Couple characteristics and outcome of therapy in vaginismus.

PubMed

Munasinghe, Thiloma; Goonaratna, Colvin; de Silva, Padmal

2004-06-01

To describe couple characteristics and outcome of therapy in vaginismus. A prospective before-after intervention descriptive study. Department of Physiology, Faculty of Medicine, Colombo, Sri Lanka. Fifty six couples with vaginismus, mostly self referrals and referrals from gynaecologists and general practitioners, were treated with a standard cognitive behaviour therapy protocol with before-after assessments of the degree of vaginismus and individual partner self-ratings of the relationship and psychological status (GHQ-30). Success at the end of the therapy was equated to the absence of or only mild vaginismus and, improvement in the couple relationship and psychological status scores. Twenty seven (48%) of the 52 (93%) couples with non-consummation reported failure of coitus following previous non-surgical and surgical interventions. Love marriages (70%), frequent attempts at sex (75%, 3 or 4 times/week) and sexual arousal (women = 86%, men = 89%) characterised couples. Ten men developed sexual problems, mostly erectile failure and premature ejaculation secondarily. Couple therapy enabled penetrative sex in 45 (80.3%). The single prognostic indicator of outcome was the degree of vaginismus at first visit, those with mild and moderate vaginismus (77%) being significantly more likely to establish coitus (p<0.001) and complete the therapy (p<0.001). The couple relationship improved marginally (women p<0.01, men 0.025

0.01) but the psychological status remained unchanged. Dropouts and referrals for psychiatric and marital counselling failed to complete therapy. Couple sex therapy is effective in the management of vaginismus. Health professionals, especially gynaecologists and general practitioners, need to be aware of the problem and the satisfactory outcome of sex therapy.

[Vaginismus].

PubMed

Harrison, C M

1996-03-01

This paper defines vaginismus in depth, discusses therapeutic options with emphasis on the psycho-therapeutic approach in combination with behavioural therapy. Of 26 couples completing such treatment, 22 (85%) on completion were able to achieve full penetrative intercourse without discomfort and reported greater fulfillment in their sexual relationship. Although not all wanted to conceive, seven have since reported a pregnancy.

Disgust and contamination sensitivity in vaginismus and dyspareunia.

PubMed

de Jong, Peter J; van Overveld, Mark; Schultz, Willibrord Weijmar; Peters, Madelon L; Buwalda, Femke M

2009-04-01

This study examined the potential role of disgust propensity and contamination sensitivity in vaginismus. Women suffering from vaginismus (n = 20) or dyspareunia (n = 22), and a group of women without sexual complaints (n = 30) completed self report measures indexing their (1) general dispositional disgust propensity, and (2) sensitivity for (ideational) contamination by sexual stimuli as a function of its source (self, partner, unknown). In support of the idea that disgust may be involved in vaginismus, women with vaginistic complaints displayed a generally enhanced dispositional disgust propensity. The sensitivity for contamination by sexual stimuli did not vary across groups. However, especially when the source was the participant's partner, the willingness ratings might have been influenced by demand and may, therefore, not accurately reflect participant's actual sensitivity for contamination by sexual stimuli. Future studies using more implicit or behavioral measures are necessary to more definitely test the role of disgust in vaginismus.

Does vaginismus exist? A critical review of the literature.

PubMed

Reissing, E D; Binik, Y M; Khalifé, S

1999-05-01

The basic strategies and methods for assessing and treating vaginismus were proposed by the early 20th century and have not essentially changed. Etiological theories have changed over time but are not supported by controlled empirical studies. This critical review of the literature disputes the widely held belief that vaginismus is an easily diagnosed and easily treated sexual dysfunction. We propose a reconceptualization of vaginismus as either an aversion/phobia of vaginal penetration or a genital pain disorder.

Vaginismus and dyspareunia: automatic vs. deliberate disgust responsivity.

PubMed

Borg, Charmaine; de Jong, Peter J; Schultz, Willibrord Weijmar

2010-06-01

The difficulty of penetration experienced in vaginismus and dyspareunia may at least partly be due to a disgust-induced defensive response. To examine if sex stimuli specifically elicit: (i) automatic disgust-related memory associations; (ii) physiological disgust responsivity; and/or (iii) deliberate expression of disgust/threat. Two single target Implicit Association Task (st-IAT) and electromyography (EMG) were conducted on three groups: vaginismus (N = 24), dyspareunia (N = 24), and control (N = 31) group. st-IAT, to index their initial disgust-related associations and facial EMG for the m. levator labii and m. corrugator supercilii regions. Both clinical groups showed enhanced automatic sex-disgust associations. As a unique physiological expression of disgust, the levator activity was specifically enhanced for the vaginismus group, when exposed to a women-friendly SEX video clip. Also at the deliberate level, specifically the vaginismus group showed enhanced subjective disgust toward SEX pictures and the SEX clip, along with higher threat responses. Supporting the view that disgust is involved in vaginismus and dyspareunia, for both, clinical groups' sex stimuli automatically elicited associations with disgust. Particularly for the vaginismus group, these initial disgust associations persisted during subsequent validation processes and were also evident at the level of facial expression and self-report data. Findings are consistent with the notion that uncontrollable activated associations are involved in eliciting defensive reactions at the prospect of penetration seen in both conditions. Whereas deliberate attitudes, usually linked with the desire for having intercourse, possibly generate the distinction (e.g., severity) between these two conditions.

Vulvar vestibulitis syndrome and vaginismus. A case report.

PubMed

Wijma, B; Jansson, M; Nilsson, S; Hallböök, O; Wijma, K

2000-03-01

Recent reports have argued for a revision of the criteria used for the establishment of a diagnosis of vulvar vestibulitis syndrome (VVS). On theoretical grounds it might be hypothesized that women with VVS also suffer from vaginismus. A young woman presented with a history, symptoms and objective findings typical of vaginismus, yet she suffered from continuous, burning pain and itching in the vestibule. Earlier in the course of the problem she had received a diagnosis VVS. The patient was treated with behavioral therapy developed for vaginismus. Notations made during the course of therapy supported the assumption that the pain and itching were conditioned responses to penetration in the same way that a vaginal muscular reflex is. Differential diagnostic difficulties exist in the field of VVS and vaginismus. Psychophysiologic theories are needed as the basis for research to clarify the connections between different diagnostic entities associated with coital burning pain and itching in the vestibule.

Different treatment modalities for refractory vaginismus in western Saudi Arabia.

PubMed

Fageeh, Wafa M K

2011-06-01

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. This study is aimed to evaluate the presentation and different modalities of management in patients with severe refractory vaginismus in western Saudi Arabia. Successful penetrative sexual intercourse suggesting that common elements of the therapies used were successful. 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. 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. 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. © 2011 International Society for Sexual Medicine.

Botulinum toxin in the treatment of refractory vaginismus.

PubMed

Ghazizadeh, Shirin; Nikzad, Masoomeh

2004-11-01

To investigate the efficacy of botulinum toxin injection to treat women with moderate and severe vaginismus. Twenty-four women referred to our clinic from February 2002 to February 2004 (mean age 25 years; range 19-34 years) with third- to fourth-degree vaginismus were recruited for this study. These women had previous unsuccessful treatments. Botulinum toxin (150-400 mIU) was injected into the puborectalis muscles in 3 sites on each side of the vagina. Twenty-three patients (95.8%) had vaginal examinations 1 week postoperatively that showed little or no vaginismus, 18 (75%) achieved satisfactory intercourse after the first injection, 4 (16.7%) had mild pain, 1 was cured after a second injection, 1 patient refused vaginal examination and did not attempt to have coitus, and another had no coitus as a result of her husband's secondary impotence. The women were followed up for a mean of 12.3 months (range 2-24 months), and there were no cases of recurrence. In refractory cases of vaginismus when conventional therapies have failed, local injection of botulinum toxin can be considered. III.

Vaginismus Treatment: Clinical Trials Follow Up 241 Patients.

PubMed

Pacik, Peter T; Geletta, Simon

2017-06-01

Vaginismus is mostly unknown among clinicians and women. Vaginismus causes women to have fear, anxiety, and pain with penetration attempts. To present a large cohort of patients based on prior published studies approved by an institutional review board and the Food and Drug Administration using a comprehensive multimodal vaginismus treatment program to treat the physical and psychologic manifestations of women with vaginismus and to record successes, failures, and untoward effects of this treatment approach. Assessment of vaginismus included a comprehensive pretreatment questionnaire, the Female Sexual Function Index (FSFI), and consultation. All patients signed a detailed informed consent. Treatment consisted of a multimodal approach including intravaginal injections of onabotulinumtoxinA (Botox) and bupivacaine, progressive dilation under conscious sedation, indwelling dilator, follow-up and support with office visits, phone calls, e-mails, dilation logs, and FSFI reports. Logs noting dilation progression, pain and anxiety scores, time to achieve intercourse, setbacks, and untoward effects. Post-treatment FSFI scores were compared with preprocedure scores. One hundred seventy-one patients (71%) reported having pain-free intercourse at a mean of 5.1 weeks (median = 2.5). Six patients (2.5%) were unable to achieve intercourse within a 1-year period after treatment and 64 patients (26.6%) were lost to follow-up. The change in the overall FSFI score measured at baseline, 3 months, 6 months, and 1 year was statistically significant at the 0.05 level. Three patients developed mild temporary stress incontinence, two patients developed a short period of temporary blurred vision, and one patient developed temporary excessive vaginal dryness. All adverse events resolved by approximately 4 months. One patient required retreatment followed by successful coitus. A multimodal program that treated the physical and psychologic aspects of vaginismus enabled women to achieve

Vaginismus and dyspareunia: relationship with general and sex-related moral standards.

PubMed

Borg, Charmaine; de Jong, Peter J; Weijmar Schultz, Willibrord

2011-01-01

Relatively strong adherence to conservative values and/or relatively strict sex-related moral standards logically restricts the sexual repertoire and will lower the threshold for experiencing negative emotions in a sexual context. In turn, this may generate withdrawal and avoidance behavior, which is at the nucleus of vaginismus. To examine whether indeed strong adherence to conservative morals and/or strict sexual standards may be involved in vaginismus. The Schwartz Value Survey (SVS) to investigate the individual's value pattern and the Sexual Disgust Questionnaire (SDQ) to index the willingness to perform certain sexual activities as an indirect measure of sex-related moral standards. The SVS and SDQ were completed by three groups: women diagnosed with vaginismus (N=24), a group of women diagnosed with dyspareunia (N=24), and a healthy control group of women without sexual complaints (N=32). Specifically, the vaginismus group showed relatively low scores on liberal values together with comparatively high scores on conservative values. Additionally, the vaginismus group was more restricted in their readiness to perform particular sex-related behaviors than the control group. The dyspareunia group, on both the SVS and the SDQ, placed between the vaginismus and the control group, but not significantly different than either of the groups. The findings are consistent with the view that low liberal and high conservative values, along with restricted sexual standards, are involved in the development/maintenance of vaginismus. © 2010 International Society for Sexual Medicine.

The treatment of vaginismus by the gynecologist: an eclectic approach.

PubMed

Reamy, K

1982-01-01

Thirteen of 14 patients with vaginismus have been successfully treated using systematic in vivo desensitization and other simple but individualized behavioral techniques. Resolution of symptoms was usually effected within 3 to 4 weekly sessions with important supplementary home assignments. All but 1 patient were seen without partners. Neither mechanical dilators nor hymenotomy was employed. Primary orgasmic dysfunction was associated wih vaginismus in a minority of patients and was treated concomitantly. Vaginismus appears to be more frequent than the literature indicates and can be situational or absolute. Presenting symptoms include an inability to tolerate pelvic examination, severe superficial dyspareunia, and a history of unconsummated coitus. Although gynecologic experience with vaginismus has been generally limited, the gynecologist is seen as a potentially ideal therapist for establishing or confirming the diagnosis at that time of pelvic examination.

Vaginismus: A Review

ERIC Educational Resources Information Center

Fertel, Norman S.

1977-01-01

Vaginismus includes both physical as well as psychological aspects that make vaginal penetration extremely painful if not altogether impossible. Aside from history, diagnosis rests on the physical examination. The most important considerations in therapy seem to be the patient's understanding of the problem and flexibility of approach. (Author)

Management and outcome of primary vaginismus.

PubMed

Jeng, Cherng-Jye; Wang, Lih-Rong; Chou, Chun-Shan; Shen, Jenta; Tzeng, Chii-Ruey

2006-01-01

Our objective was to access the success rate, and the factors affecting it, of treatment based on Masters and Johnson's sex therapy. For this prospective study, we enrolled 120 couples with unconsummated coitus due to vaginismus. We made a clinical diagnosis after taking a detailed history taking and conducting a clinical examination. Participants completed a questionnaire regarding characteristics of vaginismus after participating in a face-to-face interview. Both of these were done prior to treatment, after 3 months, and after 12 months. We provided sex therapy based on Masters and Johnson's method. Treatment results were then analyzed. After therapy, 93.3% of vaginismic women were successfully penetrated, and 83.3% had regular intercourse with orgasm. The abilities to reach orgasm and sexual desire were not different than that among normal women. There was a correlation between duration of unconsummation and success rate and also between severity of vaginismus, treatment sessions, and success rate. Because of our high success rate, we encourage vaginismic women and their partners to accept aggressive management.

Successful management of vaginismus: An eclectic approach.

PubMed

Harish, Thippeswamy; Muliyala, Krishnaprasad; Murthy, Pratima

2011-04-01

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.

Successful management of vaginismus: An eclectic approach

PubMed Central

Harish, Thippeswamy; Muliyala, KrishnaPrasad; Murthy, Pratima

2011-01-01

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. PMID:21772650

The Treatment of Vaginismus

PubMed Central

Szasz, George; Stuart, Freida; Maurice, William L.; Garry, Matthew

1977-01-01

The treatment of vaginismus was the subject of grand rounds in the Department of Obstetrics and Gynecology at Vancouver General Hospital. Staff members of the UBC Sex Therapy Unit participated in the presentation of a case of unconsummated marriage. PMID:21304871

[Vaginismus--a psychiatric perspective, "secrets" and other psychodynamic causes].

PubMed

Sheinfeld, H; Roshka, P; Finkelshtein, I; Davis, H

2001-09-01

Vaginismus is a disorder involving both psychiatry and gynecology. Psychiatric help is sought in only a small proportion of cases, although it is probable that the psychological etiology of the disorder is more frequent than generally recognized. This article deals with the causes and psychological circumstances of the disorder. Five cases are presented. In the first three cases, primary vaginismus caused unconsummated marriage in young women of religious or traditional background. In these cases a "secret" was revealed relating to a previous sexually related experience. This provides the basis for therapy. The other cases describe secondary vaginismus which appeared in older women who developed the symptom after a number of years of marriage. This article discusses the different psychotherapeutic approaches for the two types of cases. In the former cases, therapy may be brief and the prognosis is favorable. In the second case type, there is often more significant personality or marital pathology requiring prolonged and extensive psychotherapy. The authors stress the need for physicians to be mindful of cases of vaginismus requiring psychiatric intervention rather than gynecological treatment.

Therapist-Aided Exposure for Women with Lifelong Vaginismus: A Replicated Single-Case Design

ERIC Educational Resources Information Center

ter Kuile, Moniek M.; Bulte, Isis; Weijenborg, Philomeen T. M.; Beekman, Aart; Melles, Reinhilde; Onghena, Patrick

2009-01-01

Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other object. Lifelong vaginismus occurs when a woman has never been able to have intercourse. A replicated single-case A-B-phase design was used to investigate the effectiveness of therapist-aided exposure for lifelong vaginismus. A baseline period…

Vaginismus and subfertility: case reports on the association observed in clinical practice.

PubMed

Ramli, M; Nora, Mz; Roszaman, R; Hatta, S

2012-01-01

To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman's wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms. We report a series of cases of Malaysian women who had been suffering from vaginismus and 'infertility'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety. The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.

Vulvar vestibulitis syndrome: an important factor in the evaluation of lifelong vaginismus?

PubMed

Ter Kuile, Moniek M; Van Lankveld, Jacques J D M; Vlieland, Corrie Vliet; Willekes, Christine; Weijenborg, Philomeen T M

2005-12-01

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.

A psychophysiological investigation of sexual arousal in women with lifelong vaginismus.

PubMed

Cherner, Rebecca A; Reissing, Elke D

2013-05-01

Relatively little is known about the subjective reactions of women with lifelong vaginismus to erotic stimuli and genital arousal has never been investigated. Reports of maladaptive cognitions and fears regarding sexuality and intercourse suggest that anxiety may interfere with sexual arousal in women with vaginismus. To examine the genital and subjective responses to sexually explicit film stimuli of women with lifelong vaginismus compared with women with lifelong dyspareunia and women with no pain. Forty-five women (15 vaginismus, 15 dyspareunia, and 15 no pain) viewed two neutral and two erotic film sets, one depicting sexual activity without vaginal penetration and the other depicting intercourse, over two testing sessions. Vulvar temperature was recorded using an infrared camera. Participants completed a measure of subjective responses after viewing each film. All groups experienced increased vulvar temperature during the erotic films regardless of activity depicted. In response to the erotic films, the vaginismus group reported less mental arousal than the no-pain group and a range of negative subjective responses, including threat and disgust. Overall, participants showed concordance between peak subjective sexual arousal and temperature change from baseline to peak arousal. Despite negative subjective responses, women with vaginismus responded with increased genital sexual arousal to erotic films. The resilience of genital arousal may have resulted from moderate levels of anxiety experienced in the laboratory setting facilitating sexual response regardless of subjective appraisal; however, anxiety experienced in a dyadic context may interfere more substantially. © 2013 International Society for Sexual Medicine.

Vaginismus and dyspareunia: is there a difference in clinical presentation?

PubMed

de Kruiff, M E; ter Kuile, M M; Weijenborg, P T; van Lankveld, J J

2000-09-01

The purpose of this exploratory study was to identify clinical similarities and differences in patients with vaginismus and dyspareunia. Thirty patients who were referred to an outpatient clinic for psychosomatic gynecology and sexology, with either of these two diagnoses, were investigated by means of a standardized interview, physical examination and self-rating questionnaires. Based on the interview, no significant differences were demonstrated between patients with vaginismus and dyspareunia, in the ability to insert a finger into the vagina or to have a gynecological examination. No differences were found in the reported level of pain during coitus (or attempted coitus), inserting one finger into the vagina, or during gynecological examination. Patients with vaginismus, however, more often reported that coitus was impossible. The physical examination and self-rating questionnaires showed no differences at all between patients with vaginismus and dyspareunia in palpated vaginal muscular tension and reported anxiety or tension during the examination. Moreover, in both groups redness and painful areas on the vulva were equally common. Redness and pain on the same location were more frequently present in the dyspareunia group. Patients with dyspareunia reported higher levels of pain during the examination. In conclusion, neither the interview nor the physical examination produced useful criteria to distinguish vaginismus from dyspareunia. A multi-axial description of these syndromes is suggested, rather than viewing them as two separate disorders.

Vaginismus in Iran: A Single Center Report of 7 Years Experience.

PubMed

Akhavan-Taghavi, Mohammad Hossein; Asghari-Moghaddam, Mohammad Ali; Froutan, Seyed Kazem; Jadid-Milani, Maryam

2015-11-01

Vaginismus is a sexual disorder that can cause painful intercourse. Although several studies have shown a relationship between higher education and socio-economic level of women with vaginismus, the relationship between demographic characteristics and other variables remains unclear. The present study was conducted to determine the demographic characteristics of women with vaginismus, coming to family health clinic, between 2007 and 2013. This study is a cross-sectional study that was conducted on 115 clinical records, from early 2007 until the end of 2013, that have received a diagnosis of vaginismus. In these clinical records, the data on female and male age, education and employment, duration of marriage, type of marriage (traditional, virtual, etc.), being a virgin, erectile dysfunction of husband, information of families, sexual satisfaction, marital satisfaction, residential, non-medical types of medical treatment and hymenectomy were derived. The results showed that the average age of women was 29 ± 5 years and the average age of the spouses was 33 ± 6 years. Undergraduate education most prominent among women (52%) and spouses (42%). In terms of employment status, most women were housewives (54%) and the majority of male were employees (54%). The most frequent form of marriage was traditional (80%). The maximum elapsed time of marriage was between 1 - 3 years (43%). In most women, the first attempt for intercourse was from the second day of marriage to the end of the first week (73%). Hymenectomy was done by 9% of women. Totally, 45% of the men, the wives of whom were suffering from vaginismus, experienced erectile dysfunction. In 37% of couples, their sexual life was satisfactory. The most referred specialist for treatment was the urologist (17%). In 27% of women with vaginismus, numerous references to a variety of medical specialists and psychologists were also recorded. Of the total, 7% of couples experienced traditional and non-academic treatments. As

Vaginismus in Iran: A Single Center Report of 7 Years Experience

PubMed Central

Akhavan-Taghavi, Mohammad Hossein; Asghari-Moghaddam, Mohammad Ali; Froutan, Seyed Kazem; Jadid-Milani, Maryam

2015-01-01

Background: Vaginismus is a sexual disorder that can cause painful intercourse. Although several studies have shown a relationship between higher education and socio-economic level of women with vaginismus, the relationship between demographic characteristics and other variables remains unclear. Objectives: The present study was conducted to determine the demographic characteristics of women with vaginismus, coming to family health clinic, between 2007 and 2013. Patients and Methods: This study is a cross-sectional study that was conducted on 115 clinical records, from early 2007 until the end of 2013, that have received a diagnosis of vaginismus. In these clinical records, the data on female and male age, education and employment, duration of marriage, type of marriage (traditional, virtual, etc.), being a virgin, erectile dysfunction of husband, information of families, sexual satisfaction, marital satisfaction, residential, non-medical types of medical treatment and hymenectomy were derived. Results: The results showed that the average age of women was 29 ± 5 years and the average age of the spouses was 33 ± 6 years. Undergraduate education most prominent among women (52%) and spouses (42%). In terms of employment status, most women were housewives (54%) and the majority of male were employees (54%). The most frequent form of marriage was traditional (80%). The maximum elapsed time of marriage was between 1 - 3 years (43%). In most women, the first attempt for intercourse was from the second day of marriage to the end of the first week (73%). Hymenectomy was done by 9% of women. Totally, 45% of the men, the wives of whom were suffering from vaginismus, experienced erectile dysfunction. In 37% of couples, their sexual life was satisfactory. The most referred specialist for treatment was the urologist (17%). In 27% of women with vaginismus, numerous references to a variety of medical specialists and psychologists were also recorded. Of the total, 7% of couples

Efficacy of functional electrical stimulation-biofeedback with sexual cognitive-behavioral therapy as treatment of vaginismus.

PubMed

Seo, Ju Tae; Choe, Jin Ho; Lee, Won Sik; Kim, Kyung Hee

2005-07-01

To report 12 cases of vaginismus that were successfully treated with functional electrical stimulation (FES)-biofeedback with sexual cognitive-behavioral therapy (SCBT) to determine the efficacy of FES-biofeedback with SCBT as a standard therapy for vaginismus. Vaginismus is an involuntary spasm of the musculature of the outer third of the vagina that leads to impossible vaginal penetration, causing personal distress. Various therapeutic approaches, both physiologic and psychological, have been considered. Twelve women with vaginismus referred from a checkup outpatient clinic participated in this study. The patients enrolled in this study had vaginismus according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders. The patients were assessed before and after treatment with gynecologic examinations and structured interviews pertaining to sexual function and psychological adjustment. After the diagnosis of vaginismus, we conducted weekly pelvic floor muscle relaxation using FES-biofeedback. Once the patients became tolerable to vaginal manipulation, the eight-stage SCBT (eight-stage gradual desensitization described by Kaplan using vaginal self-dilation with fingers and vaginal probe insertion) was added for 8 weeks. After 8 weeks of treatment, all 12 couples had completed the program, had become tolerable to vaginal insertion of larger size probes, and could achieve satisfactory vaginal intercourse. FES-biofeedback with SCBT is an effective aid for patients with vaginismus to learn muscle control. Therefore, it may increase the success rate of treatment of vaginismus.

Etiological correlates of vaginismus: sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment.

PubMed

Reissing, Elke D; Binik, Yitzchak M; Khalifé, Samir; Cohen, Deborah; Amsel, Rhonda

2003-01-01

This study investigated the role of sexual and physical abuse, sexual self-schema, sexual functioning, sexual knowledge, relationship adjustment, and psychological distress in 87 women matched on age, relationship status, and parity and assigned to 3 groups--vaginismus, dyspareunia/vulvar vestibulitis syndrome (VVS), and no pain. More women with vaginismus reported a history of childhood sexual interference, and women in both the vaginismus and VVS groups reported lower levels of sexual functioning and a less positive sexual self-schema. Lack of support for traditionally held hypotheses concerning etiological correlates of vaginismus and the relationship between vaginismus and dyspareunia are discussed.

[Treating vaginismus in Turkish women].

PubMed

Gül, V; Ruf, G D

2009-03-01

Vaginismus is a sexual dysfunction involving various branches of medicine, including psychiatry and gynaecology. Psychiatric help is sought in only a small proportion of cases, although it is probable that the psychopathological aetiology is more frequent than generally recognized. This article deals with the causes and psychological circumstances in four Turkish couples who presented with unconsummated marriage for 3 to 7 years. Vaginismus F52.5 to the ICD-10 is a sexual dysfunction characterised as: deep anxiety about coitus leading to extreme spasm of musculature making coitus impossible or extremely unpleasant and painful. Four Turkish couples with unconsummated marriage due to the female partners' penetration phobia were included to this study. A patient-oriented multidimensional individual treatment (combination therapy) is a cost effective, short-term (typically 10- to 12-week) treatment model for both partners. It includes some elements of cognitive behavioural therapy and systemic partner therapy which were considered not radically different from previous therapeutic strategies. Results were successful in all cases; the couples were extremely satisfied with having a normal sex life for the first time. This led to desired pregnancies and avoiding of possible breakdown of their families. The couples did well with combination behavioural therapy. This methodology is discussed in its various aspects and with a cultural background. We also emphasise the need for physicians to be mindful of cases of vaginismus requiring psychiatric intervention rather than gynaecological treatment.

Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment.

PubMed

Lahaie, Marie-André; Boyer, Stéphanie C; Amsel, Rhonda; Khalifé, Samir; Binik, Yitzchak M

2010-09-01

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.

Vaginismus, a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus.

PubMed

van der Velde, J; Laan, E; Everaerd, W

2001-01-01

This study investigates the mechanism underlying vaginismus, which may be part of a general defense mechanism. Exposure to a threatening situation will evoke an increase in muscle activity. This muscle reaction will not be restricted to the pelvic floor but will also occur in postural muscles, such as in the trapezius region. Women with and without vaginismus were exposed to four stimuli: excerpts from threatening, erotic, neutral and sexual-threatening films. Subjects were 45 physician- or self-referred patients with vaginismus and 32 controls with no sexual or pelvic floor complaints. The activity of the pelvic floor muscles and of the muscles in the trapezius region was recorded with surface electrodes. There were no differences between women with and without vaginistic reactions. EMG measurement of both the pelvic floor muscles and the trapezius muscle showed an increase in muscle activity during the threatening and sexual-threatening excerpts in women with and without vaginismus. This increase of involuntary pelvic floor muscle activity is part of a general defense mechanism that occurs during exposure to threatening situations. This reaction is not restricted to a situation with a sexual content. The results of this study shed new light on the concept of vaginismus as a primarily sexual dysfunction.

Study of the pelvic floor muscles in vaginismus: a concept of pathogenesis.

PubMed

Shafik, Ahmed; El-Sibai, Olfat

2002-10-10

Neither the cause of vaginismus nor the muscles involved are precisely identified. To define the involved muscles and their role in the pathogenesis of vaginismus. The EMG activity of the levator ani (LA), puborectalis (PR) and bulbocavernosus (BC) muscles was studied in seven female patients (age (years): 25.6(mean)+/-1.2(S.D.)) and seven healthy volunteers who matched the patients in age. Recordings were performed at rest and during induction of vaginismus by a vaginal dilator. Upon approximating the vaginal dilator to the vaginal introitus or introducing it into the vagina of the healthy volunteers, the EMG activity of the LA, PR and BC muscles showed no significant difference from the basal activity. In the patients, the basal EMG activity of the examined muscles was significantly higher than that of the healthy volunteers (P<0.05). Upon vaginismus induction, the muscles showed a significant increase of the EMG activity (P<0.01). The latency recorded a mean of 14.2+/-2.3, 13.9+/-2.3 and 14.1+/-2.2ms (P>0.05) in the LA, PR and BC muscles, respectively. The muscle response was momentary lasting a mean of 31.2+/-5.7s. It was reproducible provided an off-time of a mean of 13.2+/-2.3s was observed. The pelvic floor muscles of vaginismus patients exhibited increased EMG activity at rest and on vaginismus induction; the cause is unknown. The concept of a disordered sacral reflex arc is put forward but needs further studies to be verified.

[Non-consummation of marriage and vaginismus: about three clinical cases].

PubMed

Karrouri, Rabie

2017-01-01

Vaginismus is a relationship issue. It is a cause of non-consummation of marriage, infertility and alteration in sexual relationship quality. We present three case reports from our daily clinical practice in order to highlight the possible causes of vaginismus, its clinical and relational characteristics and its cultural particularities. Patients were treated in the Department of Psychiatry at the Military Hospital Moulay Ismail, Meknes, over an observation period of two years.

Vaginismus and accompanying sexual dysfunctions in a Turkish clinical sample.

PubMed

Dogan, Sultan

2009-01-01

Although vaginismus is a common sexual dysfunction in Turkey, there are only limited data about sexual behavior characteristics and comorbidity with other sexual dysfunctions in vaginismic patients. To investigate the frequency of female sexual dysfunctions (FSDs) in a Turkish clinical sample and to determine the comorbidity of other FSDs in women diagnosed with lifelong vaginismus. The study included 54 female patients who presented to a psychiatry department with sexual problems/complaints. The subjects were evaluated using a semi-structured questionnaire. The questionnaire was developed by the researchers in order to assess sexually dysfunctional patients and included detailed questions about socio-demographic variables, and general medical and sexual history. All participants were also assessed using the Golombok Rust Inventory of Sexual Satisfaction. The most common primary FSD in our sample was vaginismus (75.9%), followed by hypoactive sexual desire (9.2%). Regarding comorbidity, in 36 female patients with lifelong vaginismus, we found dyspareunia in 17 women (47.2%), orgasmic disorder in eight women (22.2%), and sexual desire disorder in six women (16.6%) as a second sexual dysfunction, based on the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision criteria. With respect to FSDs within the Turkish clinical population, vaginismic patients constitute the largest group and cultural factors may play a role in the occurrence of this condition. Additionally, our data indicated that there was a strong correlation between vaginismus and dyspareunia. There was also a high frequency of hypoactive desire and orgasm disorder in vaginismic patients. These results suggest that multidimensional assessment of sexual dysfunction in female patients is of great importance.

The problem of vaginismus with congenital malformation of the genital tract.

PubMed

Jarząbek-Bielecka, Grażyna; Pisarska-Krawczyk, Magdalena; Kędzia, Witold; Mizgier, Małgorzata; Friebe, Zbigniew

2016-05-31

The persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger, and/or any object, despite the woman's expressed wish to do so" is vaginismus. Early traumatic sexual experiences (e.g. sexual abuse), religious orthodoxy, low self-esteem and body image, negative attitudes about sexuality, lack of knowledge about sex and fear responses are some of the traditional etiological correlates of vaginismus. Vaginismus is largely a diagnosis of exclusion. An interview is crucial in differentiating the causes of this disease and it should involve the following key questions: -whether the contraction of the vaginal muscles was recorded from the first sexual contact and still remains a need for sexual satisfaction is achieved without relations vaginal or -symptom occurs for some time and what circumstances it bound or -contraction of the muscles is independent of the will, reflex and is at the very idea of sexual intercourse, and -that the contraction of the vaginal muscles occurs when you try to enter the member into the vagina which is very painful. The physical, gynecological and sexuological examinations exclude local causes of the disease. The mainstay of treatment in the majority of cases is psychosexual support. The cause of organic vaginismus is congenital malformation of the genital tract. It results from abnormal development of genital paramesonephric (Müllerian) ducts and the urogenital sinus, which are structures involved in the process of oviduct, uterus, and vagina organogenesis. This has strong implications in the practices of gynecology and sexuology in general, not only in adolescent gynecology and sexuology. Vaginismus with congenital malformation is an important problem in these fields.

A comparative study of sexual function, behavior, and cognitions of women with lifelong vaginismus.

PubMed

Cherner, Rebecca A; Reissing, Elke D

2013-11-01

Vaginismus is classified as a sexual dysfunction, yet limited research is available on the sexual function and behavior of women with this condition. Comparing women with lifelong vaginismus to women with lifelong dyspareunia and women with no pain during intercourse, this study explored sexual function, anxiety, and behavior along with cognitions related to vaginal penetration. A total of 152 women completed an online survey that included a series of validated questionnaires. Main findings indicated that, relative to both comparison groups, women in the vaginismus group reported a more limited range of sexual behavior across the lifespan and more maladaptive cognitions related to fear of losing control of one's body and the situation during penetration. Compared to the no-pain group, both symptomatic groups reported more difficulties across several indicators of sexual function, more limited sexual behavior in the past year and past month, and more maladaptive cognitions related to vaginal penetration. However, women with vaginismus reported more sexual desire and less difficulty with lubrication compared to women with dyspareunia. Numerous sexual problems extending beyond vaginal penetration difficulties were confirmed, suggesting a need for broader treatment approaches not limited to the experience of vaginal penetration. Results were discussed as they relate to the fear-avoidance model of vaginismus.

Vaginismus in Assisted Reproductive Technology centers: an invisible population in need of care

PubMed Central

de Souza, Maria do Carmo B; Gusmão, Marcia C G; Antunes, Roberto A; de Souza, Marcelo M; Rito, Ana L S; Lira, Paloma; Mancebo, Ana C A; Tamm, Maria A; Panaino, Tatiana R; Bahia, Maria J

2018-01-01

Objective Genital and sexual pain is still neglected. Consequences may be dramatic, since infertility and sexual dysfunction may be reciprocally linked. This is the first study to focus on the identification of cases of vaginismus in the ART scenario and on the introduction of intra-cycle interventions as part of a comprehensive, integrated and patient-centered perspective. Methods This observational prospective study looked into 425 IVF/ICSI cycles and 226 frozen embryo transfers carried out from January 1, 2015 to December 31, 2016, and found seven cases of vaginismus. Within a six-month period, a questionnaire placed on SurveyMonkey was sent twice to 228 ART centers in Latin America. The purpose was to learn how often cases of vaginismus were found in ART centers and the perceptions around the presence of this condition. Results The few centers that took the time to answer the questionnaire (24/10.5%) stated that the number of cases in which they had trouble performing control ultrasound examination or needed to perform transfers with patients under sedation was not significant. Although 81% agreed that the incidence of these conditions is low, no references were made to cases of vaginismus, dyspareunia or sexual dysfunction. Our multidisciplinary team found seven cases of vaginismus, involving women with higher education degrees with a mean age of 37.8 years and married for a mean of four years. Although two reported they were able to tolerate intercourse, all reported undergoing treatments such as using vaginal dilators (3), psychotherapy (4) and psychiatric care (1). The care provided by the staff was designed to mitigate patient suffering. Conclusion Gentle care and sensitive listening should be integral components in the work of multidisciplinary teams to identify women with vaginismus and offer couples better quality treatment. PMID:29257632

Vaginismus in Assisted Reproductive Technology Centers: an invisible population in need of care.

PubMed

Souza, Maria do Carmo B de; Gusmão, Marcia C G; Antunes, Roberto A; Souza, Marcelo M de; Rito, Ana L S; Lira, Paloma; Mancebo, Ana C A; Tamm, Maria A; Panaino, Tatiana R; Bahia, Maria J

2018-03-01

Genital and sexual pain is still neglected. Consequences may be dramatic, since infertility and sexual dysfunction may be reciprocally linked. This is the first study to focus on the identification of cases of vaginismus in the ART scenario and on the introduction of intra-cycle interventions as part of a comprehensive, integrated and patient-centered perspective. This observational prospective study looked into 425 IVF/ICSI cycles and 226 frozen embryo transfers carried out from January 1, 2015 to December 31, 2016, and found seven cases of vaginismus. Within a six-month period, a questionnaire placed on SurveyMonkey was sent twice to 228 ART centers in Latin America. The purpose was to learn how often cases of vaginismus were found in ART centers and the perceptions around the presence of this condition. The few centers that took the time to answer the questionnaire (24/10.5%) stated that the number of cases in which they had trouble performing control ultrasound examination or needed to perform transfers with patients under sedation was not significant. Although 81% agreed that the incidence of these conditions is low, no references were made to cases of vaginismus, dyspareunia or sexual dysfunction. Our multidisciplinary team found seven cases of vaginismus, involving women with higher education degrees with a mean age of 37.8 years and married for a mean of four years. Although two reported they were able to tolerate intercourse, all reported undergoing treatments such as using vaginal dilators (3), psychotherapy (4) and psychiatric care (1). The care provided by the staff was designed to mitigate patient suffering. Gentle care and sensitive listening should be integral components in the work of multidisciplinary teams to identify women with vaginismus and offer couples better quality treatment.

Automatic affective appraisal of sexual penetration stimuli in women with vaginismus or dyspareunia.

PubMed

Huijding, Jorg; Borg, Charmaine; Weijmar-Schultz, Willibrord; de Jong, Peter J

2011-03-01

Current psychological views are that negative appraisals of sexual stimuli lie at the core of sexual dysfunctions. It is important to differentiate between deliberate appraisals and more automatic appraisals, as research has shown that the former are most relevant to controllable behaviors, and the latter are most relevant to reflexive behaviors. Accordingly, it can be hypothesized that in women with vaginismus, the persistent difficulty to allow vaginal entry is due to global negative automatic affective appraisals that trigger reflexive pelvic floor muscle contraction at the prospect of penetration. To test whether sexual penetration pictures elicited global negative automatic affective appraisals in women with vaginismus or dyspareunia and to examine whether deliberate appraisals and automatic appraisals differed between the two patient groups. Women with persistent vaginismus (N = 24), dyspareunia (N = 23), or no sexual complaints (N = 30) completed a pictorial Extrinsic Affective Simon Task (EAST), and then made a global affective assessment of the EAST stimuli using visual analogue scales (VAS). The EAST assessed global automatic affective appraisals of sexual penetration stimuli, while the VAS assessed global deliberate affective appraisals of these stimuli. Automatic affective appraisals of sexual penetration stimuli tended to be positive, independent of the presence of sexual complaints. Deliberate appraisals of the same stimuli were significantly more negative in the women with vaginismus than in the dyspareunia group and control group, while the latter two groups did not differ in their appraisals. Unexpectedly, deliberate appraisals seemed to be most important in vaginismus, whereas dyspareunia did not seem to implicate negative deliberate or automatic affective appraisals. These findings dispute the view that global automatic affect lies at the core of vaginismus and indicate that a useful element in therapeutic interventions may be the modification of

[Treatment of vaginismus with EMDR: a report of two cases].

PubMed

Torun, Fuat

2010-01-01

Vaginismus is a type of sexual dysfunction in which spasm of the vaginal musculature prevents penetrative intercourse. The main diagnostic criterion is the presence of recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse. In many cases associated pain or the fear of pain may contribute to its persistence. Herein we report 2 patients that presented with vaginismus that developed secondary to childhood sexual trauma, which was treated with the Eye Movement Desensitization and Reprocessing (EMDR) technique. EMDR is a non-pharmacologic treatment for psychological trauma. Randomized controlled trials with posttraumatic stress disorder patients and with victims of sexual abuse have shown that EMDR is effective. The standard 8-phase EMDR protocol was used in both of the presented cases. Following 3 sessions of EMDR, the patients exhibited a substantial reduction in self-reported and clinician-rated anxiety, and a reduction in the credibility of dysfunctional beliefs concerning sexual intercourse. These findings support the notion that EMDR could be an effective treatment alternative for patients with vaginismus of traumatic etiology.

Cognitive-behavioral therapy for women with lifelong vaginismus: process and prognostic factors.

PubMed

ter Kuile, Moniek M; van Lankveld, Jacques J D M; de Groot, Ellen; Melles, Reinhilde; Neffs, Janneke; Zandbergen, Maartje

2007-02-01

Cognitive-behavioral therapy (CBT) seems an effective treatment of lifelong vaginismus, but mechanisms of action have not yet been established. The present study explored whether the effect of CBT for lifelong vaginismus is mediated by changes in fear of penetration and avoidance behavior, which CBT explicitly aims to alter. A second aim of this study was to predict treatment outcome on the basis of pre-treatment variables. Participants with lifelong vaginismus were allocated at random to a 3-months CBT (n=81) or a waiting-list control condition (n=36). Full vaginal penetration with the penis of the partner constituted the primary outcome measure. Change scores in successful 'non-coital penetrative-behavior' and 'fear of coitus' were used to measure the mediating variables. Treatment resulted in an increase of intercourse (outcome), a decrease in fear of coitus, and an enhancement of successful non-coital penetration behavior, compared with no treatment. Outcome (intercourse) was partly mediated by changes in fear of coitus and changes in avoidance behavior. No treatment predictors could be detected in this study sample. It is concluded that techniques such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear, constitute an important avenue of change in the treatment of lifelong vaginismus.

Consultation and treatment history and causal attributions in an online sample of women with lifelong and acquired vaginismus.

PubMed

Reissing, Elke D

2012-01-01

Very little information is available on the consultation and treatment histories of women with lifelong and acquired vaginismus. This study was conducted to address three areas of interest: first, to collect information on which health care professionals women with acquired and lifelong vaginismus consult and how helpful such consultation were; second, to examine which treatments were typically received and how helpful patients rate such interventions; and third, to explore participants' causal attributions of the vaginal penetration problems as those are what appear to guide patients towards consulting specific health care professionals as well as affecting the openness towards different interventions. An online survey was conducted with 212 participants. Data were analyzed using the responses of 93 women with acquired vaginismus and 75 women with lifelong vaginismus. The main outcomes were the results of the online survey. Gynecologists and family doctors were most frequently consulted, but only gynecologists were rated as helpful. Psychologists and sex therapists were also frequently consulted and rated as helpful. Physiotherapists were consulted by fewer women but considered most helpful. Women with lifelong vaginismus were significantly more likely to have received vaginal dilatation, sex education, and Kegel exercises as treatment. Women with acquired vaginismus were more likely to have received pharmacological interventions and to have tried a greater range of interventions. Educational gynecological examinations, talking about the meaning of the penetration problem, vaginal dilatation, and sex education were rated as most helpful interventions. Causal attributions were pain and fear- and disgust-based attributions for women with lifelong vaginismus. Results highlight the importance of a biopsychosocial conceptualization of and multidisciplinary treatment approach to lifelong and acquired vaginismus. © 2011 International Society for Sexual Medicine.

Treatment of primary vaginismus: a new perspective.

PubMed

Shaw, J

1994-01-01

This paper challenges the efficacy of a cognitive-behavioral treatment model for women with primary vaginismus and proposes a conceptual shift from a focus on behavior to a focus on differentiation. Primary vaginismus is viewed as a somatic boundary, a symbolic description of an opportunity for differentiation. Four relevant themes are considered: 1) mastery versus incompetence; 2) autonomy versus dependence; 3) boundary versus fusion; and 4) the effect on the therapy of the therapist's level of differentiation. Change at this particular time in history involves shifts in clinical focus from sexual frequency to quality, from performance to experience, from compliance to mastery, and from utilization function to sexual potential. A case is made for sexual competence based on self-competence instead of on behavior. A reevaluation of what constitutes success, both behavioral and developmental, proposes an increase in differentiation in addition to symptom relief.

Therapist-aided exposure for women with lifelong vaginismus: a replicated single-case design.

PubMed

Ter Kuile, Moniek M; Bulté, Isis; Weijenborg, Philomeen T M; Beekman, Aart; Melles, Reinhilde; Onghena, Patrick

2009-02-01

Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other object. Lifelong vaginismus occurs when a woman has never been able to have intercourse. A replicated single-case A-B-phase design was used to investigate the effectiveness of therapist-aided exposure for lifelong vaginismus. A baseline period (Phase A) was contrasted with exposure + follow-up (Phase B), using random switching between phases. The main outcome measure (intercourse ability) was assessed daily for 24 weeks. Ten women participated. The exposure consisted of a maximum of three 2-hr sessions during 1 week at a university hospital. The participant performed vaginal penetration exercises on herself, in the presence of a female therapist. Two follow-up sessions were scheduled over a 5-week period. Nine of the 10 participants reported having intercourse after treatment, and in 5 of the 9, intercourse was possible within the 1st week of treatment. The results remained at 1-year follow-up. Furthermore, exposure was successful in decreasing fear and negative penetration beliefs posttreatment and at 3-month and 1-year follow-ups. Therapist-aided exposure appears to be an effective treatment for lifelong vaginismus.

The Neurobiology and Psychiatric Perspective of Vaginismus: Linking the Pharmacological and Psycho-Social Interventions.

PubMed

Kadir, Zuri Shahidii; Sidi, Hatta; Kumar, Jaya; Das, Srijit; Midin, Marhani; Baharuddin, Najwa

2018-01-01

Vaginismus is an involuntary muscle contraction of the outer third of vaginal barrel causing sexual penetration almost impossible. It is generally classified under sexual pain disorder (SPD). In Diagnostic and Statistical Manual, 5th edition (DSM-5), it is classified under the new rubric of Genito-Pelvic Pain/Sexual Penetration Disorder. This fear-avoidance condition poses an ongoing significant challenge to the medical and health professionals due to the very demanding needs in health care despite its unpredictable prognosis. The etiology of vaginismus is complex: through multiple biopsycho- social processes, involving bidirectional connections between pelvic-genital (local) and higher mental function (central regulation). It has robust neural and psychological-cognitive loop feedback involvement. The internal neural circuit involves an inter-play of at least two-pathway systems, i.e. both "quick threat assessment" of occipital-limbic-occipital-prefrontal-pelvic-genital; and the chronic pain pathways through the genito-spinothalamic-parietal-pre-frontal system, respectively. In this review, a neurobiology root of vaginismus is deliberated with the central role of an emotional-regulating amygdala, and other neural loop, i.e. hippocampus and neo-cortex in the core psychopathology of fear, disgust, and sexual avoidance. Many therapists view vaginismus as a neglected art-and-science which demands a better and deeper understanding on the clinico-pathological correlation to enhance an effective model for the bio-psycho-social treatment. As vaginismus has a strong presentation in psychopathology, i.e. fear of penetration, phobic avoidance, disgust, and anticipatory anxiety, we highlighted a practical psychiatric approach to the clinical management of vaginismus, based on the current core knowledge in the perspective of neuroscience. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Treatment of lifelong vaginismus in traditional Islamic couples: a prospective study.

PubMed

Yasan, Aziz; Akdeniz, Nurten

2009-04-01

As sexual values and the meaning of sexuality are culturally dependent, the efficacy of sex therapy models may not necessarily be similar across cultures. The aim was to address two questions; the first was to identify whether a group of patients with lifelong vaginismus living in traditional Islamic culture benefited from the sex therapy. The second question addressed was how Muslim culture affects sex therapy in the treatment of vaginismus. Data were obtained from all patients with lifelong vaginismus who attended an outpatient clinic in the course of 1 year. Forty-four couples were investigated in the initial session. Thirty-six couples who completed the treatment were assessed after 3 months. In the final evaluation, pleasurable full vaginal penetration after active penile insertion was accepted as a successful outcome treatment for the present study. In the study, 36 patients who had completed treatment were determined, 29 of whom had successful outcome of treatment, while eight dropped out. The model building process variable resulted in "married by matchmaker without consent (OR = 0.060, CI = 0.046-0.771, P = 0.031)" and "not allowing pelvic examination (OR = 0.124, CI = 0.016-0.941, P = 0.044)" as negative predictors for successful outcome of treatment. Sex therapy is a feasible method of treatment for vaginismus within the cultural environment investigated, although some modifications may be needed in some setting such as for those married by matchmaker without their consent.

Factors that might be predictive of completion of vaginismus treatment.

PubMed

Özdel, Kadir; Yılmaz Özpolat, Ayşegül; Çeri, Özge; Kumbasar, Hakan

2012-01-01

Vaginismus is defined as a recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse. The aim of this study was to assess the level of symptoms of depression, anxiety, obsessive-compulsive symptoms, and perfectionism among patients with vaginismus, as well as to determine if these clinical variables are related to the completion of treatment. The study included 20 women with vaginismus and their spouses that were referred as outpatients to Ankara University, School of Medicine, Department of Psychiatry, Consultation and Liaison Unit. All couples underwent cognitive behavioral therapy, which was administered as 40-60-min weekly sessions. At the first (assessment) session, the female patients were assessed using a sociodemographic evaluation form, the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Maudsley Obsessive-Compulsive Inventory (MOCI), the Multidimensional Perfectionism Scale (MPS), and the Golombok Rust Inventory of Sexual Satisfaction (GRISS). The male spouses were evaluated using the GRISS. The same scales were administered after the completion of treatment to those that completed the treatment. The correlation between completion of treatment, and an elevated level of anxiety and self-oriented perfectionism was significant (P < 0.05). Among those that completed the study, depressive symptoms in the female patients improved (P< 0.05), and scale scores related to sexual functioning in both the males and females improved significantly (P < 0.05). Vaginismus is not only a sexual dysfunction, but it is related to multiple components of mental health. Anxiety and a perfectionist personality trait were important factors associated with the completion of treatment; therefore, these factors should be evaluated before treatment.

Therapist-aided exposure for women with lifelong vaginismus: a randomized waiting-list control trial of efficacy.

PubMed

Ter Kuile, Moniek M; Melles, Reinhilde; de Groot, H Ellen; Tuijnman-Raasveld, Charlotte C; van Lankveld, Jacques J D M

2013-12-01

Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other "objects" (e.g., tampons, fingers, speculum). Lifelong vaginismus is diagnosed when a woman has never been able to have intercourse. The aim of this study was to investigate the efficacy of therapist-aided exposure for lifelong vaginismus. Seventy women and their partners were randomly allocated to exposure or a waiting-list control period of 3 months. The main outcome measure (intercourse ability) was assessed daily during 12 weeks. Secondary outcome measures were complaints about vaginismus, coital pain, coital fear, sexual distress, and sexual functioning. The exposure treatment consisted of a maximum of three 2-hr sessions during 1 week at a university hospital. Each participant performed vaginal penetration exercises herself, in the presence of her partner and a female therapist. Two follow-up sessions were scheduled over a 5-week period. Thirty-one out of 35 (89%; 95% CI [72%, 96%]) participants reported having had sexual intercourse at posttreatment compared with 4 out of 35 (11%; 95% CI [4%, 28%]) participants in the control condition. In most of the successfully treated women (90%), intercourse was possible within the first 2 weeks of treatment. Moreover, treatment resulted in clinical improvement regarding other symptoms related to vaginismus, coital fear, coital pain, and sexual distress. No treatment effects were found regarding other aspects of sexual functioning in women or their partners. This study provides evidence of the efficacy of therapist-aided exposure therapy for women with lifelong vaginismus.

Use by gynecologists of a modified sensate focus technique to treat vaginismus causing infertility.

PubMed

Jindal, Umesh N; Jindal, Sheetal

2010-11-01

Of 5,341 infertile couples seen over an 8-year period, 76 (1.4%) had primary vaginismus, of whom 63 were treated with the use of a simplified sensate focus technique. There was complete symptomatic resolution of vaginismus in 60 women, and pregnancy was achieved in 33. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Sexual pain in women: exploring the manifestations of vaginismus versus vulvodynia.

PubMed

Ghizzani, Anna; Sestini, Piersante

2017-02-01

Sexual pain is frequently seen in gynecological practice as a consequence of lower tract pathology. When organic causes are ruled out, we must think of a functional pain syndrome such as the genital pelvic pain/penetration disorder (GPPD). Vaginismus and vulvodynia require different treatments. Even if gynecologists do not usually manage functional sexual pain, they can easily reach the differential diagnosis through the sexual pain anamnesis, because some symptoms are specific of one or the other condition. To verify our hypothesis we retrospectively evaluated the clinical records of 44 women affected by functional sexual pain. The words patients, used to describe their pain, were categorized in the following symptoms: dyspareunia, burning pain, stabbing pain, dryness, itching, and obstacle to penetration, each coded as present or absent. The unsupervised cluster analysis of the reported symptoms identified two groups: 19 out of 20 women were clinically diagnosed as having vaginismus, while the second group included all the 24 women clinically diagnosed with vulvodynia, plus one vaginismic patient. The high adherence between clinical and statistical findings supports that the differential diagnosis between vaginismus and vulvodynia can be reached on the basis of the elements collected during intake, including pain history.

Reproduction and mode of delivery in women with vaginismus or localised provoked vestibulodynia: a Swedish register-based study.

PubMed

Möller, L; Josefsson, A; Bladh, M; Lilliecreutz, C; Sydsjö, G

2015-02-01

To compare sociodemographics, parity and mode of delivery between women diagnosed with vaginismus or localised provoked vestibulodynia (LPV) to women without a diagnosis before first pregnancy. Retrospective, population-based register study. Sweden. All women born in Sweden 1973-83 who gave birth for the first time or remained nulliparous during the years 2001-09. Nationally linked registries were used to identify the study population. Women diagnosed with vaginismus or LPV were compared to all other women. Odds ratios for parity and mode of delivery were calculated using multinominal regression analysis and logistic regression. Parity and mode of delivery. Women with vaginismus/LPV were more likely to be unmarried (P = 0.001), unemployed (P = 0.012), have a higher educational level (P < 0.001), a lower body mass index (P < 0.001) and use nicotine during pregnancy (P = 0.008). They were less likely to give birth (adjusted odds ratio [OR] 0.61, 95% confidence interval [95% CI] 0.56-0.67). Women with vaginismus/LPV more often delivered by caesarean section (P < 0.001) especially for maternal request (adjusted OR 3.48, 95% CI 2.45-4.39). In women having vaginal delivery, those with vaginismus/LPV were more likely to suffer a perineal laceration (adjusted OR 1.87, 95% CI 1.56-2.25). Women with vaginismus/LPV are less likely to give birth and those that do are more likely to deliver by caesarean section and have a caesarean section based upon maternal request. Those women delivering vaginally are more likely to suffer perineal laceration. These findings point to the importance of not only addressing sexual function in women with vaginismus/LPV but reproductive function as well. © 2014 Royal College of Obstetricians and Gynaecologists.

Female sexual pain disorders: dyspareunia and vaginismus.

PubMed

Simonelli, Chiara; Eleuteri, Stefano; Petruccelli, Filippo; Rossi, Roberta

2014-11-01

To analyze literature on sexual pain disorders and to review and summarize the articles published throughout 2013 which contribute to the current knowledge on this subject. By age 40, 7.8% of women reported vulvar pain. Diagnostic and Statistical Manual of Mental Disorders, fifth edition, has combined vaginismus and dyspareunia into the same diagnostic label. The research reviewed in this article seems to differently point toward two conditions, focusing on different aspects both on the etiological and on the treatment area. Higher levels of partner-perceived self-efficacy and lower levels of partner catastrophizing were associated with less pain intensity in women with entry dyspareunia, independent of women's pain perception and self-efficacy. Alexithymia and fear were found to be important etiological factors in vaginismus. The present findings did not provide clear evidence in support of the superiority of any treatment and highlight the need for randomized, placebo-controlled trials that compare treatments in the future. A lot of work remained to be done to understand such a complex and multifaceted disturbance as genital sexual pain, but the articles examined showed that we are slowly adding more knowledge on the etiological cause and treatment models for such conditions.

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.

PubMed

Lahaie, Marie-Andrée; Amsel, Rhonda; Khalifé, Samir; Boyer, Stephanie; Faaborg-Andersen, Marie; Binik, Yitzchak M

2015-08-01

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.

A model for critical review of literature - with vaginismus as an example.

PubMed

Wijma, Barbro; Engman, Maria; Wijma, Klaas

2007-03-01

In this article we present a behavioral model for the critical review of the literature within a certain research field, using vaginismus as an example. We searched the literature for the title word "vaginismus" and analyzed to what extent the articles dealt with the following seven categories: prevention, etiology, maintaining factors, consequences, object of intervention, method of intervention, and method of evaluation. In each category we scrutinized the content of the articles for biological, psychological, social, relational, and gender aspects. Quality requirements of etiological and treatment studies were then added and the results presented in a "quality-adjusted" model. There were 102 articles during 1985-2001, of which 22 were included in the review. Most of the articles deal with supposed predisposing factors of etiology and different aspects of intervention. Only a few articles discuss precipitating factors, maintaining factors, or consequences of the problem. No article had a gender analysis. Only 11 of the articles fulfilled some of the proposed quality criteria. We found the behavioral model with quality requirements useful for classifying and evaluating the literature of vaginismus. The model may also be used as a guide to design methodologically good studies.

Therapist-Aided Exposure for Women with Lifelong Vaginismus: Mediators of Treatment Outcome: A Randomized Waiting List Control Trial.

PubMed

Ter Kuile, Moniek M; Melles, Reinhilde J; Tuijnman-Raasveld, Charlotte C; de Groot, Helen E; van Lankveld, Jacques J D M

2015-08-01

Therapist-aided exposure seems an effective treatment for lifelong vaginismus, but mechanisms of action have not yet been established. The purpose of the present study was to investigate whether treatment outcome of a therapist-aided exposure treatment was mediated by changes in positive and negative penetration beliefs or feelings of sexual disgust. Participants with lifelong vaginismus were allocated at random to a 3-month exposure (n = 35) or a waiting list control condition (n = 35). Full intercourse was assessed daily during 12 weeks. Secondary outcome measures (complaints about vaginismus and coital pain) were assessed at baseline and after 12 weeks. Possible mediators: penetration beliefs (catastrophic pain beliefs, genital incompatibility beliefs, perceived control beliefs) and feelings of sexual disgust were assessed at baseline and 6 weeks. Treatment outcome (coital frequency, symptoms of vaginismus, and coital pain) at 12 weeks was mediated by changes in negative and positive penetration beliefs at 6 weeks, in particular by more pronounced reduction of catastrophic pain penetration beliefs. No evidence was found that changes in feelings of sexual disgust mediated treatment outcome. The results strongly suggest that therapist-aided exposure affects negative penetration beliefs and that these changes in negative penetration beliefs mediate treatment outcome in women with lifelong vaginismus. Implications for treatment are discussed. © 2015 International Society for Sexual Medicine.

Difficulties in the differential diagnosis of vaginismus, dyspareunia and mixed sexual pain disorder.

PubMed

van Lankveld, J J; Brewaeys, A M; Ter Kuile, M M; Weijenborg, P T

1995-12-01

This retrospective study was undertaken to investigate predictors of vaginismus, dyspareunia and mixed sexual pain disorder in respect of symptom profile and treatment history variables of female patients and their partners. The study sample consisted of 147 female patients attending a university hospital outpatient clinic for Psychosomatic Gynecology and Sexology. All patients met the DSM-III-R criteria of the diagnoses of vaginismus (n = 50), dyspareunia (n = 46), or of both diagnoses (n = 51). No univariate differences were found between members of the three groups or between their partners. It was not possible to make a multivariate prediction of group membership.

Botulinum neurotoxin type A injections for vaginismus secondary to vulvar vestibulitis syndrome.

PubMed

Bertolasi, Laura; Frasson, Emma; Cappelletti, Jee Yun; Vicentini, Silvana; Bordignon, Monia; Graziottin, Alessandra

2009-11-01

To investigate whether botulinum neurotoxin type A improves vaginismus and study its efficacy with repeated treatments. Outpatients were referred because standard cognitive-behavioral and medical treatment for vaginismus and vulvar vestibular syndrome failed. From this group, we prospectively recruited consecutive women (n=39) whose diagnostic electromyogram (EMG) recordings from the levator ani muscle showed hyperactivity at rest and reduced inhibition during straining. These women were followed for a mean (+/-standard deviation) of 105 (+/-50) weeks. Recruited patients underwent repeated cycles of botulinum neurotoxin type A injected into the levator ani under EMG guidance and EMG monitoring thereafter. At enrollment and 4 weeks after each cycle, women were asked about sexual intercourse; underwent EMG evaluation and examinations to grade vaginal resistance according to Lamont; and completed a visual analog scale (VAS) for pain, the Female Sexual Function Index Scale, a quality-of-life questionnaire (Short-Form 12 Health Survey), and bowel and bladder symptom assessment. At 4 weeks after the first botulinum neurotoxin type A cycle, the primary outcome measures (the possibility of having sexual intercourse, and levator ani EMG hyperactivity) both improved, as did the secondary outcomes, Lamont scores, VAS, Female Sexual Function Index Scales, Short-Form 12 Health Survey, and bowel-bladder symptoms. These benefits persisted through later cycles. When follow-up ended, 63.2% of the patients completely recovered from vaginismus and vulvar vestibular syndrome, 15.4% still needed reinjections (censored), and 15.4% had dropped out. Botulinum neurotoxin type A is an effective treatment option for vaginismus secondary to vulvar vestibular syndrome refractory to standard cognitive-behavioral and medical management. After patients received botulinum neurotoxin type A, their sexual activity improved and reinjections provided sustained benefits. III.

Relationship Enhancement Therapy: A Case Study for Treating Vaginismus.

ERIC Educational Resources Information Center

Harman, Marsha J.; And Others

1994-01-01

A case study of Relationship Enhancement (RE) therapy with a couple, in which the woman was identified as having vaginismus, is presented including excerpts of transcripts from the therapy sessions. RE's effectiveness at improving communication skills and providing structure in which the couple could discuss the intimate issues affecting the…

Vaginismus in peri- and postmenopausal women: a pragmatic approach for general practitioners and gynaecologists.

PubMed

Hope, Mairi E; Farmer, Laura; McAllister, Kay F; Cumming, Grant P

2010-06-01

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.

Automatic and deliberate affective associations with sexual stimuli in women with lifelong vaginismus before and after therapist-aided exposure treatment.

PubMed

Melles, Reinhilde J; ter Kuile, Moniek M; Dewitte, Marieke; van Lankveld, Jacques J D M; Brauer, Marieke; de Jong, Peter J

2014-03-01

The intense fear response to vaginal penetration in women with lifelong vaginismus, who have never been able to experience coitus, may reflect negative automatic and deliberate appraisals of vaginal penetration stimuli which might be modified by exposure treatment. The aim of this study is to examine whether (i) sexual stimuli elicit relatively strong automatic and deliberate threat associations in women with vaginismus, as well as relatively negative automatic and deliberate global affective associations, compared with symptom-free women; and (ii) these automatic and more deliberate attitudes can be modified by therapist-aided exposure treatment. A single target Implicit Association Test (st-IAT) was used to index automatic threat associations, and an Affective Simon Task (AST) to index global automatic affective associations. Participants were women with lifelong vaginismus (N = 68) and women without sexual problems (N = 70). The vaginismus group was randomly allocated to treatment (n = 34) and a waiting list control condition (n = 34). Indices of automatic threat were obtained by the st-IAT and automatic global affective associations by the AST, visual analogue scales (VAS) were used to assess deliberate appraisals of the sexual pictures (fear and global positive affect). More deliberate fear and less global positive affective associations with sexual stimuli were found in women with vaginismus. Following therapist-aided exposure treatment, the strength of fear was strongly reduced, whereas global positive affective associations were strengthened. Automatic associations did not differ between women with and without vaginismus and did not change following treatment. Relatively stronger negative (threat or global affect) associations with sexual stimuli in vaginismus appeared restricted to the deliberate level. Therapist-aided exposure treatment was effective in reducing subjective fear of sexual penetration stimuli and led to more global positive affective

Who benefits from cognitive behavioral therapy for vaginismus?

PubMed

Kabakçi, Elif; Batur, Senar

2003-01-01

The purpose of this study was to investigate the characteristics of a group of Turkish vaginismus patients who benefited from Cognitive Behavioral Therapy (CBT) and to study which factors this treatment model changes. Twenty-eight couples who applied to Psychiatry Clinic of Hacettepe University Hospital, Ankara, for treatment of vaginismus within the 6-month period participated in the study. Fourteen subjects quit the therapy after the initial assessment sessions. Other couples successfully completed the treatment. We assessed all the couples that completed the CBT at three times: during the initial session, at the end of the treatment, and during the follow-up session (4 weeks after the end of the treatment). In terms of anxiety levels, and quality of marital and sexual relationships, the characteristics of the couples that quit the therapy could not be identified. But we found that all of the participants were treated effectively by CBT. At the end of the therapy, anxiety levels of the women decreased. There also were improvements on parameters related to marital harmony and overall sexual functioning of the women. We discuss the findings of our study within a cultural perspective.

Itch and burning pain in women with partial vaginismus with or without vulvar vestibulitis.

PubMed

Engman, Maria; Wijma, Klaas; Wijma, Barbro

2007-01-01

Fifty-three women with partial vaginismus with or without vulvar vestibulitis and 27 asymptomatic women estimated sensations of burning pain and itch at 20 standardized moments during a standardized penetration situation, including vaginal muscle contractions. Forty-three women with partial vaginismus (81.1%) reported burning pain, 23 (43.4%) itch, and 22 (41.5%) both complaints, compared to 0% of the asymptomatic women. In 17 of 22 cases, burning pain preceded the appearance of itch and in four cases the two complaints coincided. The median time from the moment when burning pain started until itch appeared was 150 seconds.

[Vaginismus and our experience in treating this sexual problem].

PubMed

Sirakov, M

2013-01-01

According to various statistics from 4.2 to 42% of women in reproductive age, complained of a mild or severe problems in sexual function. The study presents own data on treatment of vaginismus in 14 girls and young women aged 16 to 36 years who have turned from 2007 to 2012 to the Cabinet Children and adolescent gynaecology at the University Hospital "Maychin dom". A primary examination established a high and tenacious hymen in 7 (50%) patients. The patients demonstrated fear, but still allowed careful examination. At 3 girls (21.43%) a combined cause of complaints was found. They demonstrated fear of pain during coitus and reported bad memory of the first sexual attempts; they had high and tenacious hymen and were able to tolerate touching the vulva after much persusions. In 3 (21.43%) patients consequences of puritan education were registered. They did not allowed to touch the vulva despite the declaration that would allow such. In one patients (7.14%) a unstretchable vagina was found. She demonstrated dyspareunia (avoiding intercourse and having one failed marriage) but she tolerated penetration of her vagina of one phalanx. In all cases of vaginismus we performed educational lectures and artefitial defloration.

Pelvic floor physical therapy for lifelong vaginismus: a retrospective chart review and interview study.

PubMed

Reissing, Elke D; Armstrong, Heather L; Allen, Caroline

2013-01-01

Pelvic floor physical therapy is used in the treatment of sexual pain disorders; however, women with lifelong vaginismus have not yet been included in treatment studies or have not been differentiated from women with acquired vaginismus and/or dyspareunia. This retrospective chart review and interview study was intended to obtain initial information on physical therapy interventions, course, and outcome in women who have never been able to experience vaginal intercourse. The files of 53 women, consecutively treated at one physical therapy clinic, were included in the chart review; 13 of these women volunteered to be interviewed. The chart review revealed significant pelvic floor pathology and an average treatment course of 29 sessions. Internal manual techniques were found to be most effective, followed by patient education, dilatation exercises, and home exercises. Although participants were very satisfied with the physical therapy, some symptoms, such as pain, anxiety/fear, and pelvic floor tension remained and scores on the Female Sexual Distress Scale and Female Sexual Function Index indicated clinical levels of sexual distress and impaired sexual function after treatment. Although there appears to be no linear relation between symptom reduction and healthy sexual function, this initial information suggests that physical therapy may be a promising treatment option for some women with lifelong vaginismus and merits further evaluation.

Vaginismus: review of current concepts and treatment using botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia.

PubMed

Pacik, Peter T

2011-12-01

Vaginismus is a poorly understood condition affecting approximately 1-7% of females worldwide. This article aims to bring attention to this disorder and to review the use of Botox injections to treat these patients. Vaginismus, also known as vaginal penetration disorder, is an aversion to any form of vaginal penetration as a result of painful attempts and a fear of anticipated pain. It is involuntary and uncontrolled and functions much the same as any reflex to avoid injury. It is the most common reason for unconsummated marriages. The etiology is thought to be unknown. Numerous papers note a history of religious or strict sexual upbringing or aversion to penetration because of perceived pain and bleeding with first-time intercourse. Sexual molestation may be more prevalent in this group of patients. The Lamont classification is very helpful in stratifying these patients for treatment. Lamont grade 5 vaginismus is introduced. Vaginal Botox injections for the treatment of vaginismus has received increasing attention since the technique was first described in a 1997 case report. Plastic surgeons worldwide with their experience using Botox are well positioned to learn more about this relatively unknown entity and render treatment.

Connections between primary vaginismus and procreation: some observations from clinical practice.

PubMed

Drenth, J J; Andriessen, S; Heringa, M P; Mourits, M J; van de Wiel, H B; Weijmar Schultz, W C

1996-12-01

So far, the literature on vaginismus has mainly been contemplative. Quantitative data are scarce, while fertility and obstetrical aspects are almost never considered. In this article, these two aspects are addressed. A cohort of patients received a questionnaire, developed to obtain information about possible connections between the vaginistic reaction, the patient's treatment goals and, if relevant, obstetrical characteristics. Our data reveal that the desire to have a child is not a negative predictor for treatment outcome in terms of consummation. In some instances, however, self-insemination, as a bedroom procedure, is an effective treatment option to enable the couple to reach their fertility goal. Some women will conceive without intercourse experience; according to our data, delivery in this group is hardly more problematic than in a group of women who, after treatment for vaginismus, conceived by sexual intercourse. Having delivered a child may have a slightly positive effect on the capability to have intercourse, but only in a minority. Obstetricians should be aware that not infrequently, women give birth who suffer from severe penetration phobias.

[Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve].

PubMed

Carvalho, Joana Chaves Gonçalves Rodrigues de; Agualusa, Luís Miguel; Moreira, Luísa Manuela Ribeiro; Costa, Joana Catarina Monteiro da

Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Addressing anxiety in vivo in physiotherapy treatment of women with severe vaginismus: a clinical approach.

PubMed

Rosenbaum, Talli

2011-01-01

Physiotherapy for the treatment of vaginismus is perceived as an intervention aimed to normalize muscle tone of the pelvic floor in order to allow vaginal penetration in accordance with the traditional view of vaginal spasm as its defining feature. Newer definitions recognize the experience of anxiety as well as pain, and effective treatment approaches should address these components as well. Physiotherapists often encounter women who, as a result of severe anxiety, are unable to undergo examination and treatment, despite their expressed desire to do so. This article describes a therapeutic intervention designed to help women with vaginismus prepare for examination and treatment by addressing the component of anxiety in real-life situations. This approach is also appropriate for nurse practitioners and physicians who work with this patient population and may be adapted for sex therapists to teach as a home exercise.

The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus.

PubMed

van der Velde, J; Everaerd, W

2001-04-01

This study assessed the relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Information about this relationship may help understand the mechanism of vaginismus. Twenty-two women with vaginismus and seven control women participated in the study. Women were exposed to four emotion-inducing film excerpts. Vaginal electromyography was recorded. Experienced threat was continuously monitored with the use of a lever. Women responded with increased pelvic floor muscle activity to the threatening and sexually-threatening film excerpt. No changes occurred during the neutral and erotic excerpt. The subjective experienced threat as indicated with the lever showed the same response pattern. However, awareness of changes in muscle activity showed a slightly different pattern. Individual data were inspected. In general, agreement was found between recorded changes in muscle activity and experienced threat. The results of the erotic excerpt showed that awareness of changes in muscle activity is not only determined by information from the pelvic floor muscles, but also by other factors like situational information and the expectations of the women. The data support the idea of a general defense reaction as a mechanism of involuntary pelvic floor muscle activity.

Brain processing of visual stimuli representing sexual penetration versus core and animal-reminder disgust in women with lifelong vaginismus.

PubMed

Borg, Charmaine; Georgiadis, Janniko R; Renken, Remco J; Spoelstra, Symen K; Weijmar Schultz, Willibrord; de Jong, Peter J

2014-01-01

It has been proposed that disgust evolved to protect humans from contamination. Through eliciting the overwhelming urge to withdraw from the disgusting stimuli, it would facilitate avoidance of contact with pathogens. The physical proximity implied in sexual intercourse provides ample opportunity for contamination and may thus set the stage for eliciting pathogen disgust. Building on this, it has been argued that the involuntary muscle contraction characteristic of vaginismus (i.e., inability to have vaginal penetration) may be elicited by the prospect of penetration by potential contaminants. To further investigate this disgust-based interpretation of vaginismus (in DSM-5 classified as a Genito-Pelvic Pain/Penetration Disorder, GPPPD) we used functional magnetic resonance imaging (fMRI) to examine if women with vaginismus (n = 21) show relatively strong convergence in their brain responses towards sexual penetration- and disgust-related pictures compared to sexually asymptomatic women (n = 21) and women suffering from vulvar pain (dyspareunia/also classified as GPPPD in the DSM-5, n = 21). At the subjective level, both clinical groups rated penetration stimuli as more disgusting than asymptomatic women. However, the brain responses to penetration stimuli did not differ between groups. In addition, there was considerable conjoint brain activity in response to penetration and disgust pictures, which yield for both animal-reminder (e.g., mutilation) and core (e.g., rotten food) disgust domains. However, this overlap in brain activation was similar for all groups. A possible explanation for the lack of vaginismus-specific brain responses lies in the alleged female ambiguity (procreation/pleasure vs. contamination/disgust) toward penetration: generally in women a (default) disgust response tendency may prevail in the absence of sexual readiness. Accordingly, a critical next step would be to examine the processing of penetration stimuli following the

Brain Processing of Visual Stimuli Representing Sexual Penetration versus Core and Animal-Reminder Disgust in Women with Lifelong Vaginismus

PubMed Central

Borg, Charmaine; Georgiadis, Janniko R.; Renken, Remco J.; Spoelstra, Symen K.; Weijmar Schultz, Willibrord; de Jong, Peter J.

2014-01-01

It has been proposed that disgust evolved to protect humans from contamination. Through eliciting the overwhelming urge to withdraw from the disgusting stimuli, it would facilitate avoidance of contact with pathogens. The physical proximity implied in sexual intercourse provides ample opportunity for contamination and may thus set the stage for eliciting pathogen disgust. Building on this, it has been argued that the involuntary muscle contraction characteristic of vaginismus (i.e., inability to have vaginal penetration) may be elicited by the prospect of penetration by potential contaminants. To further investigate this disgust-based interpretation of vaginismus (in DSM-5 classified as a Genito-Pelvic Pain/Penetration Disorder, GPPPD) we used functional magnetic resonance imaging (fMRI) to examine if women with vaginismus (n = 21) show relatively strong convergence in their brain responses towards sexual penetration- and disgust-related pictures compared to sexually asymptomatic women (n = 21) and women suffering from vulvar pain (dyspareunia/also classified as GPPPD in the DSM-5, n = 21). At the subjective level, both clinical groups rated penetration stimuli as more disgusting than asymptomatic women. However, the brain responses to penetration stimuli did not differ between groups. In addition, there was considerable conjoint brain activity in response to penetration and disgust pictures, which yield for both animal-reminder (e.g., mutilation) and core (e.g., rotten food) disgust domains. However, this overlap in brain activation was similar for all groups. A possible explanation for the lack of vaginismus-specific brain responses lies in the alleged female ambiguity (procreation/pleasure vs. contamination/disgust) toward penetration: generally in women a (default) disgust response tendency may prevail in the absence of sexual readiness. Accordingly, a critical next step would be to examine the processing of penetration stimuli following the

Development and initial validation of the vaginal penetration cognition questionnaire (VPCQ) in a sample of women with vaginismus and dyspareunia.

PubMed

Klaassen, Maaike; Ter Kuile, Moniek M

2009-06-01

Although the relevance of cognitions has been implicated in the etiology, explanatory models, and treatment of female sexual pain disorders, an instrument that assesses vaginal penetration cognitions is nonexistent. The aim of this study was to develop and to investigate the psychometric properties of the Vaginal Penetration Cognition Questionnaire (VPCQ). The VPCQ was explicitly designed to assess cognitions regarding vaginal penetration in women with vaginismus and dyspareunia. A sample of 247 Dutch women with a female sexual dysfunction (FSD; 122 women with lifelong vaginismus and 125 women with dyspareunia) and 117 women without sexual complaints completed the questionnaire. Factor analyses were only conducted in the sample of women with FSD. Validation measures were conducted in both women with and without FSD. All women completed the VPCQ and several additional questions regarding biographic and complaint characteristics. Conduction of factor analyses yielded five subscales regarding cognitions about vaginal penetration: "control cognitions,"catastrophic and pain cognitions,"self-image cognitions,"positive cognitions," and "genital incompatibility cognitions." Reliability of these five VPCQ subscales ranged from 0.70 to 0.83, and the test-retest correlations were satisfactory. The five VPCQ subscales were reasonably stable across demographic variables and demonstrated good discriminant validity. All five subscales were able to detect significant differences between women with and without FSD. Additionally, the four subscales of the VPCQ concerning negative cognitions demonstrated the ability to differentiate between the two samples of women with FSD. Women with lifelong vaginismus reported lower levels of perceived penetration control and higher levels of catastrophic and pain cognitions, negative self-image cognitions, and genital incompatibility cognitions, when compared with women with dyspareunia. The present study indicates that the VPCQ is a valid and

Cognitive-behavioral therapy for women with lifelong vaginismus: a randomized waiting-list controlled trial of efficacy.

PubMed

van Lankveld, Jacques J D M; ter Kuile, Moniek M; de Groot, H Ellen; Melles, Reinhilde; Nefs, Janneke; Zandbergen, Maartje

2006-02-01

Women with lifelong vaginismus (N=117) were randomly assigned to cognitive-behavioral group therapy, cognitive-behavioral bibliotherapy, or a waiting list. Manualized treatment comprised sexual education, relaxation exercises, gradual exposure, cognitive therapy, and sensate focus therapy. Group therapy consisted of ten 2-hr sessions with 6 to 9 participants per group. Assistance with minimal-contact bibliotherapy consisted of 6 biweekly, 15-min telephone contacts. Twenty-one percent of the participants left the study before posttreatment assessment. Intent-to-treat analysis revealed that successful intercourse at posttreatment was reported by 14% of the treated participants compared with none of the participants in the control condition. At the 12-month follow-up 21% of the group therapy participants and 15% of the bibliotherapy participants, respectively, reported successful intercourse. Cognitive-behavioral treatment of lifelong vaginismus was thus found to be efficacious, but the small effect size of the treatment warrants future efforts to improve the treatment. Copyright (c) 2006 APA, all rights reserved.

The frequency of sexual dysfunctions in male partners of women with vaginismus in a Turkish sample.

PubMed

Dogan, S; Dogan, M

2008-01-01

The aim of this investigation is to determine the sexual history traits, sexual satisfaction level and frequency of sexual dysfunctions in men whose partners have vaginismus. The study included 32 male partners of vaginismic patients, who presented at a psychiatry department. Subjects were evaluated by a semi-structured questionnaire. The questionnaire was developed by researchers for assessing sexually dysfunctional patients and included detailed questions with regard to socio-demographic variables, general medical and sexual history. All participants also received the Golombok Rust Inventory of Sexual Satisfaction (GRISS). According to DSM-IV-TR criteria, 65.6% of the investigated males were diagnosed with one or more sexual dysfunctions. The most common problem was premature ejaculation (50%) and the second one was erectile dysfunction (28%). The transformed GRISS subscale scores provided similar data. It is concluded that the assessment of sexual functions of males who have vaginismic partners should be an integral part of the management procedure of vaginismus for optimal outcome.

Cognitive-Behavioral Therapy for Women with Lifelong Vaginismus: A Randomized Waiting-List Controlled Trial of Efficacy

ERIC Educational Resources Information Center

Van Lankveld, Jacques J. D. M.; ter Kuile, Moniek M.; de Groot, H. Ellen; Melles, Reinhilde; Nefs, Janneke; Zandbergen, Maartje

2006-01-01

Women with lifelong vaginismus (N = 117) were randomly assigned to cognitive-behavioral group therapy, cognitive-behavioral bibliotherapy, or a waiting list. Manualized treatment comprised sexual education, relaxation exercises, gradual exposure, cognitive therapy, and sensate focus therapy. Group therapy consisted of ten 2-hr sessions with 6 to 9…

Women's experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study.

PubMed

Macey, Kat; Gregory, Angela; Nunns, David; das Nair, Roshan

2015-06-20

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. 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. 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

[Effect of Cognitive Behavioral Therapy on Sexual Satisfaction, Marital Adjustment, and Levels of Depression and Anxiety Symptoms in Couples with Vaginismus].

PubMed

Şafak Öztürk, Cennet; Arkar, Haluk

2017-01-01

The aim of this study was to assess the effect of Cognitive Behavioral Therapy (CBT) on sexual functions of women with vaginismus and their husbands, their marital adjustment, and their levels of depression and anxiety symptoms. Twenty-six couples diagnosed as vaginismus according to DSM-IV-TR diagnostic criteria in gynecology outpatient clinics of Izmir Ege Maternity Hospital and Gynecological Diseases Training and Research Hospital were included in the study. The couples were treated with CBT through 50-minute sessions once a week. Pre- and post-treatment, all couples were assessed using a Personal Information Form, Golombok-Rust Inventory of Sexual Satisfaction, Dyadic Adjustment Scale, Beck Depression Inventory, and Beck Anxiety Inventory. There were significant differences in the total and all subscales' scores of sexual functions, significant increase in the marital adjustment, and a significant decrease in anxiety and depression symptom levels after CBT in women who completed the therapy (n = 20). In the husbands, significant recoveries were observed after the therapy in sexual functions total scores and subscales of satisfaction, avoidance, and impotence. However, there was no change in frequency, communication, sensuality, and in the premature ejaculation domains. Also, the marital adjustment scores increased, and significant decreases were observed in depression and anxiety symptom levels. It was observed that CBT is an appropriate therapy approach for vaginismus, and beneficial effects were observed in both women and their husbands in sexual functions, marital adjustment, and levels of depression and anxiety symptoms decreased.

Attentional Bias for Pain and Sex, and Automatic Appraisals of Sexual Penetration: Differential Patterns in Dyspareunia vs Vaginismus?

PubMed

Melles, Reinhilde J; Dewitte, Marieke D; Ter Kuile, Moniek M; Peters, Madelon M L; de Jong, Peter J

2016-08-01

Current information processing models propose that heightened attention bias for sex-related threats (eg, pain) and lowered automatic incentive processes ("wanting") may play an important role in the impairment of sexual arousal and the development of sexual dysfunctions such as genitopelvic pain/penetration disorder (GPPPD). Differential threat and incentive processing may also help explain the stronger persistence of coital avoidance in women with vaginismus compared to women with dyspareunia. As the first aim, we tested if women with GPPPD show (1) heightened attention for pain and sex, and (2) heightened threat and lower incentive associations with sexual penetration. Second, we examined whether the stronger persistence of coital avoidance in vaginismus vs dyspareunia might be explained by a stronger attentional bias or more dysfunctional automatic threat/incentive associations. Women with lifelong vaginismus (n = 37), dyspareunia (n = 29), and a no-symptoms comparison group (n = 51) completed a visual search task to assess attentional bias, and single target implicit-association tests to measure automatic sex-threat and sex-wanting associations. There were no group differences in attentional bias or automatic associations. Correlational analysis showed that slowed detection of sex stimuli and stronger automatic threat associations were related to lowered sexual arousal. The findings do not corroborate the view that attentional bias for pain or sex contributes to coital pain, or that differences in coital avoidance may be explained by differences in attentional bias or automatic threat/incentive associations. However, the correlational findings are consistent with the view that automatic threat associations and impaired attention for sex stimuli may interfere with the generation of sexual arousal. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Psychobiological Correlates of Vaginismus: An Exploratory Analysis.

PubMed

Maseroli, Elisa; Scavello, Irene; Cipriani, Sarah; Palma, Manuela; Fambrini, Massimiliano; Corona, Giovanni; Mannucci, Edoardo; Maggi, Mario; Vignozzi, Linda

2017-11-01

Evidence concerning the determinants of vaginismus (V), in particular medical conditions, is inconclusive. 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. 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. 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. 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). Our data demonstrate that some novel contributors of V should be investigated, namely histrionic

Therapy of vaginismus by hypnotic desensitization.

PubMed

Fuchs, K

1980-05-01

Fear and anxiety are of tremendous importance in the production and maintenance of a symptom. Vaginismus, as a reaction of avoidance of an anxiety-producing situation, is readily amenable to treatment by systematic desensitization. This may proceed mainly in two ways: "in vitro" or "in vivo." In order to strengthen and speed up the densensitization process, we used hypnotic techniques in a dynamic approach. The "in vitro" treatment proceeds with imagery, under hypnosis, of an "anxiety hierarchy" of increasingly erotic and sexually intimate situations which will be reproduced at home with the partner, until sexual intercourse is achieved. In the "in vivo" method the patient learns self-hypnosis and then inserts in the vagina first a finger, and then Hegar dilators of gradually increasing sizes. The partner, the patient, and the physician will then successively proceed to insertion, forming a team-referred work situation. This continues until the "female superior position," practiced first with the largest dilator, is reproduced at home by intercourse. Between 1965 and 1974 we treated 71 women with this method. Good results were obtained in 16 of 18 by the "in vitro" technique and in 53 of 54 by the "in vivo" technique. One patient was referred from the "in vitro" group to the "in vivo" group. In follow-up of 2 to 5 years there was no relapse or symptom substitution.

Long-term coital behaviour in women treated with cognitive behaviour therapy for superficial coital pain and vaginismus.

PubMed

Engman, Maria; Wijma, Klaas; Wijma, Barbro

2010-01-01

The purpose of the present study was to investigate long-term coital behaviour in women treated with cognitive behaviour therapy (CBT) for superficial coital pain and vaginismus. Data were taken from a questionnaire concerning long-term coital behaviour sent to 59 women who presented to Linköping University Hospital because of superficial coital pain, had been diagnosed with vaginismus, and had been treated with CBT. Data were also traced from therapy records: mean follow-up time was 39 months, the women had suffered for an average of almost 4 years, and required a mean of 14 treatment sessions. Forty-four of the 59 women returned the questionnaire, for a response rate of 74.6%. At follow-up, 81% of the treated women had had intercourse. A majority (61%) rated their ability to have intercourse without pain as 6 or higher (on a scale from 0-10), and 61% rated their ability to enjoy intercourse as 6 or higher (on a scale from 0-10). The proportion of women with positive treatment outcome at follow-up ranged from 81% (able to have intercourse) to 6% (able to have pain-free intercourse). An ability to have intercourse at end of therapy was maintained at follow-up. Two-thirds of the women reported high fulfillment of individual treatment goals. At follow-up, the women estimated a significantly higher self-worth as sex partners, and as women and human beings, than before treatment. Twelve per cent of the original sample had healed after a few assessment sessions and without treatment.

Post-coital burning pain and pain at micturition: early symptoms of partial vaginismus with or without vulvar vestibulitis?

PubMed

Engman, Maria; Wijma, Klaas; Wijma, Barbro

2008-01-01

Twenty-four women with partial vaginismus with or without vulvar vestibulitis participated in a semi-structured telephone interview concerning early signs and development of their pain symptoms during/after intercourse. At the onset of the problem, pain after intercourse was more common than pain during penetration. Pain intensity during penetration increased from the onset of the problem to when the women ceased having intercourse. Pain during penetration lasted for 1 minute, and was most often described as sharp/incisive/bursting, while pain after intercourse had a duration of 2 hours and was described as burning and/or smarting. Post-coital pain during micturition was described by 70% of the women.

Unconsummated marriage: can it still be considered a consequence of vaginismus?

PubMed

Michetti, P M; Silvaggi, M; Fabrizi, A; Tartaglia, N; Rossi, R; Simonelli, C

2014-01-01

Unconsummated marriage (UM) is the failure to perform successful sexual intercourse at the beginning of the marriage. Vaginismus has been traditionally reported as the leading cause. ED is also a leading cause for UM. This appears to be a significant problem in the conservative middle-Eastern societies and in the developing countries, where couples are strongly prevented by religious rules and cultural taboos from sexual experiences before wedding. One could think that according to major sexual freedom and information, in Western countries UM is now disappearing, but the number of observed cases by the authors in 2008-2012 was relevant. The aim of this study is to compare the literature data from non-Western countries with the features of UM in Western ones, focusing on cases observed by the authors, and to verify whether the etiology of UM proposed in the '70s is still relevant, outlining any changes that occur in current reality. In our series, traditional appearance of UM is no more effective, while the role of man is undervalued, because of his frailty, lack of self-confidence and ignorance, expressing a social and cultural change of man's role in the couple.

Development and validation of the multidimensional vaginal penetration disorder questionnaire (MVPDQ) for assessment of lifelong vaginismus in a sample of Iranian women

PubMed Central

Molaeinezhad, Mitra; Roudsari, Robab Latifnejad; Yousefy, Alireza; Salehi, Mehrdad; Khoei, Effat Merghati

2014-01-01

Background: Vaginismus is considered as one of the most common female psychosexual dysfunctions. Although the importance of using a multidisciplinary approach for assessment of vaginal penetration disorder is emphasized, the paucity of instruments for this purpose is clear. We designed a study to develop and investigate the psychometric properties of a multidimensional vaginal penetration disorder questionnaire (MVPDQ), thereby assisting specialists for clinical assessment of women with lifelong vaginismus (LLV). Materials and Methods: MVPDQ was developed using the findings from a thematic qualitative research conducted with 20 unconsummated couples from a former study, which was followed by an extensive literature review. Then, during a cross-sectional design, a consecutive sample of 214 women, who were diagnosed as LLV based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR criteria completed MVPDQ and additional questions regarding their demographic and sexual history. Validation measures and reliability were tested by exploratory factor analysis and Cronbach's alpha coefficient via Statistical Package for the Social Sciences (SPSS) version 16. Results: After conducting exploratory factor analysis, MVPDQ emerged with 72 items and 9 dimensions: Catastrophic cognitions and tightening, helplessness, marital adjustment, hypervigilance, avoidance, penetration motivation, sexual information, genital incompatibility, and optimism. Subscales of MVPDQ showed a significant reliability that varied between 0.70 and 0.87 and results of test–retest were satisfactory. Conclusion: The present study shows that MVPDQ is a valid and reliable self-report questionnaire for clinical assessment of women complaining of LLV. This instrument may assist specialists to make a clinical judgment and plan appropriately for clinical management. PMID:25097607

Development and validation of the multidimensional vaginal penetration disorder questionnaire (MVPDQ) for assessment of lifelong vaginismus in a sample of Iranian women.

PubMed

Molaeinezhad, Mitra; Roudsari, Robab Latifnejad; Yousefy, Alireza; Salehi, Mehrdad; Khoei, Effat Merghati

2014-04-01

Vaginismus is considered as one of the most common female psychosexual dysfunctions. Although the importance of using a multidisciplinary approach for assessment of vaginal penetration disorder is emphasized, the paucity of instruments for this purpose is clear. We designed a study to develop and investigate the psychometric properties of a multidimensional vaginal penetration disorder questionnaire (MVPDQ), thereby assisting specialists for clinical assessment of women with lifelong vaginismus (LLV). MVPDQ was developed using the findings from a thematic qualitative research conducted with 20 unconsummated couples from a former study, which was followed by an extensive literature review. Then, during a cross-sectional design, a consecutive sample of 214 women, who were diagnosed as LLV based on Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR criteria completed MVPDQ and additional questions regarding their demographic and sexual history. Validation measures and reliability were tested by exploratory factor analysis and Cronbach's alpha coefficient via Statistical Package for the Social Sciences (SPSS) version 16. After conducting exploratory factor analysis, MVPDQ emerged with 72 items and 9 dimensions: Catastrophic cognitions and tightening, helplessness, marital adjustment, hypervigilance, avoidance, penetration motivation, sexual information, genital incompatibility, and optimism. Subscales of MVPDQ showed a significant reliability that varied between 0.70 and 0.87 and results of test-retest were satisfactory. The present study shows that MVPDQ is a valid and reliable self-report questionnaire for clinical assessment of women complaining of LLV. This instrument may assist specialists to make a clinical judgment and plan appropriately for clinical management.

Validation of the partner version of the multidimensional vaginal penetration disorder questionnaire: A tool for clinical assessment of lifelong vaginismus in a sample of Iranian population.

PubMed

Molaeinezhad, Mitra; Khoei, Effat Merghati; Salehi, Mehrdad; Yousfy, Alireza; Roudsari, Robab Latifnejad

2014-01-01

The role of spousal response in woman's experience of pain during the vaginal penetration attempts believed to be an important factor; however, studies are rather limited in this area. The aim of this study was to develop and investigate the psychometric indexes of the partner version of a multidimensional vaginal penetration disorder questionnaire (PV-MVPDQ); hence, the clinical assessment of spousal psychosexual reactions to vaginismus by specialists will be easier. A mixed-methods sequential exploratory design was used, through that, the findings from a thematic qualitative research with 20 unconsummated couples, which followed by an extensive literature review used for development of PV-MVPDQ. A consecutive sample of 214 men who their wives' suffered from lifelong vaginismus (LLV) based on Diagnostic and Statistical Manual of Mental Disorders 4(th) version (DSM)-IVTR criteria during a cross-sectional design, completed the questionnaire and additional questions regarding their demographic and sexual history. Validation measures and reliability were conducted by exploratory factor analysis (EFA) and Cronbach's alpha coefficient through SPSS version 16 manufactured by SPSS Inc. (IBM corporation, Armonk, USA). After conducting EFA PV-MVPDQ emerged as having 40 items and 7 dimensions: Helplessness, sexual information, vicious cycle of penetration, hypervigilance and solicitous, catastrophic cognitions, sexual and marital adjustment and optimism. Subscales of PV-MVPDQ showed a significant reliability (0.71-0.85) and results of test-retest were satisfactory. The present study shows PV-MVPDQ is a multi-dimensional valid and reliable self-report questionnaire for assessment of cognitions, sexual and marital relations related to vaginal penetrations in spouses of women with LLV. It may assist specialists to base on which clinical judgment and appropriate planning for clinical management.

Validation of the partner version of the multidimensional vaginal penetration disorder questionnaire: A tool for clinical assessment of lifelong vaginismus in a sample of Iranian population

PubMed Central

Molaeinezhad, Mitra; Khoei, Effat Merghati; Salehi, Mehrdad; Yousfy, Alireza; Roudsari, Robab Latifnejad

2014-01-01

Background: The role of spousal response in woman's experience of pain during the vaginal penetration attempts believed to be an important factor; however, studies are rather limited in this area. The aim of this study was to develop and investigate the psychometric indexes of the partner version of a multidimensional vaginal penetration disorder questionnaire (PV-MVPDQ); hence, the clinical assessment of spousal psychosexual reactions to vaginismus by specialists will be easier. Materials and Methods: A mixed-methods sequential exploratory design was used, through that, the findings from a thematic qualitative research with 20 unconsummated couples, which followed by an extensive literature review used for development of PV-MVPDQ. A consecutive sample of 214 men who their wives’ suffered from lifelong vaginismus (LLV) based on Diagnostic and Statistical Manual of Mental Disorders 4th version (DSM)-IVTR criteria during a cross-sectional design, completed the questionnaire and additional questions regarding their demographic and sexual history. Validation measures and reliability were conducted by exploratory factor analysis (EFA) and Cronbach's alpha coefficient through SPSS version 16 manufactured by SPSS Inc. (IBM corporation, Armonk, USA). Results: After conducting EFA PV-MVPDQ emerged as having 40 items and 7 dimensions: Helplessness, sexual information, vicious cycle of penetration, hypervigilance and solicitous, catastrophic cognitions, sexual and marital adjustment and optimism. Subscales of PV-MVPDQ showed a significant reliability (0.71-0.85) and results of test-retest were satisfactory. Conclusion: The present study shows PV-MVPDQ is a multi-dimensional valid and reliable self-report questionnaire for assessment of cognitions, sexual and marital relations related to vaginal penetrations in spouses of women with LLV. It may assist specialists to base on which clinical judgment and appropriate planning for clinical management. PMID:25540787

Predictors of task-persistent and fear-avoiding behaviors in women with sexual pain disorders.

PubMed

Brauer, Marieke; Lakeman, Mariëlle; van Lunsen, Rik; Laan, Ellen

2014-12-01

Dyspareunia and vaginismus are the most common sexual pain disorders (SPDs). Literature suggests that many women with dyspareunia continue with intercourse despite pain (task persistence), whereas many women with vaginismus avoid penetrative activities that may cause pain (fear avoidance). Both forms of sexual pain behavior may maintain or aggravate complaints. This study examined (i) whether women with SPD differ from pain-free controls in motives for sexual intercourse, sexual autonomy, maladaptive beliefs regarding vaginal penetration, and partner responses to pain; and (ii) which of these factors best predict whether women with SPD stop or continue painful intercourse (attempts). Women with superficial dyspareunia (n = 50), women with lifelong vaginismus (n = 20), and pain-free controls (n = 45) completed questionnaires. For Aim 1, the main outcome measures were (i) motives for intercourse; (ii) sexual autonomy; (iii) maladaptive beliefs regarding vaginal penetration; and (iv) partner responses to pain. For Aim 2, sexual pain behavior (to continue or discontinue with painful intercourse) was the outcome measure. (i) Women with dyspareunia exhibited more mate guarding and duty/pressure motives for intercourse and were less sexually autonomous than controls. (ii) Symptomatic women had more maladaptive penetration-related beliefs than controls, with women with vaginismus reporting the strongest maladaptive beliefs. (iii) Partners of women with dyspareunia self-reported more negative responses to pain than those of women with vaginismus. (iv) The factors that best predicted sexual pain behavior were the partner responses to pain and the woman's maladaptive beliefs regarding vaginal penetration. Our findings reveal support for task persistence in women with dyspareunia and fear avoidance in women with lifelong vaginismus. As such, it is important to consider these distinct types of responding to sexual pain when treating SPD. © 2014 International

The Sexual Disgust Questionnaire; a psychometric study and a first exploration in patients with sexual dysfunctions.

PubMed

van Overveld, Mark; de Jong, Peter J; Peters, Madelon L; van Lankveld, Jacques; Melles, Reinhilde; ter Kuile, Moniek M

2013-02-01

Disgust may be involved in sexual problems by disrupting sexual arousal and motivating avoidance of sexual intercourse. To test whether heightened disgust for sexual contaminants is related to sexual dysfunctions, the Sexual Disgust Questionnaire (SDQ) has recently been developed. Previous research showed that particularly women with vaginismus display a generally heightened dispositional disgust propensity and heightened disgust toward stimuli depicting sexual intercourse. To determine the psychometric properties of the SDQ and test whether heightened disgust toward sexual stimuli is specific to vaginismus or can be observed in other sexual dysfunctions as well. First, a large sample of undergraduates and university employees completed the SDQ (N = 762) and several trait disgust indices. Next, women with vaginismus (N = 39), dyspareunia (N = 45), and men with erectile disorder (N = 28) completed the SDQ and were compared to participants without sexual problems (N = 70). SDQ to index sexual disgust. The SDQ proved a valid and reliable index to establish disgust propensity for sexual stimuli. Supporting construct validity of the SDQ, sexual disgust correlated with established trait indices. Furthermore, sexual disgust and willingness to handle sexually contaminated stimuli were associated with sexual functioning in women, but not in men. Specifically women with vaginismus displayed heightened sexual disgust compared to women without sexual problems, while men with erectile disorders demonstrated a lower willingness to handle sexually contaminated stimuli compared to men without sexual problems. The SDQ appears a valid and reliable measure of sexual disgust. The pattern of SDQ-scores across males and females with and without sexual dysfunctions corroborates earlier research suggesting that disgust appraisals are involved especially in vaginismus and supports the view that the difficulty with vaginal penetration experienced by women in vaginismus may partly be due to

Vaginismus

MedlinePlus

... made up of a gynecologist, physical therapist, and sexual counselor can help with treatment. Treatment involves a combination of physical therapy, education, counseling, and exercises such as pelvic floor muscle contraction ...

Fear of Vaginal Penetration in the Absence of Pain as a Separate Category of Female Sexual Dysfunction: A Conceptual Overview

PubMed Central

Rabinowitz, David; Lowenstein, Lior; Gruenwald, Ilan

2017-01-01

Functional sexual pain disorders in women are a particular challenge to the gynecologist, inasmuch as phobic avoidance and guarding on the part of the patient lead to difficulties in the gynecological examination and diagnosis. In some such cases examination may even be impossible. Vaginismus is the commonly diagnosed etiology of such cases. This article offers an overview of vaginismus and approaches to its treatment but also examines a subset of penetration-avoidant patients who do not appear to have a pain component. We have reviewed this separate category conceptually and clinically, and propose that this case subset be separated from the diagnosis of vaginismus and designated as vaginal penetration phobia (VPP). We further propose that this category be diagnosed as one of several possible presentations of phobic disorder, under the rubric of mental health disorder, and thus be separated from gynecology. The nosological implications are raised. PMID:28467769

Successful use of botulinum toxin type a in the treatment of refractory postoperative dyspareunia.

PubMed

Park, Amy J; Paraiso, Marie Fidela R

2009-08-01

Refractory dyspareunia presents a challenging therapeutic dilemma. A woman with defecatory dysfunction and dyspareunia presented with stage 2 prolapse. She underwent laparoscopic and vaginal pelvic floor reconstruction with excision of endometriosis. The patient experienced increased dyspareunia and de novo vaginismus postoperatively that were refractory to trigger point injections, physical therapy, and medical and surgical management. She underwent botulinum toxin type A injections into her levator ani muscles, which allowed her to have sexual intercourse again after 2 years of apareunia with no recurrence of pain for 12 months. Injecting botulinum toxin into the levator ani muscles shows promise for postoperative patients who develop vaginismus and do not respond to conservative therapy.

[Psychogenic purpura with hematuria and sexual pain disorder: a case report].

PubMed

Ozyildirim, Ilker; Yücel, Başak; Aktan, Melih

2010-01-01

Psychogenic purpura (Gardner-Diamond syndrome) is the occurrence and spontaneous recurrence of painful ecchymosis following emotional stress and minor trauma. Although the exact mechanism of this syndrome remains unknown, apart from skin lesions, different types of hemorrhaging have been reported, such as epistaxis, gastrointestinal bleeding, and bleeding from the ear canals and eyes. We report a psychogenic purpura case that presented with hematuria in addition to skin lesions. Based on the psychiatric evaluation she was diagnosed with major depressive disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Additionally, sexual pain disorder accompanied these disorders. With the help of antidepressant and supportive psychotherapy, the patient's ecchymosis and bleeding disappeared. During 8 months of follow-up the symptoms did not return. Vaginismus has not been reported in patients with psychogenic purpura. The presence of vaginismus, which is seen more frequently in eastern cultures and is thought to be related to sociocultural determinants, suggests that some cultural factors may be common to both psychogenic purpura and vaginismus. The aim of this case report was to call attention to a syndrome that is rarely seen and diagnosed, and to discuss its relationship to psychosocial factors. This syndrome should be considered in the differential diagnosis of not only ecchymotic lesions, but also various types of bleeding, including hematuria. Despite the fact that its etiology and treatment are not clearly understood, it should be noted that psychological factors play a role in this disease and therefore, psychopharmacological and psychotherapeutic approaches can be effective.

Internet-Based Guided Self-Help for Vaginal Penetration Difficulties: Results of a Randomized Controlled Pilot Trial.

PubMed

Zarski, Anna-Carlotta; Berking, Matthias; Fackiner, Christina; Rosenau, Christian; Ebert, David Daniel

2017-02-01

Difficulties with vaginal penetration can severely affect a woman's desire to have sexual intercourse, her sexual and general well-being, or her partnership. However, treatment opportunities for vaginismus are scarce. To evaluate the efficacy of an internet-based guided self-help intervention for vaginismus in a randomized controlled pilot trial. Seventy-seven women with vaginismus (primary inclusion criterion = no intercourse ≥ 6 months) were randomly assigned to an intervention group (IG) and a waitlist control group (WCG). The intervention consisted of 10 sessions involving psychoeducation, relaxation exercises, sensate focus, and gradual exposure with dilators. Participants received written feedback on completed sessions from an eCoach. The primary outcome was successful sexual intercourse. Secondary outcomes were non-intercourse penetration, fear of coitus, sexual functioning, and dyadic coping. Self-reported assessments were scheduled at baseline, 10 weeks, and 6 months. More participants (10 of 40, 34.48%) in the IG had intercourse compared with those in the WCG (6 of 37, 20.69%) at least once at 10 weeks or 6 months (odds ratio = 2.02). The difference was not significant (χ 2 1  = 1.38, P = .38), but in the IG, there was a significant increase in intercourse penetration from baseline to 6 months (d = 0.65). No such increase was found in the WCG (d = 0.21). There were significant between-group effects concerning non-intercourse penetration (self-insertion of a finger or dilator or insertion by the partner) in favor of the IG. Fear of coitus and dyadic coping significantly decreased in the IG. Overall satisfaction with the training was high. This randomized controlled trial showed promising effects of an internet-based intervention by increasing participants' ability to have intercourse and non-intercourse penetration while experiencing high treatment satisfaction. The WCG also showed improvement, although participants had vaginismus for an average

The DSM diagnostic criteria for dyspareunia.

PubMed

Binik, Yitzchak M

2010-04-01

The DSM-IV-TR attempted to create a unitary category of dyspareunia based on the criterion of genital pain that interfered with sexual intercourse. This classificatory emphasis of interference with intercourse is reviewed and evaluated from both theoretical and empirical points of view. Neither of these points of view was found to support the notion of dyspareunia as a unitary disorder or its inclusion in the DSM-V as a sexual dysfunction. It seems highly likely that there are different syndromes of dyspareunia and that what is currently termed "superficial dyspareunia" cannot be differentiated reliably from vaginismus. 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 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.

Latent structures of female sexual functioning.

PubMed

Carvalho, Joana; Vieira, Armando Luís; Nobre, Pedro

2012-08-01

For the last three decades, male and female sexual responses have been conceptualized as similar, based on separated and sequential phases as proposed by the models of Masters and Johnson (1966) and Kaplan (1979) model. However, there is a growing debate around the need to conceptualize female sexual response and the classification of sexual dysfunction in women, in view of the upcoming editions of the DSM and ICD. The aim of this study was to test, using structural equation modeling, five conceptual, alternative models of female sexual function, using a sample of women with sexual difficulties and a sample of women without sexual problems. A total of 1993 Portuguese women participated in the study and completed a modified version of the Female Sexual Function Index. Findings suggested a four-factor solution as the model that best fit the data regarding women presenting sexual difficulties: (1) desire/arousal; (2) lubrication; (3) orgasm; (4) pain/vaginismus. In relation to sexually healthy women, the best model was a five-factor solution comprising of (1) desire; (2) arousal; (3) lubrication; (4) orgasm; and (5) pain/vaginismus. Discriminant validity between factors was supported, suggesting that these dimensions measure distinct phenomena. Model fit to the data significantly decreased in both samples, as models began to successively consider greater levels of overlap among phases of sexual function, towards a single-factor solution. By suggesting the overlap between pain and vaginismus, results partially support the new classification that is currently being discussed regarding DSM-5. Additionally, results on the relationship between sexual desire and arousal were inconclusive as sexually healthy women were better characterized by a five-factor model that considered the structural independence among these factors, whereas women with sexual difficulties better fit with a four-factor model merging sexual desire and subjective sexual arousal.

Diagnosis and treatment of unconsummated marriage in an Iranian couple.

PubMed

Bokaie, Mahshid; Khalesi, Zahra Bostani; Yasini-Ardekani, Seyed Mojtaba

2017-09-01

Unconsummated marriage is a problem among couples who would not be able to perform natural sexual intercourse and vaginal penetration. This disorder is more common in developing countries and sometimes couples would come up with non-technical and non-scientific methods to overcome their problem. Multi-dimensional approach and narrative exposure therapy used in this case. This study would report a case of unconsummated marriage between a couple after 6 years. The main problem of this couple was vaginismus and post-traumatic stress. Treatment with multi-dimensional approach for this couple included methods like narrative exposure therapy, educating the anatomy of female and male reproductive system, correcting misconceptions, educating foreplay, educating body exploring and non-sexual and sexual massage and penetrating the vagina first by women finger and then men's after relaxation. The entire stages of the treatment lasted for four sessions and at the one-month follow-up couple's satisfaction was desirable. Unconsummated marriage is one of the main sexual problems; it is more common in developing countries than developed countries and cultural factors are effective on intensifying this disorder. The use of multi-dimensional approach in this study led to expedite diagnosis and treatment of vaginismus.

[Investigation of sexual problems in married people living in the center of Konya].

PubMed

Yilmaz, Ertan; Esra Zeytinci, Ismet; Sari, Serap; Fatih Karababa, Ibrahim; Savaş Cilli, Ali; Kucur, Rahim

2010-01-01

Sexual problems are widely encountered in community. While studies clinically performed concerning sexual problems in Turkey exist, there are no field studies related to sexual problems witnessed in both men and women. In this study, sexual problems in married population and the level of their sexual knowledge have been tried to be investigated. The cosmos of the study consisted of the whole married population between the ages of 18 and 60 and living in the province of Konya. Sociodemografic Information Form and Golombok-Rust Inventory of Sexual Satisfaction were performed in 945 subjects accepting to take part in the study and appropriate. Average age rate of the males taking part in the study was 38.5+/-9.5 and the same rate of women was 34.2+/-9.8. According to the findings provided via GRISS, the rate of erectile dysfunction (ED) in men was 14.5 %, the rate of premature ejeculation (PE) 29.3 %, the rate of anorgasmia in women was found to be 5.3 %,and the rate of vaginismus to be 15.3 %. Prevalence rates of PE, ED and anorgasmia in our sample was parallel to those provided from other countries at same age group. Vaginismus rate in our study is higher compared to other studies.

Pregnancy Outcome of Home Intravaginal Insemination in Couples with Unconsummated Marriage

PubMed Central

Banerjee, Kaberi; Singla, Bhavana

2017-01-01

Unconsummated marriage are mainly due to vaginismus or erectile dysfunction. They contribute to about 5% of couples in an infertility clinic. Their incidence is increasing in the metropolitan cities because of stressful lifestyles. Many of couples are advised intrauterine insemination as fertility treatment. However, home insemination is a simple, inexpensive and effective way of achieving pregnancy in such couples. We present the first study to document pregnancy rates of artificial home intravaginal insemination in couples with unconsummated marriage. Aim: To assess the pregnancy rates (PR) with intravaginal insemination (IVI) by couples with nonconsummation of marriage. Setting: Infertility outpatient clinic, New Delhi. Design: Retrospective analysis. Material and Methods: 55 couples of unconsummated marriage were evaluated in a period of two years. Group 1 contains 29 patients aged between 20 to 33 years; group 2 includes 14 patients aged between 33 to 36 years and group 3 includes 12 patients aged more than 36 years. Result(s): Unconsummated marriage was caused by vaginismus in 67% of the cases, erectile dysfunction in 22% and premature ejaculation in 11%. Clinical pregnancy rate was 69% in group 1; 43% in group 2 and 25% in group 3 after 6 cycles of AI. Conclusion(s): Intravaginal insemination is a simple, short, economical, effective and painless procedure for conception in nonconsummation of marriage. PMID:29430157

Sexual pain.

PubMed

Boardman, Lori A; Stockdale, Colleen K

2009-12-01

Sexual pain is an underrecognized and poorly treated constellation of disorders that significantly impact affected women and their partners. Recognized as a form of chronic pain, sexual pain disorders are heterogeneous and include dyspareunia (superficial and deep), vaginismus, vulvodynia, vestibulitis, and noncoital sexual pain disorder. Women too often tolerate pain in the belief that this will meet their partners' needs. This article provides a review of the terminology and definition of the condition, theories on the pathophysiology, diagnostic considerations, and recommendations on the management of female sexual pain.

Incidence of sexual dysfunction: a prospective survey in Ghanaian females

PubMed Central

2010-01-01

Background Sexuality is a complex phenomenon that is being influenced by psychological as well as physiological factors. Its dysfunction includes desire, arousal, orgasmic and sex pain disorders. The present study aimed to assess the incidence of sexual dysfunction (SD) and related risk factors in a cohort of Ghanaian women. Method The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was administered to 400 healthy women between 18 and 58 years old (mean +/- SD: 30.1 +/- 7.9) domiciled in the Kumasi metropolis. Results The response rate was 75.3% after 99 were excluded. Of the remaining 301 women, 50% were engaged in exercise, 26.7% indulge in alcoholic beverages and only 2% were smokers. A total of 62.1% of the women had attained high education, whilst, 28.9% were married. After logistic regression analysis, alcohol emerged (OR: 2.0; CI: 1.0 - 3.8; p = 0.04) as the main risk factor for SD. The overall prevalence of SD in these subjects was 72.8%. Severe difficulties with sexual function were identified in 3.3% of the studied population. The most prevalent areas of difficulty were anorgasmia (72.4%), sexual infrequency (71.4%), dissatisfaction (77.7%), vaginismus (68.1%), avoidance of sexual intercourse (62.5%), non-sensuality (61.5%) and non-communication (54.2%). Whereas 8% had severe difficulties with anorgasmia, only 6% had severe difficulties with vaginismus. Conclusion SD affects more than 70% of Ghanaian women who are sexually active. Alcohol significantly influences sexual activity. PMID:20809943

Preliminary Validation of a German Version of the Sexual Complaints Screener for Women in a Female Population Sample.

PubMed

Burri, Andrea; Porst, Hartmut

2018-06-01

To date, neither the original English nor any of the translated versions of the Sexual Complaints Screener for Women (SCS-W) have been tested for their psychometric properties. To evaluate the validity and utility of the German version of the SCS-W by assessing content, convergent, and discriminant validity. A population sample of 309 women (mean age = 26.9 years) completed the online survey and had matching data available on the SCS-W and the Female Sexual Function Index (FSFI). Spearman bivariate correlations between the SCS-W and FSFI domain scores and exploratory factor analysis with principal component analysis were conducted. Convergent validity was excellent for the domain of orgasm, good for satisfaction, dyspareunia, and the total questionnaire score, and acceptable for desire, lubrication, arousal, and vaginismus. Discriminant validity was present for all domains apart from arousal, lubrication, and vaginismus. Varimax rotation suggested an 8-factor model was the most robust. This brief screener seems suitable to provide a brief overview of female patients' sexual problems in a clinical setting. This is the 1st study to assess the psychometric properties of the German version of the SCS-W. However, available information on the psychometric properties of the German SCS-W was limited because the validity of the screener could not be counterchecked against a clinical diagnosis of female sexual dysfunction. Our results provide preliminary evidence of good validity of the German version of the SCS-W. Overall, the SCS-W can offer support for clinicians who are less familiar with sexual medicine and who might not routinely discuss sexual issues with their patients. Burri A, Porst H. Preliminary Validation of a German Version of the Sexual Complaints Screener for Women in a Female Population Sample. Sex Med 2018;6:123-130. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Managing pregnancy and delivery in women with sexual pain disorders.

PubMed

Rosenbaum, Talli Y; Padoa, Anna

2012-07-01

Vaginismus and dyspareunia most commonly affect women in their childbearing years, yet sexual function, and not childbirth, has been the focus of most research. The aim of this study is to discuss pregnancy and birth outcomes in women with sexual pain disorders (SPDs) and address practical concerns of patients and practitioners regarding management during pregnancy, pelvic examination, labor, and delivery. Review of the relevant literature and recommendations based on clinical expertise of the authors. A review of SPD, conception, and birth outcomes is provided as well as clinical recommendations for prenatal, labor, and delivery management of women with SPD. Practitioners involved in obstetrical care should be knowledgeable about SPD and provide appropriate modifications and interventions. © 2012 International Society for Sexual Medicine.

Concordance of sexual dysfunction and dissatisfaction by self-report and those by partner's perception in young adult couples.

PubMed

Gungor, S; Keskin, U; Gülsün, M; Erdem, M; Ceyhan, S T; Ergün, A

2015-07-01

We evaluated concordance levels of young adult spouses (N=107 couples, total N=214) with regards to sexual satisfaction by using Golombock-Rust Inventory of Sexual Satisfaction (GRISS). Each spouse of the couples filled out both female and male forms of the GRISS. Self- and spouse-reported scores were analyzed in terms of inter-rater correlation and agreement. The prevalence of overall sexual dissatisfaction was 10.3% and 26.2% in wives and husbands, respectively. The correlation coefficient (r) between the self-reported overall sexual satisfaction scores and those assessed by the spouses was 0.25 (P=0.014) and 0.04 (P=0.680) for wives and husbands, respectively. The sensitivity for perception of partner's sexual problems ranged 11% to 47%, and the specificity was around 64% to 100%, except for vaginismus, which had a sensitivity of 83% and a specificity of 25%. The prevalance-adjusted and bias-adjusted kappa (PABAK) value for overall sexual dissatisfaction reported by themselves and that assessed by their spouses was 0.68 and 0.16 for the wives and husbands, respectively. For specific female sexual problems, the PABAK value was the highest in female dissatisfaction (0.81) followed by anorgasmia (0.78), female avoidance (0.44), vaginismus (0.44), infrequency (0.33), non-communication (0.14) and female nonsensuality (0.14). For specific male sexual problems, the PABAK value was the highest in male nonsensuality (1.00), followed by male dissatisfaction (0.78), infrequency (0.46), non-communication (0.42), male avoidance (0.36), impotence (0.27) and premature ejaculation (-0.04). Our findings suggested that in this clinical sample the partner's perception of sexual dysfunction and dissatisfaction did not correlate well with the subject's self-reported sexual problems, and generally male sexual problems were less correctly perceived by the partners than were female sexual problems. This result may provide helpful information for clinicians who take care of patients

Anatomy of sex: Revision of the new anatomical terms used for the clitoris and the female orgasm by sexologists.

PubMed

Puppo, Vincenzo; Puppo, Giulia

2015-04-01

Sexual medicine experts and sexologists must spread certainties on the biological basis of the female orgasm to all women, not hypotheses or personal opinions. Therefore, they must use scientific anatomical terminology. The anatomy of the clitoris and the female orgasm are described in textbooks, but some researchers have proposed a new anatomical terminology for the sexual response in women. The internal/inner clitoris does not exist: the entire clitoris is an external organ. The clitoris is not composed of two arcs but of the glans, body, and crura or roots. "Clitoral bulbs" is an incorrect term from an embryological and anatomical viewpoint: the correct term is "vestibular bulbs." The bulbocavernosus muscles are implicated in inferior vaginismus, while the pubovaginal muscle is responsible for superior vaginismus. The clitoral or clitoris-urethro-vaginal complex has no embryological, anatomical and physiological support: the vagina has no anatomical relationship with the clitoris, and the clitoris is a perineal organ while the supposed G-spot is in the pelvic urethra. G-spot/vaginal/clitoral orgasm, vaginally activated orgasm, and clitorally activated orgasm, are incorrect terms: like "male orgasm," "female orgasm" is the correct term. The "vaginal" orgasm that some women report is always caused by the surrounding erectile organs (triggers of female orgasm). The male penis cannot come in contact with the venous plexus of Kobelt or with the clitoris during vaginal intercourse. Also, female ejaculation, premature ejaculation, persistent genital arousal disorder (PGAD), periurethral glans, vaginal-cervical genitosensory component of the vagus nerve, and G-spot amplification, are terms without scientific basis. Female sexual satisfaction is based on orgasm and resolution: in all women, orgasm is always possible if the female erectile organs, i.e. the female penis, are effectively stimulated during masturbation, cunnilingus, partner masturbation, or during vaginal

A Qualitative Study on Experiences After Vulvar Surgery in Women With Lichen Sclerosus and Sexual Pain.

PubMed

Brauer, Marieke; van Lunsen, Rik H W; Laan, Ellen T M; Burger, Matthé P M

2016-07-01

Lichen sclerosus (LS) of the vulva can profoundly affect sexual interaction because of painful fissures and narrowing of the vaginal introitus. Successful surgical treatment is usually defined as restoration of (pain-free) penetrative sexual activity. To evaluate the impact of surgery on (dyadic) sexual functioning and pleasure and psychological well-being. Nineteen women with anogenital LS participated in audiotaped, qualitative, individual interviews after surgery to re-enable sexual intercourse. Physical, sexual, and psychological experiences were analyzed using the constant comparative method. Vulvar surgery resulted in a decrease of sexual pain in 13 of 19 patients (68%). Of these 13 patients, 4 were completely free of pain and the other 9 patients expressed a shift from preoperative sexual pain to postoperative sexual discomfort. These women reported improved sexual functioning, increased sexual activity and intimacy with the partner, and reinstated feelings of being an adequate woman and sexual partner. In 1 of the 19 patients (5%), surgery did not result in decreased sexual pain, yet she continued to have intercourse. Five of the 19 patients (26%) stopped having intercourse because of pain; one woman had secondary vaginismus and another woman, in retrospect, had premorbid generalized unprovoked vulvodynia. Four of these women were unable to communicate with their partner about sexual matters and to change their sexual repertoire (satisfactorily) once they had ceased intercourse (attempts). Eighteen women (95%) reported a decrease of LS symptoms in daily life. Vulvar surgery seems an effective treatment for most women with LS who experience sexual pain owing to anatomic or epithelial changes and who wish to resume intercourse. To assess whether women might benefit from such surgery and/or whether (additional) sexual counseling is indicated, preoperative sexological couple-based consultation is needed. This consultation should exclude comorbid vaginismus and

Management of female sexual pain disorders.

PubMed

Boyer, Stéphanie C; Goldfinger, Corrie; Thibault-Gagnon, Stéphanie; Pukall, Caroline F

2011-01-01

Our understanding of the sexual pain disorders vaginismus and dyspareunia has been fundamentally altered over the past two decades due to increased attention and empirically sound research in this domain. This increased knowledge base has included a shift from a dualistic view of the etiology of painful and/or difficult vaginal penetration being due to either psychological or physiological causes, to a multifactorial perspective. The present chapter reviews current classification and prevalence rates, including ongoing definitional debates. Research regarding the etiology, assessment and management of sexual pain disorders is discussed from a biopsychosocial perspective. Cyclical theories of the development and maintenance of sexual pain disorders, which highlight the complex interplay among physiological, psychological and social factors, are described. Medical/surgical treatment options, pelvic floor rehabilitation and psychological approaches are reviewed, as well as future directions in treatment research. Copyright © 2011 S. Karger AG, Basel.

Psychological and psychosexual aspects of vulvar vestibulitis.

PubMed Central

Nunns, D; Mandal, D

1997-01-01

AIMS: To objectively assess the psychological and psychosexual morbidity of patients with vulvar vestibulitis. METHODS: 30 patients with variable degrees of vulvar vestibulitis were recruited from a vulval clinic. Each patient underwent a detailed history and clinical examination. Friedrich's criteria were used for the diagnosis of vulvar vestibulitis. Standardised questionnaires to assess psychological and psychosexual function were completed by the patient before review. These questionnaires were the STAI and a modified psychosexual questionnaire introduced by Campion. RESULTS: Patients experienced considerable psychological dysfunction compared with controls. All aspects of psychosexual dysfunction were affected. CONCLUSIONS: When managing patients, psychosexual and psychological issues must be considered in addition to other conventional types of therapy. Vulvar vestibulitis may be a risk factor for developing psychosexual complications including vaginismus, low libido, and orgasmic dysfunction. Consideration of these factors must be an integral part of the management of patients with all chronic vulval conditions. PMID:9582478

Sex therapy for female sexual dysfunction

PubMed Central

2013-01-01

Introduction About 45% of women suffer from some form of sexual dysfunction. Despite its high prevalence, there are few studies that have systematically evaluated sex therapy in comparison with other interventions. Objective Review randomized clinical trials that present psychotherapeutic interventions for female sexual dysfunctions. Method Through a search in three databases (Medline, Web of Science and PsycInfo), 1419 references were found. After an analysis of the abstracts, twenty-seven articles met the inclusion criteria and composed this review. Results Sex therapy, as proposed by Masters and Johnson and Heiman and LoPiccolo, is still the most commonly used form of therapy for sexual dysfunctions; although it has shown results, the results do not consistently support that this is the best alternative in the treatment of sexual dysfunctions. Conclusion There is a lack of systematic study of many female sexual dysfunctions. Orgasmic disorder and sexual pain (vaginismus and dyspaurenia) are the most extensively studied disorders and those in which sex therapy seems to have better outcomes. PMID:24066697

Somatoform and psychoform dissociation among women with orgasmic and sexual pain disorders.

PubMed

Farina, Benedetto; Mazzotti, Eva; Pasquini, Paolo; Mantione, Maria Giuseppina

2011-01-01

Since the 20th century, psychogenic female sexual dysfunctions (FSD), like some somatoform and conversion disorders, have been considered an expression of somatoform dissociation. Several studies have reported dissociative symptoms in different somatoform and conversion disorders, but limited data are available on dissociation among patients with FSD. The aim of this study was to assess somatoform and psychoform dissociation among patients with women's orgasmic disorder, dyspareunia, and vaginismus. A battery of self-administered questionnaires (Somatoform Dissociation Questionnaire, Dissociative Experiences Scale, Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised) was given to 200 gynecological outpatients to assess psychoform and somatoform dissociation and their association with FSD. A strong association between somatoform dissociation and FSD was observed (adjusted odds ratio [OR] = 5.39, 95% confidence interval [CI] = 1.15-25.32), the association between somatoform and psychoform dissociation being estimated by an adjusted OR of 4.83 (95% CI = 1.17-19.91). Our results are compatible with the idea that some forms of FSD could be regarded as somatoform dissociative disorders.

Associations among everyday stress, critical life events, and sexual problems.

PubMed

Bodenmann, Guy; Ledermann, Thomas; Blattner, Denise; Galluzzo, Claudia

2006-07-01

This study addresses the question of how stress is linked to sexual problems among women and men in close relationships. Psychological symptoms, relationship quality, internal daily stress (i.e., originating within the couple such as conflicts, worry for the partner), external daily stress (i.e., stress arising outside the couple such as job stress, stressful relatives, and so forth), and critical life events were examined with regard to their association with different sexual problems. The results support the hypotheses that (1) there is an incremental effect of stress on sexual problems after controlling for psychological symptoms and relationship quality, and that (2) it is primarily internal daily stress and in some cases critical life events rather than external daily stress that are related to sexual problems, particularly hypoactive sexual desire in women and men, sexual aversion in women, vaginismus in women, and premature ejaculation in men. Our findings indicate that the treatment of these sexual problems should address relationship issues and include a focus on helping individuals improve their stress management skills within their couple relationship.

Women's sexual pain disorders.

PubMed

van Lankveld, Jacques J D M; Granot, Michal; Weijmar Schultz, Willibrord C M; Binik, Yitzchak M; Wesselmann, Ursula; Pukall, Caroline F; Bohm-Starke, Nina; Achtrari, Chahin

2010-01-01

Women's sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and treatment of women's sexual pain disorders. An expert committee, invited from six countries by the 3rd International Consultation, was comprised of eight researchers and clinicians from biological and social science disciplines, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of women's sexual pain disorders. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee discussion, public presentation, and debate. Results. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence-based recommendations for assessment of women's sexual pain disorders are reviewed. An evidence-based approach to management of these disorders is provided. Continued efforts are warranted to conduct research and scientific reporting on the optimal assessment and management of women's sexual pain disorders, including multidisciplinary approaches.

[Treatment of female sexual disorders].

PubMed

Lamontagne, Y; Nobert, F

1976-12-01

The recent developments in the treatment of female sexual dysfunctions are reported. 4 types of sexual dysfunction are distinguished: general sexual dysfunction or frigidity; orgasmic dysfunction; vaginismus; dyspareunia and sexual anaesthesia. Treatments are suggested for each of these types of sexual dysfunction; Masters and Johnsons's and Kaplan's therapies are evaluated. The same basic principles apply for male and female sexual problems. However in the case of women, one must add to the basic technics the apprenticeship of masturbation with the help of an electric vibrator when necessary. It is suggested that an efficient therapy for female sexual problems should include the 6 following principles: evaluation of the problem, physical examination, sexual education, participation of the husband to the therapy, application of therapeutic techniques; finally there should be ideally 2 therapists: a man and a woman. The case of a woman who had been married for 6 years and had never had a complete sexual intercourse is reported as an illustration of the efficiency of this method. The authors believe that physicians should learn at least to evaluate sexual disfunctions and be aware of the available therapies. Sexual education programs should also be developed.

Ultrasound in the investigation of posterior compartment vaginal prolapse and obstructed defecation.

PubMed

Dietz, H P; Beer-Gabel, M

2012-07-01

Recent developments in diagnostic imaging have made gynecologists, colorectal surgeons and gastroenterologists realize as never before that they share a common interest in anorectal and pelvic floor dysfunction. While we often may be using different words to describe the same phenomenon (e.g. anismus/vaginismus) or attributing different meanings to the same words (e.g. rectocele), we look after patients with problems that transcend the borders of our respective specialties. Like no other diagnostic modality, imaging helps us understand each other and provides new insights into conditions we all need to learn to investigate better in order to improve clinical management. In this review we attempt to show what modern ultrasound imaging can contribute to the diagnostic work-up of patients with posterior vaginal wall prolapse, obstructed defecation and rectal intussusception/prolapse. In summary, it is evident that translabial/perineal ultrasound can serve as a first-line diagnostic tool in women with such complaints, replacing defecation proctography and MR proctography in a large proportion of female patients. This is advantageous for the women themselves because ultrasound is much better tolerated, as well as for healthcare systems since sonographic imaging is much less expensive. However, there is a substantial need for education, which currently remains unmet. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Standard operating procedures for female genital sexual pain.

PubMed

Fugl-Meyer, Kerstin S; Bohm-Starke, Nina; Damsted Petersen, Christina; Fugl-Meyer, Axel; Parish, Sharon; Giraldi, Annamaria

2013-01-01

Female genital sexual pain (GSP) is a common, distressing complaint in women of all ages that is underrecognized and undertreated. Definitions and terminology for female GSP are currently being debated. While some authors have suggested that GSP is not per se a sexual dysfunction, but rather a localized genial pain syndrome, others adhere to using clearly sexually related terms such as dyspareunia and vaginismus. The aims of this brief review are to present definitions of the different types of female GSP. Their etiology, incidence, prevalence, and comorbidity with somatic and psychological disorders are highlighted, and different somatic and psychological assessment and treatment modalities are discussed. The Standard Operating Procedures (SOP) committee was composed of a chair and five additional experts. No corporate funding or remuneration was received. The authors agreed to survey relevant databases, journal articles and utilize their own clinical experience. Consensus was guided by systematic discussions by e-mail communications. MAIN OUTCOME/RESULTS: There is a clear lack of epidemiological data defining female GSP disorders and a lack of evidence supporting therapeutic interventions. However, this international expert group will recommend guidelines for management of female GSP. GSP disorders are complex. It is recommended that their evaluation and treatment are performed through comprehensive somato-psychological multidisciplinary approach. © 2012 International Society for Sexual Medicine.

[Sexual pain disorders in females and males].

PubMed

Monforte, M; Mimoun, S; Droupy, S

2013-07-01

The occurrence of pain during sex is one of the most common complaints in gynecological and sexological practice but nonetheless one of the most difficult problems to deal with and treat effectively. A literature review was conducted on Medline considering the articles listed until January 2012 dealing with sexual pain in women and men. The different descriptions of painful intercourse (dyspareunia, vestibulo-vulvodynies, vaginismus) are not separate entities but the result of the interaction of many factors including genital pain, emotional and behavioral responses to penetration, caresses, desire and excitement, in a context of possible organic pathology (infection, endometriosis, inflammatory or dermatological disease, morphological or pelvic abnormality, hormonal deficiency) sometimes associated with chronic pain phenomena self-sustained by neurogenic inflammation. The clinical expression of sexual pain is as variable as its causes are many. The etiological investigation is essential but should not omit the sexological context and the need for appropriate management. The neurogenic inflammation and hypersensitivity impose an algological approach associated to etiological and sexological treatment. Chronic sexual pains, whether they are superficial or deep, can be the sign of organic or psycho-sexual (primary or secondary) disorders. The development of a "therapeutic program" helps patients, allows them to restore self-confidence and leads to the disappearance of the symptom in more than half cases. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

A Comparative study on sexual dysfunctions before and after menopause

PubMed Central

Beigi, Marjan; Fahami, Fariba

2012-01-01

Background: Sexual instinct which is the cause of numerous changes in an individual’s life could be influenced by different factors such as menopause and ageing. This study was designed to compare sexual dysfunction before and after menopause. Materials and Methods: This was a cross-sectional study. Participants were 174 menopausal women who referred to medical health centers of Isfahan, Iran. Data were collected through self constructed sexual dysfunctions questionnaire in relation to their sexual activities before and after menopause. The reliability and validity of this questionnaire was determined by content validity and Cronbach’s alpha coefficient. Findings: Findings showed that the relative frequency of sexual dysfunctions was 38% in the productive period and 72.4% in the menopause period. There was a significant association between sexual dysfunctions before and after the menopause period (p < 0.001). Sexual dysfunctions in these women in the productive and menopause period were 49.2% and 62.6% in desire disorder, 34.3% and 34.9% in dyspareunia, 26.8% and 75.3% in arousal disorder, 23.5% and 56.3% in orgasmic disorder and 16.4% and 15.6% in vaginismus, respectively. Conclusions: A considerable percentage of women experienced sexual dysfunctions in productive and menopause periods, and menopause could be a factor to maintain or intensify sexual dysfunctions. PMID:23833604

Childhood trauma and dissociation among women with genito-pelvic pain/penetration disorder

PubMed Central

Özen, Beliz; Özdemir, Y Özay; Beştepe, E Emrem

2018-01-01

Objective Causes such as childhood trauma, negative attitude about sexuality, inadequate sexual knowledge and education, relationship problems, and unconscious motivation are reported about psychosexual development in the etiology of genito-pelvic pain/penetration disorder (GPP/PD). There are few studies that focus directly on research etiology of GPP/PD and use structured scales. The aim of this study was to research childhood trauma and dissociation forms among women with GPP/PD. Patients and methods Fifty-five women with GPP/PD according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and 61 healthy women with no complaints of sexual function as a control group, in the age range of 18–60 years, were included in this study. Sociodemographic data form, Childhood Trauma Questionnaire (CTQ-28), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ-20) were administered to all participants. Results Sexual abuse, emotional abuse, and emotional neglect scores, which comprise the subgroups of CTQ, were found high among women with GPP/PD compared with the control group (p=0.003, p=0.006, p=0.001). While a significant difference between the two groups’ SDQ scores was obtained (p=0.000), no significant difference was detected between the two groups’ DES scores (p=0.392). Discussion The results evoke the question are genitopelvic pain conditions, vaginismus and dyspareunia, that cannot be explained with a medical cause and that cause penetration disorder, a kind of dissociative symptom prone to develop in some women with childhood psychogenic trauma. PMID:29503548

Management of vaginal penetration phobia in Arab women: a retrospective study.

PubMed

Muammar, Tarfah; McWalter, Patricia; Alkhenizan, Abdullah; Shoukri, Mohamed; Gabr, Alia; Bin, Abdulaziz AlDanah

2015-01-01

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. Retrospective descriptive in a general gynecology community setting over a 6-year period. 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. 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. 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).

Sexual Dysfunction in Women Undergoing Fertility Treatment in Iran: Prevalence and Associated Risk Factors

PubMed Central

Bakhtiari, Afsaneh; Basirat, Zahra; Nasiri-Amiri, Fatemeh

2016-01-01

Background: Sexual dysfunctions are one of the most fundamental difficulties for infertile women, which can be as the cause of infertility. This study investigated the prevalence of this disorder and associated factors in order to improve infertility treatment process and the quality of life of women referring to infertility center. Methods: A cross sectional study was performed on 236 women who referred to Fatima Zahra infertility center of Babol, Iran. Data collection tool was a questionnaire contained two parts; demographic characteristics and infertility information. Also, data for sexual dysfunction was obtained through diagnostic interview based on the international classification DSM-IV. For data analysis, logistic and linear regression analysis were used. The p<0.05 was considered significant. Results: Most of women (84.9%) suffered from primary infertility and the mean duration of infertility was 60.2±8.4 months. The prevalence of sexual dysfunction was 55.5% (n=131); including dyspareunia in 28% (n=66), impaired sexual desire and lack of orgasm in 26.3% (n=62 patients), vaginismus in 15.2% (n=36) and lack of sexual stimulation in 13.6% (n=32). Binary logistic regression analysis showed that age, sexual satisfaction and history of mental illness had a significant effect on the probability of experiencing the sexual dysfunction. Conclusion: There is a high prevalence of sexual dysfunction among infertile women. Considering the interaction between sexual dysfunction and infertility, professional health care centers should be sensitive to this effect. Also, more attention must be paid on marital relationships, economic and social situation and infertility characteristics in order to prevent sexual dysfunction development through early screening and psychological interference. PMID:26962480

Revised definitions of women's sexual dysfunction.

PubMed

Basson, Rosemary; Leiblum, Sandra; Brotto, Lori; Derogatis, Leonard; Fourcroy, Jean; Fugl-Meyer, Kerstin; Graziottin, Alessandra; Heiman, Julia R; Laan, Ellen; Meston, Cindy; Schover, Leslie; van Lankveld, Jacques; Schultz, Willibrord Weijmar

2004-07-01

Existing definitions of women's sexual disorders are based mainly on genitally focused events in a linear sequence model (desire, arousal and orgasm). To revise definitions based on an alternative model reflecting women's reasons/incentives for sexual activity beyond any initial awareness of sexual desire. An International Definitions Committee of 13 experts from seven countries repeatedly communicated, proposed new definitions and presented at the 2nd International Consultation on Sexual Medicine in Paris July 2003. Expert opinions/recommendations are based on a process that involved review of evidence-based medical literature, extensive internal committee discussion, informal testing and re-testing of drafted definitions in various clinical settings, public presentation and deliberation. Women have many reasons/incentives for sexual activity. Desire may be experienced once sexual stimuli have triggered arousal. Arousal and desire co-occur and reinforce each other. Women's subjective arousal may be minimally influenced by genital congestion. An absence of desire any time during the sexual experience designates disorder. Arousal disorder subtypes are proposed that separate an absence of subjective arousal from all types of sexual stimulation, from an absence of subjective arousal when the only stimulus is genital. A new arousal disorder has provisionally been suggested, namely that of persistent genital arousal. Orgasm disorder is limited to absence of orgasm despite high subjective arousal. Dyspareunia includes partial painful vaginal entry attempts as well as pain with intercourse. Variable reflex muscle tightening around the vagina and an absence of abnormal physical findings are noted in the definition of vaginismus. Women's sexuality is highly contextual and descriptors are recommended re past psychosexual development, current context, as well as medical status. Diagnosing sexual disorders need not imply intrinsic dysfunction of the woman's own sex response

Sexual dysfunction, Part II: Diagnosis, management, and prognosis.

PubMed

Halvorsen, J G; Metz, M E

1992-01-01

Sexual problems are common but infrequently diagnosed. They are classified into four major categories: (1) sexual desire disorders, (2) sexual arousal disorders, (3) orgasmic disorders, and (4) sexual pain disorders. MEDLINE files from 1966 to the present were searched using the specific sexual dysfunctions as key words along with the general key word "sexual dysfunction" to review the published literature. Additional articles came from the reference lists of dysfunction-specific reviews. The key to diagnosis often rests on the physician's willingness to raise the issue with patients. A rational protocol can be followed to identify causative organic and psychogenic factors using the psychosexual and medical history, a comprehensive physical examination, psychological assessment instruments, laboratory tests, and special procedures. Current psychological treatment includes one or more of the following components: sensate focus exercises, cognitive-behavioral therapy, relaxation training, hypnosis and guided imagery, and group therapies. Specific techniques, such as directed self-stimulation, the stop-start and squeeze techniques, the sexological examination, systematic desensitization, and Kegel exercises, are added therapy when appropriate. Marital therapy to improve communication and resolve conflict is also part of standard therapy. Medical management can include pharmacologic agents to correct endocrine dysfunctions or to alter the progression of the sexual response. Surgical management can involve arterial revascularization, venous ligation, and penile implants. A noninvasive vacuum constriction device is also used to treat erectile disorders. The long-term prognosis of the sexual dysfunctions varies with the type of disorder and its causes. Generally good results (80 to 95 percent satisfaction) are obtained when treating vaginismus, dyspareunia, male erectile disorders, and female orgasmic dysfunctions. Long-term results are modestly successful (40 to 80

Sexual problems in a sample of the Turkish psychiatric population.

PubMed

Hariri, Aytul Gursu; Karadag, Figen; Gurol, Defne Tamar; Aksoy, Umut Mert; Tezcan, Ahmet Ertan

2009-01-01

Sexual functioning has received little attention as an important aspect of patient care for those who have severe mental disorders. The aim of this study is to compare sexual difficulties seen in Turkish psychiatric patients and healthy control subjects. Study group consisted of outpatients in remission with schizophrenia (n = 84), bipolar affective disorders (n = 90), heroin addiction (n = 88), and healthy control group (n = 98). A sociodemographical data form and the Golombok Rust Inventory of Sexual Satisfaction were applied to all groups (N = 360). Half of the patient groups and 72.8% of control subjects reported that they had regular sexual life. The patients with heroin addiction complained about more problems in their sexual life than in the other groups. Controls (86.2%) felt more satisfied with their sexual life. Female patients with heroin addiction had statistically significant higher scores in nonsensuality subscale of Golombok Rust Inventory of Sexual Satisfaction. Female patients with schizophrenia and bipolar disorder had statistically significant higher scores in vaginismus subscale than in control group. Between the groups, male patients with bipolar disorder had higher score in most of the items except noncommunication and erectile dysfunction and also had higher total score than in the controls. More men (especially with heroin addiction) thought that their illness and drugs were responsible for their sexual problems, knew the effect of the illness and drugs on their sexual life, and asked questions to their psychiatrists about the problems more than women. Patients with bipolar disorders and schizophrenia were unaware of effects of their medication on their sexual life. Finally, it was also found that clinicians in our country do not pay sufficient attention to the sexual problems of psychiatric patients.

Resident education and training in female sexuality: results of a national survey.

PubMed

Pancholy, Apurva B; Goldenhar, Linda; Fellner, Angela N; Crisp, Catrina; Kleeman, Steve; Pauls, Rachel

2011-02-01

Considering the prevalence of female sexual dysfunction, the lack of education and training in female sexual function and dysfunction (FSF&D) during and obstetrics and gynecology residency highlights a need for greater focus on this topic. To assess understanding and confidence among third and fourth year Ob/Gyn residents with respect to FSF&D. An Internet-based survey was constructed to evaluate third and fourth year residents in American Council for Graduate Medical Education-approved Ob/Gyn programs. Residents were asked about familiarity, knowledge, and confidence in treating various aspects of FSF&D, based on the Council on Resident Education in Obstetrics and Gynecology (CREOG) Educational Objectives for Ob/Gyn training. They were also queried regarding areas of improvement for their education.   Responses to survey instrument. Two hundred thirty-four residents responded. The majority (91.5%) reported attending ≤5 didactic activities on FSF&D. Only 19.6% reported often or always screening women for sexual function problems; most had very little or no knowledge in administering or interpreting screening questionnaires. While many (82.8%) felt confident about obtaining a complete sexual history, only 54.7% felt able to perform a targeted physical exam. Although most residents had cared for women with dyspareunia (55.1%), a minority had managed many women with low desire (18.4%), arousal problems (8.1%), anorgasmia (5.6%), or vaginismus (16.7%). In treating patients, 34-56% reported rarely or never suggesting ancillary therapy such as counseling and medications. However, the majority believed that their confidence would increase through FSF&D lectures (97.9%), FSF&D patient observations (97.4%), rotating with a urogynecologist (94.4%), and online modules (90.6%). Despite CREOG requirements for Ob/Gyn training in female sexuality, most residents feel ill-equipped to address these problems. Additional evidence-based educational and didactic activities would

Associations of unhealthy lifestyle factors with sexual inactivity and sexual dysfunctions in Denmark.

PubMed

Christensen, Birgitte S; Grønbaek, Morten; Pedersen, Bo V; Graugaard, Christian; Frisch, Morten

2011-07-01

Studies have linked obesity, a sedentary lifestyle, and tobacco smoking to erectile dysfunction, but the evidence linking unhealthy lifestyle factors to other sexual dysfunctions or to sexual inactivity is conflicting. To examine associations between unhealthy lifestyle factors and sexual inactivity with a partner and four specific sexual dysfunctions in each sex. We used nationally representative survey data from 5,552 Danish men and women aged 16-97 years in 2005. Cross-sectional associations of lifestyle factors with sexual inactivity and sexual dysfunctions were estimated by logistic regression-derived, confounder-adjusted odds ratios (ORs). We calculated ORs for sexual inactivity with a partner and for sexual dysfunction and sexual difficulties overall in both sexes, for erectile dysfunction, anorgasmia, premature ejaculation, and dyspareunia in men, and for lubrication insufficiency, anorgasmia, dyspareunia, and vaginismus in women. Obesity (body mass index [BMI]≥30 kg/m(2) ) or a substantially increased waist circumference (men ≥102 cm; women ≥88 cm), physical inactivity, and, among women, tobacco smoking were each significantly associated with sexual inactivity in the last year. Among sexually active men, both underweight (BMI <20 kg/m(2) ) and obesity, a substantially increased waist circumference, physical inactivity in leisure time, high alcohol consumption (>21 alcoholic beverages/week), tobacco smoking, and use of hard drugs were each significantly positively associated with one or more sexual dysfunctions (ORs between 1.71 and 22.0). Among sexually active women, the only significant positive association between an unhealthy lifestyle factor and sexual dysfunction was between hashish use and anorgasmia (OR 2.85). In both sexes, several unhealthy lifestyle factors were associated with sexual inactivity with a partner in the last year. Additionally, among sexually active participants, men with unhealthy lifestyles were significantly more likely to

Sexual satisfaction, anxiety, depression and quality of life among Turkish colorectal cancer patients [Izmir Oncology Group (IZOG) study].

PubMed

Akyol, Murat; Ulger, Eda; Alacacioglu, Ahmet; Kucukzeybek, Yuksel; Yildiz, Yasar; Bayoglu, Vedat; Gumus, Zehra; Yildiz, Ibrahim; Salman, Tarık; Varol, Umut; Ayakdas, Semra; Tarhan, Mustafa Oktay

2015-07-01

Determination of psychological problems will shed light on the terms of solution and provide support to patients about these problems will ensure the patients' coherence to the treatment and will enhance the benefits they receive from treatment. In this study, we aimed to determine these psychosocial problems and the interactions with each other in colon cancer patients. In this study, 105 patients with colorectal cancer were included. The forms consist of sociodemographic features, Hospital Anxiety and Depression Scale, European Organization for Research on Treatment of Cancer Questionnaires Quality of Life-C30 and Golombok-Rust Inventory of Sexual Satisfaction questionnaires. Male patients had significantly higher European Organization for Research on Treatment of Cancer Questionnaires Quality of Life-C30 function scales and global quality-of-life scores than female patients. Golombok-Rust Inventory of Sexual Satisfaction scores of female patients were significantly higher than that of male patients. European Organization for Research on Treatment of Cancer Questionnaires Quality of Life-C30 function scales and global quality-of-life scores of the patients with high depression scores were significantly lower, conversely symptom scale scores of the patients with high depression scores were significantly higher than that of the patients with low depression scores. Patients with low anxiety scores had significantly higher European Organization for Research on Treatment of Cancer Questionnaires Quality of Life-C30 function scales and global quality-of-life scores than the patients with high anxiety scores. Symptom scale scores of the patients with high anxiety scores were significantly higher than that of the patients with low anxiety scores. The scores of Golombok-Rust Inventory of Sexual Satisfaction except premature ejaculation and vaginismus were significantly higher in patients with high anxiety scores and a significant difference was determined in touch

Sexual dysfunction among married couples living in Kumasi metropolis, Ghana

PubMed Central

2011-01-01

.5) obtained by the wives, indicates the likely presence of sexual dysfunction. The prevalence of impotence and premature ejaculation were 60.9% and 65.4% respectively from this study and the prevalence of vaginismus and anorgasmia were 69.3% and 74.9% respectively. The highest prevalence of SD subscales among the men was dissatisfaction with sexual act followed by infrequency, whereas the highest among the women was infrequency followed by anorgasmia. Dissatisfaction with sexual intercourse among men correlated positively with anorgasmia and wife's non-sensuality and infrequency of sex. Conclusion The prevalence of sexual dysfunction in married couples is comparable to prevalence rates in the general male and female population and is further worsened by duration of marriage. This could impact significantly on a couple's self-esteem and overall quality of life. PMID:21366917

AB022. The psyche of male sexual difficulties related to related to the partner

PubMed Central

Adaikan, P. Ganesan

2015-01-01

Impression management for men aiming at courtship and love is cognitively taxing and is costly. Recent research suggests that when a man tries to impress an attractive woman his cognitive performance could be impaired and depleted. However, cognitive performance of a woman is not affected during her interaction with someone of the opposite sex (Karremans et al. 2009). By dictation of nature and anatomically too, men take an active and positive role in sexual performance; their failures in sexual performances will be revealed to the partner then and there. Men react negatively to such a failure when their confidence or self-esteems are at stake. Their psyche will strike it as a failure of life time, failure of their genetic spread and survival of the species. In subsequent sexual encounter their body and subconscious mind will switch to the physiology of anti-erectile transmission and limit the expansion of desire and arousal on other attempts. In general, we call this performance anxiety. Masters and Johnson’s pioneering work in the 70’s highlighted the negative impact of performance anxiety on sexual function. As a form of therapy, exercise such as Sensate Focus were designed for the couple to overcome the performance anxiety and phobic quality in man so that sexual arousal and penetrative erection can be practiced/achieved in a relaxed state. At the Fertility, menopausal and andrology settings of OBGYN, it is not uncommon to see male sexual dysfunctions that include lack of desire, psychogenic ED and ejaculatory dysfunctions. One of the main causes of complaints of unconsummated marriages is vaginismus (and dyspareunia) in the partner which causes psychogenic erectile dysfunction in husbands who fail to penetrate at the first or second attempts. Such couple tend to drift from sexual intimacy for months and years until there is an extended family pressure for conception. Another situation that compromises erectile capacity of otherwise a normal man with