RESUMEN

BACKGROUND: Vaginismus is one of the leading causes of painful sex (dyspareunia) for women. General practitioners (GPs) play a vital role in diagnosing and treating vaginismus, as well as coordinating a multidisciplinary team to support people with vaginismus. OBJECTIVE: The aim of this article is to summarise what is currently known about vaginismus, including its aetiology and contributing factors, how a diagnosis can be made, the implications of vaginismus on primary care clinical practice and the available treatment options for people with vaginismus. The article focuses on treating vaginismus exclusively, where other possible medical causes or comorbidities have been examined and excluded (eg vulvodynia). DISCUSSION: GPs play a vital role in helping people recover from vaginismus through validating people's experiences, making an accurate diagnosis and making referrals to other relevant health professionals. GPs can also offer a range of treatment options for people with vaginismus. While the management of vaginismus can be time-consuming and take some trial and error, multidisciplinary care with multimodal therapy often results in positive patient outcomes.

Asunto(s)

Asunto(s)

RESUMEN

Vaginismus is a sexual dysfunction occurring in females presented as a contraction of the muscles around the vagina as a reflex, causing the failure of vaginal penetration. Although many psychological, social, and cultural factors that may cause vaginismus have been suggested, its underlying mechanisms are not clear. The aim of this study was to determine the sexual attitude, sexual self-awareness, and sociocultural status of women with and without lifelong vaginismus. This is a case-control study. A total of 148 women were included in the study: 74 women with a lifelong vaginismus diagnosis and 74 women without a history of vaginismus/painful sexual activity controls. Data were collected using a structured questionnaire, the Sexual Self-Consciousness Scale, and the Hendrick Brief Sexual Attitudes Scale. Sexual shyness (OR = 0.854), sexual self-focus (OR = 0.888) and birth control (OR = 1.279), communion (OR = 1.198), and instrumentality (OR = 1.330; the sub-dimensions of the Sexual Attitude Scale) were associated with (χ2 = 96.130, p < .001) vaginismus at the rate of 63%. Those who did not receive sexual information; those who obtained information about sexuality from the social media; those who had negative thoughts about sexuality due to religious reasons; those who found the genitals and sexuality as disgusting; and those having more feelings of fear and pain are more likely to have vaginismus. Some socio-cultural factors may negatively affect women and cause vaginismus. Women with vaginismus had low sexual self-consciousness and negative attitudes toward sexuality. It may be incomplete to consider vaginismus only as a vaginal entry problem. Therefore, in the treatment of vaginismus, women's sexual attitude, sexual self-awareness, and sociocultural factors should be evaluated in a holistic manner.

Asunto(s)

RESUMEN

Genital pain associated with sex is a prevalent and distressing problem with a complex research and clinical profile. This article reviews the historical context of the "sexual pain disorders" and the circuitous trajectory that has led from the first mention of painful sex in ancient documents to the latest diagnostic category of genito-pelvic pain penetration disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as well as in other existing and proposed nomenclatures. Prominent etiologic research and emergent theoretical models are critically assessed, as is the latest treatment outcome research of note. Finally, the review points to a number of extant needs in the research and clinical effort, including an integrated biopsychosocial and multidisciplinary approach, randomized clinical trials, targeting of treatment barriers, and expansion of the entire enterprise to include populations that have not been considered.

Asunto(s)

RESUMEN

Vaginismus and dyspareunia are common sexual difficulties; they often take a long time to be appropriately diagnosed, and their origins remain unclear. This paper examines the metaphors used by women to describe bodily experiences associated with vaginismus and dyspareunia, and highlights the contribution this form of analysis can make to the study of sexuality and sexual difficulties. A secondary analysis was conducted on primary data from biographic interviews exploring women's experiences of sexual pain and difficulties with sexual intercourse. Metaphor analysis was used to analyse a data subset of 28 interviews translated from German into English. Metaphorical concepts lying at the basis of the metaphors used were identified and grouped into three themes: characterisation of sexual difficulties; split body and 'self'; and sexual agency and objectification. Results are discussed with in the context of literature regarding the function of metaphors and the utility of metaphor analysis for research, and healthcare research and interventions more generally.

Asunto(s)

RESUMEN

OBJECTIVE: There are many predisposing factors associated with vaginismus, but there is lack of data in the literature regarding which and how of these factors influence the success rate of treatment. Our aim is to investigate the effects of factors that are considered as predisposing factors for vaginismus on treatment prognosis and success rate, with cognitive-behavioral therapy and desensitization exercises after sexual therapy. METHODS: Patients with vaginismus were divided into three groups. Group 1: patients who successfully completed vaginal penetration exercises after sexual therapy and experienced vaginal sexual intercourse; Group 2: patients who started penetration exercises but could not reach success; Group 3: patients who discontinued treatment before starting exercises. Demographic and sexual parameters were compared between the groups. RESULTS: There were statistically significant differences between the groups in terms of history of vaginismus in relatives (4.3%, 23% and 35.7%, p=0.047, respectively), the unsuccessful therapy history (69%, 61% and 21.4%, p=0.014, respectively), and anal and/or oral sex ratios (47.8%, 7.7% and 57.1%, p=0.019, respectively). Mean number of sessions were significantly higher in patients saying, "It is my fault" than among those perceiving it as a common problem (10.6±2.9 ve 7.5±5.7, p=0.042, respectively), and in patients with sexual disorder in their male partners than those not having any problem (13.3±3.7 ve 8.2±3.7, p=0.013, respectively). CONCLUSION: Patients are more resistant to treatment if they have a history of vaginismus among relatives or when one of the couple say, it is his or her fault.

Asunto(s)

RESUMEN

OBJECTIVE: Vaginismus is caused by involuntary spasm of muscle surrounding the vaginal wall, a condition which makes it impossible to have a comfortable sexual intercourse. Due to its significant psychogenic part this topic is often neglected by specialists, however it is a very sensitive one for women patients. We are bringing a summary of literature dealing with vaginismus, clarifying the possibilities of diagnostics, therapy and we are discussing relation of this dysfuntion to reproduction. DESIGN: Review article. Material a methods: Recent scientific articles indexed in Pubmed, Medline, Web of Science, consultation of Czech specialists and discussion forums of patients have been used. RESULTS: Vaginismus influences the quality of life, in the most serious form in can result in unconsumated marriage, sterility and thus can lead to the separation of a couple. When adeaquately approached the problem can mostly be solved. CONCLUSIONS: There are women for whom vaginismus is a serious problem and who are not able to cope with the situation without specialists help. Deepening the specialists knowledge in this field is essential for successful treatment.

Asunto(s)

RESUMEN

Abstract Genito-pelvic pain/penetration disorder (GPPPD) can be an extremely bothersome condition for patients, and a tough challenge for professionals regarding its assessment and treatment. The goal of the present paper is to review the etiology, assessment, and treatment of GPPPD, especially focusing on the cognitive aspects of the disease and cognitive-behavioral treatment options, through a non-systematic review of articles indexed to the Medline, Scopus and Web of Science databases, using the following MeSH queries: pelvic pain; dyspareunia; vaginismus; vulvodynia; and cognitive therapy. Altogether, 36 articles discussing the etiology, diagnosis and management of GPPPD were selected. We provide an overview of GPPPD based on biological, psychological and relational factors, emphasizing the last two. We also summarize the available medical treatments and provide strategies to approach the psychological trigger and persisting factors for the patient and the partner. Professionals should be familiarized with the factors underlining the problem, and should be able to provide helpful suggestions to guide the couple out of the GPPPD fear-avoidance circle.

Resumo A perturbação de dor gênito-pélvica e da penetração (PDGPP) é uma patologia com elevado impacto no bem-estar das pacientes, e traduz-se num desafio diagnóstico e de tratamento para os profissionais que as acompanham. O objetivo deste artigo é rever a etiologia e o tratamento da PDGPP, tendo em conta, principalmente, os aspetos cognitivos e as abordagens de inspiração psicoterapêutica cognitivo-comportamental. Para tal, foi efetuada uma revisão não sistemática dos artigos indexados às bases de dados Medline, Scopus e Web of Science, usando os termos: dor pélvica; dispareunia; vaginismo; vulvodinia; e terapia cognitiva. No total, foram incluídos 36 artigos discutindo a etiologia, diagnóstico e tratamento da PDGPP. Neste artigo, proporcionamos uma revisão do tratamento da PDGPP baseado em fatores biológicos, psicológicos e relacionais, enfatizando os últimos dois. Também resumimos as opções de tratamento

Asunto(s)

RESUMEN

Genito-pelvic pain/penetration disorder (GPPPD) can be an extremely bothersome condition for patients, and a tough challenge for professionals regarding its assessment and treatment. The goal of the present paper is to review the etiology, assessment, and treatment of GPPPD, especially focusing on the cognitive aspects of the disease and cognitive-behavioral treatment options, through a non-systematic review of articles indexed to the Medline, Scopus and Web of Science databases, using the following MeSH queries: pelvic pain; dyspareunia; vaginismus; vulvodynia; and cognitive therapy. Altogether, 36 articles discussing the etiology, diagnosis and management of GPPPD were selected. We provide an overview of GPPPD based on biological, psychological and relational factors, emphasizing the last two. We also summarize the available medical treatments and provide strategies to approach the psychological trigger and persisting factors for the patient and the partner. Professionals should be familiarized with the factors underlining the problem, and should be able to provide helpful suggestions to guide the couple out of the GPPPD fear-avoidance circle.

A perturbação de dor gênito-pélvica e da penetração (PDGPP) é uma patologia com elevado impacto no bem-estar das pacientes, e traduz-se num desafio diagnóstico e de tratamento para os profissionais que as acompanham. O objetivo deste artigo é rever a etiologia e o tratamento da PDGPP, tendo em conta, principalmente, os aspetos cognitivos e as abordagens de inspiração psicoterapêutica cognitivo-comportamental. Para tal, foi efetuada uma revisão não sistemática dos artigos indexados às bases de dados Medline, Scopus e Web of Science, usando os termos: dor pélvica; dispareunia; vaginismo; vulvodinia; e terapia cognitiva. No total, foram incluídos 36 artigos discutindo a etiologia, diagnóstico e tratamento da PDGPP. Neste artigo, proporcionamos uma revisão do tratamento da PDGPP baseado em fatores biológicos, psicológicos e relacionais, enfatizando os últimos dois. Também resumimos as opções de tratamento médico disponíveis, e disponibilizamos estratégias para abordar os fatores desencadeantes e de manutenção tanto nas doentes quanto nos seus parceiros. Os profissionais devem estar familiarizados com os fatores subjacentes a este problema, e devem ser capazes de oferecer sugestões úteis para ajudar o casal a quebrar o círculo vicioso de medo e evitamento associado à PDGPP.

Asunto(s)

RESUMEN

El médico de familia está capacitado para resolver la mayoría de los problemas de salud de sus pacientes. Dentro del consultorio, el cansancio constituye un motivo de consulta muy frecuente. Su abordaje debe incluir la evaluación del contexto del paciente y un enfoque sistémico que incluya otros niveles diagnósticos y terapéuticos. Se presenta el caso de una paciente que, a partir de este motivo de consulta tan frecuente y junto a intervenciones de su médico de cabecera, logró modificar el foco del problema y comenzar un tratamiento acorde. (AU)

Family physicians are able to solve the majority of their patients' health issues. In the office, fatigue is a common complaint. Its approach should include the evaluation of the context of the patient and a systemic approach that includes other diagnostic and therapeutic levels. We present the case of a patient who went to his doctor with a common complaint and was able to change the focus of the problem and begin a consistent treatment. (AU)

Asunto(s)

RESUMEN

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Asunto(s)

RESUMEN

INTRODUCTION: 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. AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.

Asunto(s)

RESUMEN

Vulvar pain and discomfort (vulvodynia) are common conditions that can have a significant impact on a patient's quality of life. Vulvodynia is a difficult condition to evaluate and treat. This article gives the primary gynecologist a basic framework with which to identify, diagnose, and begin treatment for these patients and refer if necessary. Initial evaluation and physical examination are discussed in detail. Treatments ranging from self-management strategies to nonpharmacologic and pharmacologic therapies will be explored. Because vulvodynia is a chronic pain disorder, diagnosis is the key to beginning treatment and support for this patient population.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

INTRODUCTION AND HYPOTHESIS: This clinical opinion was written to bring attention to the understanding and treatment of vaginismus, a condition that is often under diagnosed and therefore inadequately treated, yet affects millions of women worldwide. Despite its description more than a century ago, vaginismus is rarely taught in medical school, residency training, and medical meetings. The DSM 5 classification stresses that vaginismus is a penetration disorder in that any form of vaginal penetration such as tampons, finger, vaginal dilators, gynecological examinations, and intercourse is often painful or impossible. Compared with other sexual pain disorders such as vulvodynia and vestibulodynia, the treatment of vaginismus has the potential for a high rate of success. Stratifying the severity of vaginismus allows the clinician to choose among numerous treatment options and to better understand what the patient is experiencing. Vaginismus is both a physical and an emotional disorder. In the more severe cases of vaginismus women (and men) complain that attempted intercourse is like "hitting a wall" suggestive of spasm at the level of the introitus. The emotional fallout resulting from this needs to be addressed in any form of treatment applied. METHODS: This article is based on lessons learned in the treatment of more than 250 patients and evaluation of more than 400 inquiries, and was written to make vaginismus more widely understood, to aid in the differential diagnosis of sexual pain, suggest a variety of effective treatments, and explain how Botox can be used as part of a multimodal treatment program to treat vaginismus. CONCLUSIONS: With greater awareness among clinicians it is hoped that medical schools, residency programs, and medical meetings will begin teaching the understanding and treatment of vaginismus.

Asunto(s)

RESUMEN

Vaginismo é condição clínica rara em que a penetração vaginal, seja pelo ato sexual, espéculo ginecológico ou outro objeto, é impedida. Associa-se a multiplicidade de fatores que incluem condições sociais, psicológicas, psiquiátricas, ginecológicas, psicanalíticas e sexológicas. Sua etiologia está ligada, principalmente, a traumas sexuais e educação sexual rígida, embora nem sempre essas associações possam ser feitas. É assunto sobre o qual existe grande desconhecimento, inclusive pelos médicos, o que torna sua abordagem difícil, muitas vezes iatrogênica. O tratamento inclui técnicas de psicoterapia cognitiva e comportamental, tratamento médico com ansiolíticos e anestésicos tópicos, além de uso de vasodilatadores vaginais. Tratamentos com base em fisioterapia por eletroestimulação vaginal e injeções vaginais de neurotoxina botulínica têm sido propostos, ainda sem evidência científica que os autorize. Esta revisão discute conceitos e tratamentos do vaginismo.

Vaginismus is a rare clinical condition that prevents vaginal penetration, either during the sexual act, or by a gynecological speculum or any other object. It is associated to multiple factors including social, psychological, psychiatric, gynecological, psychoanalytical, and sexual conditions. Its etiology is mainly linked to sexual traumas and rigid sexual education,even though this kind of association is not always traceable. Knowledge about the subject is extremely limited, even among physicians. This is a difficult topic to approach, sometimes requiring iatrogenic approaches. Its treatment includes cognitive and behavioral psychotherapy, medical treatment with anxiolytics and topic anesthetics, as well as use of vaginal vasodilators. Treatment methods based on physical therapy by vaginal electrostimulation and vaginal injections of botulinum neurotoxin have been proposed, although no scientific evidence currently evidently supports their use. This review discusses concepts and treatment methods for vaginismus.

Asunto(s)

RESUMEN

INTRODUCTION: 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. METHODS: A literature review was conducted on Medline considering the articles listed until January 2012 dealing with sexual pain in women and men. RESULTS: 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. CONCLUSION: 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.

Asunto(s)