical Factors and Depression on Sexual Function. J Sex Med 2015; 12:1557-67. [PMID: 26054013 DOI: 10.1111/jsm.12913] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is likely to have an impact on sexual function because of its symptoms, like diarrhea, fatigue, and abdominal pain. Depression is commonly reported in IBD and is also related to impaired sexual function. This study aimed to evaluate sexual function and its association with depression among patients with IBD compared with controls. METHODS IBD patients registered at two hospitals participated. The control group consisted of a general practitioner practice population. The web-based questionnaire included the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function (IIEF) for men. Other variables evaluated were depression, disease activity, IBD-related quality of life, body image, and fatigue. RESULTS In total, 168 female and 119 male patients were available for analysis (response rate 24%). Overall, patients with IBD did not significantly differ in prevalence of sexual dysfunctions from controls: female patients 52%, female controls 44%, male patients and male controls both 25%. However, men and women with an active disease scored significantly lower than patients in remission and controls, indicating impaired sexual functioning during disease activity. Significant associations were found between active disease, fatigue, depressive mood, quality of life, and sexual function for both male and female patients. The association between disease activity and sexual function was totally mediated by depression. CONCLUSION Male and female IBD patients with an active disease show impaired sexual function relative to patients in remission and controls. Depression is the most important determinant for impaired sexual function in IBD.
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Affiliation(s)
- Linda G J Bel
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anna M Vollebregt
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andrea E Van der Meulen-de Jong
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Herma H Fidder
- Department of Gastroenterology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Willem R Ten Hove
- Department of Gastroenterology, Diaconessenhuis Leiden, Leiden, The Netherlands
| | | | - Moniek M Ter Kuile
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Helena E de Groot
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Stephanie Both
- Outpatient Clinic for Psychosomatic Gynaecology and Sexology, Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands
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Bakker RM, Vermeer WM, Creutzberg CL, Mens JWM, Nout RA, Ter Kuile MM. Qualitative accounts of patients' determinants of vaginal dilator use after pelvic radiotherapy. J Sex Med 2014; 12:764-73. [PMID: 25424559 DOI: 10.1111/jsm.12776] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Treatment with pelvic external beam radiotherapy with brachytherapy (EBRT/BT) for gynecological cancers may cause sexual dysfunction because of vaginal shortening and tightening. Regular vaginal dilator use is thought to reduce vaginal shortening and/or tightening, but compliance is poor. AIMS This study identified determinants of patients' adherence with dilator use after EBRT/BT. METHODS Semi-structured interviews were conducted with 30 women, aged 32-67 years, treated with EBRT/BT for gynecological cancers at two university medical centers in the past 36 months. Transcriptions were coded and analyzed with N-Vivo software. MAIN OUTCOME MEASURES Determinants of dilator use were clustered based on the Health Action Process Approach, which describes (i) motivation processes that lead to a behavioral intention and (ii) volition processes that lead to the initiation or maintenance of actual behavior. RESULTS Almost all women attempted to perform long-term regular vaginal dilator use. Intended dilator use was determined by the expectation that it would prevent the development of vaginal adhesions and stenosis. Planning dilator use and making it part of a routine, using it under the shower, using lubricants, a smaller dilator size, or vibrators helped women. Others reported a lack of time or privacy, forgetting, or feeling tired. Women self-regulated dilator use by rotating the dilator and timing dilator use. Influencing factors were negative emotions regarding dilator use or its hard plastic design, (being anxious for) pain or blood loss, and an association with EBRT/BT. Some women mentioned a lack of instrumental support, for example, lubricants. Others received reassurance through informational support or were supported socially. CONCLUSION Motivation and volition processes that determined dilator use were identified and used in the development of a sexual rehabilitation intervention. It is important to provide sufficient patient information and support, and enlarge patients' perceived self-efficacy.
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Affiliation(s)
- Rinske M Bakker
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
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12
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Reissing ED, Borg C, Spoelstra SK, Ter Kuile MM, Both S, de Jong PJ, van Lankveld JJDM, Melles RJ, Weijenborg PTM, Weijmar Schultz WCM. "Throwing the baby out with the bathwater": the demise of vaginismus in favor of genito-pelvic pain/penetration disorder. Arch Sex Behav 2014; 43:1209-1213. [PMID: 25024064 DOI: 10.1007/s10508-014-0322-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Elke D Reissing
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1C 6N5, Canada,
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Garvelink MM, Ter Kuile MM, Louwé LA, Hilders CGJM, Stiggelbout AM. A Delphi consensus study among patients and clinicians in the Netherlands on the procedure of informing young breast cancer patients about Fertility Preservation. Acta Oncol 2012; 51:1062-9. [PMID: 23050612 DOI: 10.3109/0284186x.2012.702927] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to obtain feedback from, and reach consensus among different experts who are or have been involved in information provision about FP, regarding the (procedure of) information provision about Fertility Preservation (FP) and use of a web-based decision aid (DA) about FP to create optimal conditions for the implementation of the DA-website, as we prepare to implement a DA about FP in the Netherlands. MATERIAL AND METHODS A two round Delphi study in which experts (patients and clinicians) rated their (dis)agreement with a list of statements (Rounds 1, 2), and additional online forum to discuss dissensus (Round 3). We assessed opinions about FP, web-based DAs, and about the procedure of informing patients. Answer categories ranged from 1 (totally disagree) to 5 (totally agree). Consensus was considered significant when at least 80% of the experts scored either the lowest or the highest two categories. RESULTS Experts reached rapid consensus on all five statements about the use of a DA (5/5; 100%), and all eight statements about which patients should be offered information about FP (8/8; 100%). However opinions about FP (4/11 statements; 36%), and procedural aspects such as who should inform the patient (6/10 statements; 60%) and when (3/10 statements; 30%) remained for discussion in round 3. In the online discussion some level of agreement was reached for these statements after all. CONCLUSION It was deemed important that FP options exist. Every eligible patient should receive at least some (general) information about FP, soon after diagnosis. Detailed information should be provided by a fertility expert at a later moment. Exact timing and amount of information should be adjusted to patient's needs and situational context. A DA-website can offer a fair contribution to this.
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Affiliation(s)
- Mirjam M Garvelink
- Department of Gynecology, Leiden University Medical Center (LUMC), the Netherlands.
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Ter Kuile MM, Both S, Van Uden J. The Effects of Experimentally-Induced Sad and Happy Mood on Sexual Arousal in Sexually Healthy Women. J Sex Med 2010; 7:1177-84. [DOI: 10.1111/j.1743-6109.2009.01632.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
From population-based surveys, chronic pelvic pain (CPP) in women is a common condition with a spectrum of associated disability and distress. Those seen by gynaecologists in a referral setting often have substantial impairment of function and mood disturbance. Because in most cases, the aetiology of CPP cannot be explained and the range of effective interventions remains limited, treatment of CPP might easily result in a sense of frustration not only for the patient but also for the gynaecologist. To avoid this situation in clinical practice, a structured assessment of women suffering from CPP using a cognitive behavioural model, is suggested. This type of assessment provides information about the impact of CPP on a particular patient's daily life. It also facilitates referral for pain management. Future studies are needed to show further evidence of benefit of this approach for women with CPP.
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Klaassen M, Ter Kuile MM. Development and Initial Validation of the Vaginal Penetration Cognition Questionnaire (VPCQ) in a Sample of Women with Vaginismus and Dyspareunia. J Sex Med 2009; 6:1617-1627. [DOI: 10.1111/j.1743-6109.2009.01217.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ter Kuile MM, Vigeveno D, Laan E. Preliminary evidence that acute and chronic daily psychological stress affect sexual arousal in sexually functional women. Behav Res Ther 2007; 45:2078-89. [PMID: 17481578 DOI: 10.1016/j.brat.2007.03.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 03/05/2007] [Accepted: 03/13/2007] [Indexed: 10/23/2022]
Abstract
It is assumed that psychological stress may inhibit sexual arousal in women. Research on the effect of (acute and chronic) psychological stressors on genital and subjective sexual arousal, however, is scarce. To investigate whether psychological stressors indeed inhibit sexual responding, sexually functional women were randomly assigned to an experimental condition (n=30) in which acute psychological stress was induced by a frustrating computer task or a control condition (n=29). After the acute psychological stress or control induction women were exposed to an erotic stimulus. Genital sexual arousal was assessed using vaginal photoplethysmography. Self-report ratings of subjective sexual arousal were collected after the erotic stimulus. Furthermore, women were post hoc divided into a 'low' and a 'high' chronic stress group, based on their pre-assessment scores on a chronic daily stress questionnaire. As predicted, it was found that women in the acute stress condition responded with lower levels of genital and subjective sexual arousal to an erotic stimulus than women in the control condition. In addition, women with high levels of chronic stress responded with lower levels of genital sexual arousal to an erotic stimulus than women with low levels of chronic stress. Chronic stress did not affect the level of subjective sexual arousal.
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Affiliation(s)
- Moniek M Ter Kuile
- Department of Psychosomatic Gynaecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands.
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18
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Weijenborg PTM, Greeven A, Dekker FW, Peters AAW, Ter Kuile MM. Clinical course of chronic pelvic pain in women. Pain 2007; 132 Suppl 1:S117-S123. [PMID: 17689866 DOI: 10.1016/j.pain.2007.06.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 05/06/2007] [Accepted: 06/15/2007] [Indexed: 12/01/2022]
Abstract
A follow-up study on a cohort of women with chronic pelvic pain (CPP) was conducted, to evaluate the clinical course and to identify factors associated with outcome. Participants were over 18 years of age and had initially visited a multidisciplinary CPP-team of a Gynaecological Department of a University Hospital. The course of chronic pelvic pain was evaluated using the Life Chart Interview (LCI) method. All participants completed questionnaires covering demographic and clinical characteristics, pain (McGill) and psychological distress (SCL-90) at baseline and follow up. The response rate was 60%. A survival analysis was conducted. After a mean follow-up period of 3.4 years, 18 women (25%) of the study sample (N=72) reported recovery from pelvic pain (i.e. pelvic pain for less than 3 months per year). Eight of these 18 women (11% of the total sample) reported no pain at all at follow up. Relapse of symptoms was not encountered. Not any demographic, clinical or pain related variable measured at baseline, nor any intervention between baseline and follow up, was associated with outcome. Our results indicate that chronic pelvic pain in women in secondary care is a longstanding condition. Further research is recommended to identify risk factors for persistence of symptoms.
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Affiliation(s)
- Philomeen T M Weijenborg
- Department of Gynaecology, Leiden University Medical Centre (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands Department of Clinical and Health Psychology, Leiden University, The Netherlands Department of Clinical Epidemiology, Leiden University Medical Centre, The Netherlands
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Ter Kuile MM, Van Lankveld JJDM, Vlieland CV, Willekes C, Weijenborg PTM. Vulvar vestibulitis syndrome: an important factor in the evaluation of lifelong vaginismus? J Psychosom Obstet Gynaecol 2005; 26:245-9. [PMID: 16457419 DOI: 10.1080/01674820500165935] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The aim of the study was to investigate the prevalence of vulvar vestibulitis syndrome (VVS) in a sample of women suffering from lifelong vaginismus (N=91). Lifelong vaginismus is defined as "having a history of never having been able to experience penile entry of the vagina". The results with respect to VVS are compared with the results of women who are suffering from pain during intercourse (superficial dyspareunia) (N=84). Both patients groups were recruited from two treatment outcome studies. Using a standard physical examination, erythema was found in 77%, pain "on touch" in 69% and erythema and pain on the same location was seen in 56% of the patients with lifelong vaginismus. Furthermore, it was found that erythema (94%), pain (98%) and erythema and pain on the same location (92%) were more frequently found in patients with dyspareunia compared to women with lifelong vaginismus. It is concluded that pain is an integral part of the experiences in the majority of women with lifelong vaginismus.
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Affiliation(s)
- Moniek M Ter Kuile
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands.
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Van Lankveld JJ, Ter Kuile MM. The Golombok Rust Inventory of Sexual Satisfaction (GRISS): predictive validity and construct validity in a Dutch population. Personality and Individual Differences 1999. [DOI: 10.1016/s0191-8869(98)00200-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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van Lankveld JJDM, Weijenborg PTM, Ter Kuile MM. Psychologic Profiles of and Sexual Function in Women With Vulvar Vestibulitis and Their Partners. Obstet Gynecol Surv 1997. [DOI: 10.1097/00006254-199702000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The purpose of the present study was to investigate the active cognitive ingredients of change in psychological treatments for long-term chronic headache complaints. The primary questions this study addressed were: (1) Is a cognitive self-hypnosis training which explicitly attempts to change appraisal and cognitive coping processes more effective in producing these changes than a relaxation procedure, and (2) are changes in pain appraisal and cognitive coping related to changes in pain and adjustment in the short and long term? A total of 144 patients were assigned at random to a cognitive self-hypnosis (CSH) treatment or autogenic training (AT) with a duration of 7 weeks. Measures used were: Headache Index (HI), Symptom Checklist-90 (SCL-90), Coping Strategy Questionnaire (CSQ), Multidimensional Locus of Pain Control Questionnaire (MLPC) and treatment expectations. The results indicated that patients successfully changed their use of coping strategies and pain appraisals. Cognitive therapy was more effective than relaxation training in changing the use of cognitive coping strategies which were the direct targets of treatment. However, treatment effects were only related with changes in the use of coping strategies and appraisal processes to a limited extent and the mediational role of cognitive processes in pain reduction and better adjustment was inconclusive.
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Affiliation(s)
- Moniek M Ter Kuile
- Department of Psychiatry, University of Leiden, 2300 RC Leiden The Netherlands Department of Medical Statistics, University of Leiden, 2300 RC Leiden, The Netherlands
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Ter Kuile MM, Spinhoven P, Linssen CGA, Zitman FG, Van Dyck R, Rooijmans HGM. Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups. Pain 1994; 58:331-340. [PMID: 7838582 DOI: 10.1016/0304-3959(94)90127-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aims of this study were to (a) investigate the efficacy of autogenic training (AT) and cognitive self-hypnosis training (CSH) for the treatment of chronic headaches in comparison with a waiting-list control (WLC) condition, (b) investigate the influence of subject recruitment on treatment outcome and (c) explore whether the level of hypnotizability is related to therapy outcome. Three different subjects groups (group 1, patients (n = 58) who were referred by a neurological outpatient clinic; group 2, members (n = 48) of the community who responded to an advertisement in a newspaper; and group 3, students (n = 40) who responded to an advertisement in a university newspaper) were allocated at random to a therapy or WLC condition. During treatment, there was a significant reduction in the Headache Index scores of the subjects in contrast with the controls. At post-treatment and follow-up almost no significant differences were observed between the 2 treatment conditions or the 3 referral sources regarding the Headache Index, psychological distress (SCL-90) scores and medication use. Follow-up measurements indicated that therapeutic improvement was maintained. In both treatment conditions, the high-hypnotizable subjects achieved a greater reduction in headache pain at post-treatment and follow-up than did the low-hypnotizable subjects. It is concluded that a relatively simple and highly structured relaxation technique for the treatment of chronic headache subjects may be preferable to more complex cognitive hypnotherapeutic procedures, irrespective of the source of recruitment. The level of hypnotic susceptibility seems to be a subject characteristic which is associated with a more favourable outcome in subjects treated with AT or CSH.
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Affiliation(s)
- Moniek M Ter Kuile
- Department of Psychiatry, University of Leiden, 2300 RC LeidenThe Netherlands Department of Psychiatry, Catholic University of Nijmegen, 6525 MK. NijmegenThe Netherlands Department of Psychiatry, Free University of Amsterdam, 1075 GB AmsterdamThe Netherlands
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Abstract
The use of strategies for coping with chronic pain was assessed by means of the Coping Strategy Questionnaire (CSQ) in a Dutch sample of 108 chronic low back pain (LBP) patients referred for behavioral treatment. The 3 factors of the CSQ were related to measurements of behavioral and emotional adjustment to LBP above and beyond the effects of demographic and medical status variables. Especially patients high on the factor Helplessness reported higher levels of pain, functional impairment, anxiety, depression and psychoneuroticism, while patients high on the factor Perceived Control reported lower levels of pain, functional impairment and also manifested a higher level of uptime. The causal role of coping strategies in adjustment to pain, the selectivity of focusing on LBP patients selected through referral and implications for pain management are discussed.
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Affiliation(s)
- Philip Spinhoven
- Department of Psychiatry and Health Psychology, State University of Leiden, LeidenThe Netherlands Department of Psychiatry and Clinical and Health Psychology, State University of Leiden, LeidenThe Netherlands
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