Psychiatric morbidity across the life course and provoked vulvodynia: is it dependent upon the presence of non-stress-related immune dysfunction?

BACKGROUND: Vulvodynia impacts up to 8% of women by age 40, and these women may have a more compromised immune system than women with no vulvar pain history. AIM: Given that psychiatric morbidity is associated with vulvodynia and is known to activate immune inflammatory pathways in the brain and systemically, we sought to determine whether the association between psychiatric morbidity and vulvar pain was independent of or dependent upon the presence of immune-related conditions. METHODS: Women born in Sweden between 1973 and 1996 with localized provoked vulvodynia (N76.3) and/or vaginismus (N94.2 or F52.5) diagnosed between 2001 and 2018 were matched to two women from the same birth year with no vulvar pain. International Statistical Classification of Diseases and Related Health Problems (ICD-9 or -10 codes) were used to identify women with a history of depression, anxiety, attempted suicide, neurotic disorders, stress-related disorders, behavioral syndromes, personality disorders, psychotic disorders, or chemical dependencies, as well as a spectrum of immune-related conditions. The Swedish National Prescribed Drug Register was used to identify women with filled prescriptions of antidepressants or anxiolytics. OUTCOMES: Vulvodynia, vaginismus, or both were outcomes assessed in relation to psychiatric morbidity. RESULTS: Women with vulvodynia, vaginismus, or both, relative to those without vulvar pain, had adjusted odds ratios between 1.4 and 2.3, with CIs highly compatible with harmful effects. When we assessed women with and those without a lifetime history of immune-related conditions separately, we also observed elevated odds ratios in both groups for mood, anxiety, and neurotic and stress disorders. CLINICAL IMPLICATIONS: Documenting psychiatric impairment as a cause or consequence of vulvodynia is critical in clinical practice because psychiatric conditions may impact treatment efficacy. STRENGTHS AND LIMITATIONS: Strengths of this study include a data source that represents the entire population of women in Sweden that is known to be highly accurate because Sweden provides universal healthcare. Limitations include difficulty in making an accurate assessment of temporality between psychiatric morbidity and the first onset of vulvar pain. In addition, because Swedish registry data have limited information on lifestyle, behavioral, and anthropomorphic factors such as smoking, diet, physical activity, and obesity, these conditions could not be assessed as confounders of psychiatric morbidity and vulvar pain. CONCLUSIONS: Immune pathways by which women with psychiatric conditions increase their risk of vulvar pain could be independent from other immune pathways.

Association between non-penetrative sexual activities and depression in women with vaginismus: a cross-sectional study.

OBJECTIVE: This cross-sectional study aimed to explore the association between non-penetrative sexual activities (NPSA) and depression levels in women diagnosed with vaginismus. METHODS: A cross-sectional retrospective study was conducted between March 2016 and June 2019, after approval by the Firat University Faculty of Medicine ethics committee. Participants comprised married women referred to our female sexual dysfunction outpatient clinic with vaginismus. Diagnosis of vaginismus was established following comprehensive evaluations, including gynecological examination and psychiatric assessment. Sociodemographic data and Beck Depression Inventory (BDI) scores were collected. We compared depression levels between women who engaged in NPSA and those who did not. RESULTS: Of the 75 women with primary vaginismus included in the study, 18 did not engage in any NPSA and 57 engaged in at least one NPSA. The average BDI score of those who engaged in NPSA was significantly lower than those who did not. A negative correlation was found between the number of NPSA engaged in and BDI scores (r = -0.494). CONCLUSIONS: Women with vaginismus had high depression scores, but engaging in NPSA was associated with lower depression levels. The findings suggest that incorporating NPSA into clinical interventions may be beneficial for managing depression in women with vaginismus.

Care for breast cancer survivors in Asian countries: A review of sexual dysfunction.

Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.

Patients' recommendations to improve help-seeking for vaginismus: a qualitative study.

BACKGROUND: Research to improve healthcare experiences for women with vaginismus tends to be produced from the perspective of healthcare professionals or health-based researchers. There is lacking research on women's experiences and recommendations to improve help-seeking for vaginismus from their perspective. To address this research gap, this qualitative study aimed to identify the issues that women face when help-seeking for vaginismus and their recommendations to address it. This sought to support the wellbeing of patients to advocate for their healthcare needs which is often overlooked. METHODS: Using a feminist theoretical approach, semi-structured interviews were conducted with 21 participants who sought help for their vaginismus. Thematic analysis was employed to analyse participants' recommendations. RESULTS: Four main themes emerged: Increase awareness of vaginismus, Dismantle myths about sex, Destigmatise vaginismus, and Empower people with vaginismus during medical consultations. Subthemes were identified as actionable strategies that participants recommended to improve help-seeking and healthcare for vaginismus. CONCLUSIONS: The findings from this study can inform healthcare practice and policy to foster better synchronicity between health professionals and their patients' perceptions and expectations of treating vaginismus. This can promote more acceptance of patients' advocacy of their needs and goals to improve the therapeutic alliance and treatment outcomes for vaginismus in healthcare practice. The strategies recommended to increase awareness of vaginismus and challenge its stigma should be considered in policy to incite a culture of change in healthcare practice and broader society.

Clinical assessment and management of vaginismus.

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.

Analysis of sexual dysfunction development among male and female living kidney donors.

INTRODUCTION: Living kidney donations (LKDs) face a persistent demand for patients with end-stage renal disease, emphasizing the importance of LKDs' growth and success. Although living kidney donors generally exhibit excellent survival rates, little research has explored the development of long-term sexual dysfunction following LKD. OBJECTIVES: This study aimed to analyze differences in 5-year sexual dysfunction outcomes between male and female living kidney donors, utilizing the TriNetX database, a federated network of electronic medical records from multiple U.S. healthcare organizations. METHODS: A propensity score-matched cohort study compared 45-year sexual dysfunction outcomes in adult male and female living kidney donors from December 2013 to December 2022. Cohorts were matched on age; sex; race and ethnicity; diabetes, cardiovascular, genitourinary, and psychiatric comorbidities; lifestyle-related factors; and medications that may impact normal sexual functioning. Primary outcomes included hazard ratio (HR) for decreased libido, sexual dysfunction (composite of male erectile dysfunction, ejaculatory disorders, vaginismus/dyspareunia, infertility, orgasmic disorders, arousal/desire disorders), and sexually transmitted diseases. Secondary outcomes assessed sex counseling and interpersonal relationship issues with spouses or partners. RESULTS: The matched cohorts included 2315 patients each (male, female), and the mean age was 42.3 ± 12.5 years. At 5 years, male donors had a significantly higher HR for sexual dysfunction (HR, 3.768; 95% confidence interval, 1.929-7.358). Erectile dysfunction occurred in 1% of male patients, while vaginismus/dyspareunia affected <1% of female patients. Other sexual disorders, decreased libido, sexually transmitted diseases, and incidences of sexual and interspousal counseling were not significantly different. CONCLUSION: Male living kidney donors faced a higher risk of developing sexual dysfunction 5 years after donation. While LKD remains a safe and viable alternative, clinicians and donors should be mindful of the potential association with sexual dysfunction postdonation. Further research may enhance support for the well-being of living kidney donors.

Unconsummated marriage: a systematic review of etiological factors and clinical management.

BACKGROUND: Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse. AIM: The study sought to systematically review current evidence regarding the etiological factors and clinical management of UCM. METHODS: A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in June 2023. Studies were selected if they described married couples who never had sexual intercourse in case report or case series evaluating the related causes and/or management and reporting data with qualitative, quantitative, or mixed methods. The review was reported according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) statement and registered in PROSPERO with ID CRD42023433040. RESULTS: A total of 27 studies including 1638 males and 1587 females were selected. Eight (29.6%) articles were case reports involving a single couple and 19 (70.4%) studies were case series. Mean Murad score was 4.1 (range, 1-8) showing low-intermediate overall study quality. All articles had a level of evidence of 4. Most of studies were conducted in Egypt (n = 5 [18.4%]), Israel (n = 4 [14.9%]), and the United States (n = 4 [14.9%]). The mean age of males and females varied between 24.2 and 37.6 years and from 21 to 27.4 years, respectively. The reasons for the medical visit that led to the diagnosis of UCM were inability to consummate in 23 (85.2%) studies, inability to conceive in 1 (3.7%) article, and mixed in 3 (11.1%) articles. The mean duration of UCM varied from 7 days to 3.5 years. Eight studies involving both men and women showed that vaginismus (8.4%-81%) and erectile dysfunction (10.5%-61%) were the most common causes of UCM. Three articles reported that 16.6% to 26% of all UCM cases were due to both male and female factors. Sildenafil, tadalafil, intracavernosal injection, penile plication, female genital reconstructive surgery, vaginal dilators, lubricants, psychosexual therapy, and sex education were the various treatment modalities in 27 studies to achieve consummation rate of 66.6% to 100%. STRENGTHS & LIMITATIONS: A strength is that this is the first systematic review covering the entire spectrum of UCM. Limitations comprised the low quality of most of the included articles and the large percentage of UCM cases probably not published. CONCLUSION: Erectile dysfunction and vaginismus are the most reported causes of UCM; however, a strong psychological component certainly underlies a significant number of cases. A multidisciplinary approach based on strategic integration of sex education, medical therapy, psychosexual support, and surgical treatment would seem the most suitable option to manage couples with UCM.

The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review.

BACKGROUND: There is low social awareness of vaginismus despite it being a relatively common female sexual dysfunction that makes vaginal penetration painful, difficult, and/or impossible. While existing literature on vaginismus has had a clinical focus on the affected genitalia, there is a lack of research on women's help-seeking experiences of vaginismus from their perspective. OBJECTIVES: This integrative review's objective was to explore: women's help-seeking experiences of vaginismus, and how such help-seeking experiences impact their sense of self. DESIGN: Cooper's five-step integrative review approach was followed to develop a research question, a search strategy, selection criteria, and data evaluation, analysis, and presentation. DATA SOURCES AND METHODS: A systematic search of the literature was completed in the following seven databases in January 2023: PsycINFO, ProQuest Central, PubMed, Scopus, CINAHL, Cochrane, and Embase. Out of the 373 articles found through database searches and additional citation searching, 22 studies were included in this review for meeting the eligibility criteria of having an empirical design, being written in English, and examining women's help-seeking experiences for vaginismus and its impact on their sense of self. RESULTS: Thematic analysis was used to summarize the findings from the included studies which were informed by 1671 participants. Help-Seeking Process, Medical Management, Help-Seeking and Sense of Self, and Holistic Care Recommendations from the Findings emerged as four major themes with corresponding subthemes. CONCLUSION: This review indicates that women continue to face difficulties in seeking and receiving help for vaginismus even through the healthcare system. However, the studies did not explicitly discuss how women's help-seeking for vaginismus impacted their sense of self. This highlights an epistemological gap on how women's help-seeking for their vaginismus impacts their sense of self, which can affect their treatment responses. Recommendations are provided for future healthcare and research to improve health outcomes for women with vaginismus.

Component of sexual health services for vaginismus management: A qualitative study.

BACKGROUND: Provision of sexual health services requires gender-sensitive management, facilities, and staff, as well as planning for gender-sensitive caregivers and education. Couples suffering from vaginismus face many types of barriers to accessing sexual health services. This qualitative study was conducted to explain the needs of sexual health services in women with primary vaginismus in Iran. METHODS: This qualitative study was conducted through the participation of 20 participants including service providers, women with vaginismus and their husbands in 2022, Iran. The samples were selected using purposive sampling method and considering the maximum variation. For data collection, in-depth semi-structured individual interviews were conducted and continued until data saturation was reached. The collected data were analyzed in MAXQDA10 software using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman. RESULTS: Data analysis led to the emergence of three main themes: 1) Comprehensive preventive sex education which included the three categories of sex education in the education system, premarital sex education through the health system, and sex education through the media with scientific content; 2) Efficient sexual health clinics which included three categories of therapist's skills, empowerment of sexual therapist, and structural features of sexual health clinics and cultural considerations in establishing sexual health clinics; and 3) Protocol for management and treatment of sexual problems which consisted of sexual education and counseling content, treatment requirements, and sex education approaches. CONCLUSION: Based on the results of the study, comprehensive preventive sex education through the education system and the Ministry of Health can improve the attitudes of adolescents and young people. Moreover, it can take a fundamental step in solving sexual problems by providing the infrastructure necessary for the establishment of efficient sexual health clinics and protocols required to manage and treat such problems.

The Association Between Immune-Related Conditions Across the Life-Course and Provoked Vulvodynia.

Vulvodynia, impacts up to 8% of women by age 40, and is hypothesized to manifest through an altered immune-inflammatory response. To test this hypothesis, we identified all women born in Sweden between 1973 and 1996 diagnosed with localized provoked vulvodynia (N76.3) and/or vaginismus (N94.2 or F52.5) between 2001 and 2018. We matched each case to two women from the same birth year with no vulvar pain ICD codes. As a proxy for immune dysfunction, we used Swedish Registry data to capture 1) immunodeficiencies, 2) single organ and multiorgan autoimmune conditions, 3) allergy and atopies, and 4) malignancies involving immune cells across the life course. Women with vulvodynia, vaginismus or both were more likely to experience immune deficiencies (OR 1.8, 95% CI, 1.2-2.8), single organ (OR 1.4, 95% CI, 1.2-1.6) and/or multi-organ (OR 1.6, 95% CI, 1.3-1.9) immune disorders, and allergy/atopy conditions (OR 1.7, 95% CI, 1.6-1.8) compared to controls. We observed greater risk with increasing numbers of unique immune related conditions (1 code: OR = 1.6, 95% CI, 1.5-1.7; 2 codes: OR = 2.4, 95% CI, 2.1-2.9; 3 or more codes: OR = 2.9, 1.6-5.4). These findings suggest that women with vulvodynia may have a more compromised immune system either at birth or at points across the life course than women with no vulvar pain history. PERSPECTIVE: Women with vulvodynia are substantially more likely to experience a spectrum of immune related conditions across the life course. These findings lend support to the hypothesis that chronic inflammation initiates the hyperinnervation that causes the debilitating pain in women with vulvodynia.

Successful management of penetration disorder: A holistic approach to an age-old problem.

Penetration disorder, formerly referred to as vaginismus, is the recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration. It is a common female psychosexual problem and is a cause of significant personal and relationship distress. In this report, we describe the successful treatment of vaginismus in a 28-year-old woman by using a combination of different interventions. This involved providing sexual education, psychotherapy, serial dilation using graded plastic dilators, sensate-focused therapy, and anti-anxiety medication.

Sexual function among women with vaginismus: a biopsychosocial approach.

BACKGROUND: Vaginismus is known as a type of sexual pain disorder. Regarding the multifactorial nature of vaginismus, the biopsychosocial model is one of the best models to describe this sexual disorder. AIM: The present research was conducted to study the determinants of sexual function in women with and without vaginismus based on the biopsychosocial model. METHODS: This case-control study was conducted in Iran on 420 women with and without primary vaginismus who met the inclusion criteria. All eligible people were included in the research once their eligibility was verified and their informed permission was acquired; convenience and purposive sampling techniques were used continually. Data collection tools included the demographic and obstetric information form and multiple published scales and questionnaires. Structural equation modeling with LISREL 9.2 software (Scientific Software International) was used to evaluate the determinants of the sexual function of vaginismus. OUTCOMES: Participants rated their determinants of sexual function based on the biopsychosocial model. RESULTS: The mean ages of the case and control groups were 27.67 and 28.44 years, respectively. The direct, indirect, and total effects of the dimensions of sexual health on sexual function and the diagnostic score of vaginismus of the women with vaginismus were significant (P < .001). Furthermore, based on the results, the diagnostic score of vaginismus in women with vaginismus was significantly affected by the direct, indirect, and cumulative impacts of vaginal penetration cognition and fear of sex (P = .016, P = .005). Women with and without vaginismus were able to accept the models' excellent fit. CLINICAL IMPLICATIONS: This study helps inform health planners and policy makers about the sexual function of women with vaginismus, the factors related to this disorder, and the multidimensional nature of this sexual problem. STRENGTHS AND LIMITATIONS: This study attempted to offer a more comprehensive and complete view of present knowledge via surveying different aspects of sexual health and by means of valid and reliable tools and path analysis. The study's merits include the use of the biopsychosocial model to evaluate sexual function in women with vaginismus, the use of a variety of questionnaires to compare women with and without vaginismus, and the size of the sample. The research was limited by the fact that electronic sampling was conducted because of the COVID-19 epidemic. CONCLUSION: Based on the findings of the present study for the group of women with vaginismus, the direct, indirect, and overall effects of the majority of dimensions of sexual health were significantly correlated with sexual function and vaginismus.

Obstetric outcomes in women with vulvodynia or vaginismus.

PURPOSE: Vulvodynia and vaginismus are common chronic vulvar pain disorders for which there is a paucity of literature on pregnancy outcomes of affected women. The study objective was to evaluate the associations between vulvodynia and vaginismus and obstetric outcomes. METHODS: We performed a retrospective cohort study including all birth-related admissions from 1999 to October 2015 extracted from the Healthcare Cost and Utilization Project-National Inpatient Sample from the United States. Women with vulvodynia or vaginismus were identified using the appropriate ICD-9 codes. Multivariate logistic regression models, adjusted for baseline maternal characteristics, were performed to evaluate the effect of vulvodynia and vaginismus on obstetrical and neonatal outcomes. RESULTS: A total of 879 obstetrical patients with vulvodynia or vaginismus were identified in our cohort of 13,792,544 patients admitted for delivery in US hospitals between 1999 and 2015, leading to an overall prevalence of 6 cases per 100,000 births. Between 1999 and 2015, the annual prevalence of vulvodynia or vaginismus rose from 2 to 16 cases per 100,000. Vulvodynia and vaginismus were associated with increased risks of eclampsia, chorioamnionitis, post-term pregnancy, cesarean delivery, instrumental vaginal delivery, blood transfusions, prolonged hospital stays, congenital anomalies and intrauterine growth restriction. CONCLUSION: Vulvodynia and vaginismus in pregnancy appears underreported in pregnancy compared to reported population rates. Prevalence of reporting seems to have increased in the last decades and is associated with increased risks of maternal and newborn morbidities. Obstetrical caregivers should be aware of the underreporting of these conditions and the associated adverse effects when counseling obstetrical patients.

Outcomes of Vaginismus Therapy Assessed by Penetrative Intercourse, Psychiatric Symptoms, and Marital Satisfaction.

We evaluated the treatment outcomes of the patients with primary vaginismus in a specialized clinic. Cognitive-Behavioral Therapies (CBT), finger exercises, and vaginal dilators were used. Symptom Checklist-90 Revised, Martial Adjustment Inventory, Female Sexual Function Index and Golombok-Rust Index for Sexual Satisfaction were applied pre-and post-treatment. Twenty-three patients were enrolled. All patients achieved sexual intercourse at the end of the treatment. After treatment, the results improved in the SCL-90 R test and sexual function indexes Marriage adjustment scores did not improve. With vaginismus, improvement in psychological scores emphasizes the importance of sexual therapy in couples having sexual dysfunctions.

The effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment: a randomized controlled study.

INTRODUCTION AND HYPOTHESIS: The purpose of this study is to determine the effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment. METHODS: A total of 34 women at the vaginismus treatment stage, including 17 in the experiment group and 17 in the control group, were included in the study with a randomized controlled design. In addition to the routine treatment protocol, women in the experiment group were provided with pelvic relaxation and sexual counseling based on the Information, Motivation, Behavior (IMB) model consisting of four sessions. The control group received the routine treatment protocol. The assessments were made at the 3rd week and 2nd month after coitus. The women filled out an Information Form, the validated Female Sexual Function Index (FSFI), and the Vaginal Penetration Cognition Questionnaire (VPCQ). RESULTS: The mean age of the women was 27.59±5.32, and their mean duration of marriage/relationship was 33.44±12.11 months. After the treatment statistically significant increases were observed in the total FSFI scores and the desire, arousal, and pain dimension scores of the experiment group in comparison with the control group (p<0.05). In the VPCQ total scores, there was a significant reduction in the experiment group in comparison with the control group and after the treatment in comparison with before the treatment (p<0.01). CONCLUSIONS: The sexual counseling based on the IMB model and pelvic relaxation interventions provided to the women who were receiving vaginismus treatment affected their sexual function positively. It may be recommended to conduct comparative studies with a broader sample and different models.

Botulinum toxin injection in vulva and vagina. Evidence from a literature systematic review.

INTRODUCTION: Botulinum toxin (BoNT) administration has been proposed in the gynecologic field for pelvic, vulvar and vaginal disorders. On this regard, we aimed assessing the therapeutic effectiveness and safety of BoNT usage in the treatment of vaginal, vulvar and pelvic pain disorders. METHODS: We searched for all the original articles without date restriction until 31.12.2021. We included all the original articles which administered botulinum toxin in the vulva or vagina of women suffering from vaginismus, dyspareunia, and chronic pelvic pain. Only English language studies and those performed in humans were eligible. We excluded all case reports and pilot study from the qualitative analysis, although we accurately evaluated them. 22 original studies were finally included in the systematic review. RESULTS: Botulinum toxin injection was found to be effective in improving vulvar and vaginal dyspareunia, vaginismus, and chronic pelvic pain. No irreversible side effects were detected. Major side effects reported were transient urinary or fecal incontinence, constipation and rectal pain. The risk of bias assessment proved original articles to be of medium quality. No metanalysis could have been performed since lack of congruency in the definition of pathology and methods of botulinum toxin administration. CONCLUSION: Data extraction pointed out different endpoints and different methods of analysis. Studies focus on different types of participants and use various techniques and timing. According to the best evidence available, different techniques provide evidence about positive outcomes, with the need for a standardized protocol.

Percepções do viver com vaginismo: estudo por meio do Desenho-Estória com Tema / Perceptions of living with vaginismus: study through Thematic Drawing and Story / Percepciones de vivir con vaginismo: estudio a través de Dibujo-Cuento con Tema

Considerando que experienciar uma disfunção sexual afeta profundamente a autopercepção e a qualidade de vida, este estudo almejou compreender a experiência de viver com vaginismo. Trata-se de uma pesquisa empírica, qualitativa, de caráter exploratório, em que participaram nove mulheres diagnosticadas em algum período da vida com vaginismo. Os dados foram coletados por meio de entrevistas semidirigidas e do procedimento de desenhos-estórias com o tema "Vaginismo", sendo que, neste trabalho, destaca-se a análise dos desenhos e histórias devido à riqueza deste instrumento. O material foi interpretado em conjunto possibilitando a construção de três categorias temáticas: "Representações: o vaginismo como protagonista", "O percurso e a história de vida: os diferentes momentos do vaginismo" e "A solidão e os relacionamentos". Os resultados apontaram para diferentes percepções do vaginismo de acordo com o momento do tratamento, destacando-se a longa duração dos sintomas e o árduo processo de viver com esta disfunção. (AU)

Considering that sexual dysfunction profoundly affects self-perception and quality of life, this study aims to understand the experience of living with vaginismus. This is an empirical, qualitative, exploratory research, in which nine women diagnosed with vaginismus at some point in their lives participated. Data were collected through individual semi-directed interviews and application of the drawing and story procedure with the theme "Vaginismus". In this paper, the analysis of the drawings and stories is highlighted due to the richness of this instrument. The material was interpreted together, enabling the construction of three thematic categories: "Representations: vaginismus as a protagonist", "The course and history of life: the different moments of vaginismus" and "Loneliness and relationships". The results pointed to different perceptions of vaginismus according to the time of treatment, highlighting the long duration of symptoms and the arduous process of living with this disorder. (AU)

Considerando que experiencia una disfunción sexual afecta profundamente la autopercepción y la calidad de vida, este trabajo tiene como objetivo comprender la experiencia de vivir con vaginismo. Se trata de una investigación empírica, cualitativa, exploratoria, en la que participaron nueve mujeres diagnosticadas de vaginismo en algún momento de su vida. Los datos fueron recolectados a través de entrevistas individuales semidirigidas y aplicación del procedimiento de dibujo-cuento con el tema "Vaginismo". En este trabajo se destaca el análisis de los dibujos y cuentos por la riqueza de este instrumento. El material fue interpretado en conjunto, posibilitando la construcción de tres categorías temáticas: "Representaciones: el vaginismo como protagonista", "El curso y la historia de la vida: los diferentes momentos del vaginismo" y "La soledad y las relaciones". Los resultados apuntaron a diferentes percepciones del vaginismo según el tiempo de tratamiento, destacando la larga duración de los síntomas y el arduo proceso de convivencia con este trastorno. (AU)

Comparative Study of 150 vs. 200 Units of Botulinum Toxin as Treatment for Vaginismus / Estudo comparativo de 150 vs. 200 unidades de toxina botulínica como tratamento para vaginismo

Abstract Objective To comparatively evaluate the outcome of treatment with 150 versus 200 units (U) of botulinum toxin in achieving pain-free intercourse and relieving muscle contraction in order to allow gynecological examination. Methods In this comparative prospective observational study, 99 patients with vaginismus were treated with botulinum toxin injections from September 2016 to August 2021. Diagnosis and grading of vaginismus severity were assessed using a Female Sexual Function Index (FSFI) questionnaire. Under local or general anesthesia, botulinum toxin diluted with preservative-free saline (150 U and 200 U) was injected into, above, and below the right and left bulbospongiosus muscle and the lateral submucosal areas of the introitus and perineal body using an insulin syringe. Patients were recalled after 2 weeks, and the postoperative outcome was recorded using a similar preoperative questionnaire. Results Overall, the mean age of patients was 30.2 years. The baseline and clinical characteristics were comparable between the 2 groups (p > 0.05). Significant improvements were seen in the pain and anxiety scores of finger penetration, dilator use, intercourse, and cotton swab in individual groups. The intergroup comparisons between 150 U and 200 U of Botox were not statistically significant (p > 0.05). Conclusion Low-dose Botox (150 U) is equally effective as high dose Botox injections (200 U) in vaginismus patients. Therefore, Botox-150 U can be used to treat vaginismus as an alternative to high doses of the same substance.

Resumo Objetivo Avaliar comparativamente o resultado do tratamento com 150 versus 200 unidades (U) de toxina botulínica na obtenção de relações sexuais sem dor e no alívio da contração muscular para permitir o exame ginecológico. Métodos Neste estudo observacional prospectivo comparativo, 99 pacientes com vaginismo foram tratadas com injeções de toxina botulínica de setembro de 2016 a agosto de 2021. O diagnóstico e a classificação da gravidade do vaginismo foram avaliados usando um questionário Female Sexual Function Index (FSFI). Sob anestesia local ou geral, injetou-se toxina botulínica diluída em soro fisiológico sem conservantes (150 U e 200 U) nos músculos bulbo esponjoso direito e esquerdo e nas áreas submucosas laterais do intróito e corpo perineal, utilizando-se uma seringa de insulina. Os pacientes foram chamados após 2 semanas, e o resultado pós-operatório foi registrado usando um questionário pré-operatório semelhante. Resultados No geral, a média de idade dos pacientes foi de 30,2 anos. As características basais e clínicas foram comparáveis entre os 2 grupos (p > 0,05). Melhorias significativas foram observadas nos escores de dor e ansiedade à penetração com dedo, uso de dilatador, relação sexual e cotonete em grupos individuais. As comparações intergrupos entre 150 U e 200 U Botox foram não estatisticamente significativas (p > 0,05). Conclusão Botox de baixa dose (150 U) é tão eficaz quanto injeções de Botox de alta dose (200 U) em pacientes com vaginismo. Portanto, o Botox-150 U pode ser usado para tratar o vaginismo como alternativa às altas doses da mesma substância.

High/severe fear of childbirth and related risk factors among pregnant women: is vaginismus a risk factor?

This study aimed to investigate the prevalence of fear of childbirth (FOC) and associated factors including vaginismus in pregnant women with high/severe FOC. In the study, 407 women who were at 24-40 weeks of gestation were included. The Wijma Delivery Expectancy/Experience Questionnaire Version A (WDEQA), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and vaginismus sub-scale of the Golombok Rust inventory of sexual satisfaction (GRISS) were used. 186 (46%) participants had high/severe FOC. Pregnant women with high/severe FOC had a significantly higher fear of pain during sexual intercourse, higher scores in the WDEQA, BDI, BAI, and vaginismus sub-scale of GRISS. Depression and anxiety level, educational level, access to information on delivery during pregnancy, presence of medical disease, and expression of FOC were predictors of high/severe FOC. Assessment of FOC and associated risk factors, including vaginismus, during pregnancy, will enable the identification of risk groups and the creation of support programmes.Impact StatementWhat is already known on this subject? The range of fear of childbirth (FOC) changes from mild anxiety to severe fear. The prevalence and severity of FOC and related risk factors vary in the studies due to cultural factors, differences in the definition of FOC and measurement tools. The relationship between FOC and vaginismus has not been sufficiently investigated.What do the results of this study add? This study aimed to investigate the prevalence of fear of childbirth (FOC) and associated factors including vaginismus in pregnant women with high/severe FOC.What are the implications of these findings for clinical practice and/or further research? This is the first study that evaluates vaginismus as a risk factor for FOC. Assessment of FOC and associated risk factors, including vaginismus, in pregnant women, will enable the identification of risk groups and the creation of support programs for risk reduction.