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.

Surgical Technique and Outcomes of Inverted-Y Plasty Procedure in Clitoral Hoodoplasty Operations.

STUDY OBJECTIVE: Labia minora reduction is the most common operation requested by women concerned with the appearance of their vulvar area. In most cases, a concomitant clitoral hoodoplasty (CP) should be performed to achieve better esthetic outcomes. There are different surgical methods for removing excess tissue in the clitoral hood area. This study aims to describe the surgical technique of inverted-Y plasty as with central longitudinal excision in CP and to elaborate on different hoodoplasty techniques in the literature. DESIGN: Case series. SETTING: Private practice. PATIENTS: A total of 63 patients who underwent labiaplasty with curvilinear labial excision and concomitant CP with the inverted-Y plasty technique. INTERVENTIONS: The operations were performed by a single senior surgeon between May 2017 and December 2019. The inverted-Y plasty technique is described in detail regarding its advantages and important issues. MEASUREMENTS AND MAIN RESULTS: The patients' median age was 33.2 (19-47) years. Of the patients, 57 (90.5%) requested the operation because of dissatisfaction with the esthetic appearance. Furthermore, 60 (95.2%) patients requested minimum remaining labia. The median operation time was 45 (35-62) minutes in labiaplasty and 34 (25-42) minutes in CP. No major complications occurred. At the postoperative second month, 96.9% of the patients were satisfied with the esthetic results. CONCLUSION: CP with the inverted-Y plasty technique is extremely safe and highly satisfactory in most patients, allowing maximum trimming of the excess tissue and providing lifting of the clitoral hood area.

Importance of gynecological assessment for the treatment of vaginismus as a predictive value.

AIM: In this study, we aimed to analyze the impact of a detailed anamnesis and gynecological examination findings of women with vaginismus on its treatment success in a tertiary therapy center with 18 years of experience. METHODS: The socio-demographical factors, gynecological examination notes and the treatment results of 281 vaginismus patients were analyzed between July 2018 and July 2019. The relationship with these parameters and the number of sessions for treatment were evaluated. RESULTS: The women with higher vaginismus grade had a longer duration of marriage (P < 0.001) and they needed more CBT sessions (P = 0.004). On the other hand, the age of the patient, duration of the relationship, education level, and surgical intervention (hymenotomy, hymenectomy) or presence of anatomically pathological hymen did not affect the outcomes regarding the number of sessions, duration of the treatment and the rate of successful penetration. CONCLUSION: Gynecological evaluation and detailed anamnesis that is taken upon the first admission has an important impact on the management of therapy and the treatment success.

A New Practical Surgical Technique for Hymenoplasty: Primary Repair of Hymen With Vestibulo-Introital Tightening Technique.

BACKGROUND: Hymenoplasty is distinct from other genital surgeries with its ethical and psychological issues. It is performed to narrow the vaginal opening to ensure vaginal bleeding with penetration. There are various kinds of techniques with different success rates. OBJECTIVES: The authors sought to report a new hymenal reconstruction technique with vestibulo-introital tightening with the results of 145 procedures. METHODS: The new technique included a diamond-shaped incision to the vestibulum with the base in the posterior midline and superior corner 2 to 3 cm higher above the hymen. The angles were accommodated according to the degree of tightening, and the submucosal layer was closed from the apex downwards involving the vaginal mucosa. RESULTS: The satisfaction rate of the patients was 99.3%. No adverse events were observed. CONCLUSIONS: Compared with previous techniques described, this hymenal reconstruction technique is an alternative with the advantage of low risk of loosening because the tension on the hymen alone is decreased. Additional tightening of the introitus increases the satisfaction rates in some patients.

Evaluation of Sexual Function in Women with Hypogonadotropic Hypogonadism Using the Female Sexual Function Index (FSFI) and the Beck Depression Inventory (BDI).

BACKGROUND Hypogonadotropic hypogonadism (HH), or secondary hypogonadism, results from reduced secretion of gonadotropins, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH), by the pituitary gland, resulting in lack of production of sex steroids. The aim of this study was to evaluate self-reported sexual function in sexually active women with and without HH using two evaluation methods, the Female Sexual Function Index (FSFI) and the Beck Depression Inventory (BDI). MATERIAL AND METHODS The study recruited 88 women who attended an outpatient in vitro fertilization (IVF) clinic in Turkey for primary infertility, between August 2013 and August 2016. All patients were sexually active with an age that ranged from 20-41 years. Following an initial examination, including measurement of FSH and LH levels, all study participants were asked to complete the FSFI and BDI self-reporting questionnaires. Patients were divided into Group 1 (with HH) (N=42) and Group 2 (the control group) (N=46). RESULTS Analysis of the patient responses to questions regarding their sexual function in the FSFI and BDI showed that of the 42 patients in Group 1 (the HH group), 27 patients (64.28%) reported sexual dysfunction; of the 46 patients in Group 2 (the control group) 14 patients (30.34%) reported sexual dysfunction. Analysis of the FSFI lubrication scores and orgasm scores showed a statistically significant difference between the two groups (both, p<0.01). CONCLUSIONS Women with HH require both physical and psychological support to improve their sexual function, self-esteem, mental health, and quality of life.

Vestibular hyaluronic acid injection in provoked vestibulodynia patients and its effect on pain and sexual function: A preliminary report.

OBJECTIVE: Provoked vestibulodynia (PVD) is a challenging and distressing problem for women. The aim of this study was to examine the effect of hyaluronic acid (HA) in the management of this condition. METHOD: This is a retrospective review of 12 women diagnosed with PVD and treated with HA (19 mg/mL) applied, point-by-point, to the vestibular region at 2 mm intervals and at a depth of 0.5 mm. Women completed a pain VAS and a Female Sexual Function Index (FSFI) before and 45 days after treatment. RESULTS: An improvement was observed both in mean FSFI scores (17.8 to 23.3; p = 0.003) and mean VAS scores (7.2 to 4.1; p = 0.002) after HA application respectively. However, on a telephone interview 3 months post treatment, five women (41.7 %) complained of recurrence of their dyspareunia. CONCLUSION: HA is a promising management option in provoked vestibulodynia. However, further larger studies with possible alternative regimens and longer follow-up are required.

Predictive value of middle cerebral artery to uterine artery pulsatility index ratio in preeclampsia.

OBJECTIVE: To determine the predictive value of middle cerebral artery (MCA) to uterine artery pulsatility index (PI) ratio in preeclamptic patients. METHODS: This prospective cross-sectional study was performed on 64 preeclamptic and 131 normal pregnancies at or beyond 26 weeks of gestation between June 2007-August 2008 in the high-risk pregnancy unit of Dr. Zekai Tahir Burak Women Health Teaching and Research Hospital, Ankara. Doppler blood flow velocimetry of the uterine and umbilical arteries and fetal MCA was measured. The ratios between the PI of MCA and the mean PI value of both uterine arteries were calculated and values below the fifth percentile were considered as brain-sparing. The ratios between the PI of MCA and PI of the umbilical artery were calculated and values lower than 1.08 were considered as brain-sparing and the results were related to perinatal outcome. Statistical analysis were performed using the SPSS Software (SPSS, Chicago, IL, USA) version 9.0 for Windows. Odds ratio with 95% confidence interval (95%) was also used for statistical analysis. RESULTS: In 11 (42.3%) of the preeclamptic pregnancies that had abnormal MCA/uterine artery PI, 4 of them had severe preeclampsia and 7 had mild preeclampsia. In the low MCA/uterine artery PI ratio group, a statistically significantly higher rate of Cesarean section (66 vs. 88.46%), NICU admission (26.3 vs. 57.6%), preterm birth (52.6 vs. 92.3%) was found. Abnormal MCA/uterine artery PI ratio and abnormal MCA/umbilical artery PI ratio in the prediction of adverse outcome of pregnancy was compared. In the prediction of preterm birth, which was better for the MCA/uterine artery, there was a significant difference between the ratios (P = 0.005). CONCLUSION: Our results suggest that MCA/uterine artery PI ratio is a good predictor of neonatal outcome in preeclamptic patients in the third trimester and could be used to identify fetuses at risk of morbidity and mortality.

Do women with vaginismus have a lower threshold of pain?

OBJECTIVE: Vaginismus and dyspareunia are together categorized as a genito-pelvic pain and penetration disorder. We aimed to evaluate the threshold of pain and the pain sensitivity in women with vaginismus. STUDY DESIGN: In this prospective case-control study; 32 women with vaginismus and 29 healthy women were enrolled. Sociodemographic Information Form, Female Sexual Function Index (FSFI), Pain Beliefs Questionnaire (PBQ), Revised Fibromyalgia Impact Questionnaire (FIQR), The Lamont Scale of Vaginismus were applied. Threshold of pain was measured with algometer in terms of Newton (N). RESULTS: The pain thresholds vaginismus and control group were as follows; left posterior superior iliac crest (40.3 N, 84.9 N respectively;p < 0.001), right posterior superior iliac crest (42.9 N, 76.1 N respectively;p = 0.007), left lateral trochanter (42.0 N, 69.8 N respectively; p = 0.015), right lateral trochanter (43.8 N, 75.3 N respectively; p = 0.003), left anterior superior iliac spine (29.2 N, 51.2 N respectively; p = 0.003), left insertion of gracilis muscle (27.3 N, 45.2 N respectively; p = 0.038), left medial vastus muscle (37.0 N, 52.4 N respectively; p = 0.025) and the pain thresholds were significantly lower in the vaginismus patients. CONCLUSION: Women with vaginismus have a lower threshold of pain, and the pain threshold decreases in higher grades of vaginismus. The pain may aggravate the avoiding behavior of women from sexual intercourse.

Insights Into the Vaginismus Treatment by Cognitive Behavioral Therapies: Correlation With Sexual Dysfunction Identified in Male Spouses of the Patients.

Objective: To examine retrospectively sexual dysfunction in the male spouses of 425 female patients who had presented to our clinic and were diagnosed with primary vaginismus. Materials and methods: Seven questions related to age, profession, educational status, number of marriages, personality structure, sexual experience, and sexual dysfunction history were directed to the spouses of the 425 female patients presenting to our clinic for vaginismus treatment between 2015 and 2018. Men reporting sexual dysfunction were evaluated by a urologist, and the necessary treatment was initiated. Cognitive-behavioral couple therapy was started for all patients. Results: Of the 425 men, 73.9% stated that they did not have any sexual problems. Of the 111 men (26.1%) stated that they had one or more sexual problems, 77 (18.1%) were diagnosed with premature ejaculation, 25 (5.8%) erectile dysfunction, 36 (8.4%) hypoactive sexual desire, and one (0.2%) had delayed ejaculation. Premature ejaculation and erectile dysfunction were identified in nine patients, premature ejaculation and hypoactive sexual desire in seven, and erectile dysfunction and hypoactive sexual desire in four patients. There was an increased rate of sexual dysfunction in men in cases where the duration of marriage without coitus was longer than three years. Conclusion: In the treatment of vaginismus, male sexual dysfunction should not be ignored. Spouses should be questioned for sexual dysfunction and included in the treatment process.

The histopathological results of vestibulectomy specimens in localized provoked vulvodynia in Turkey.

INTRODUCTION: Localized Provoked Vulvodynia (LPV) is a gynecological disease that is difficult to manage. Despite the wide spectrum of pathophysiological mechanisms and treatment modalities, there is limited success in the management of this disease. Surgical treatment is usually performed as the last resort. We aimed to investigate the histopathological results of 38 women with LPV who underwent surgical vestibulectomy. METHODS: of the 55 women that were diagnosed with LPV and underwent vulvar vestibulectomy, 38 patients with complete histopathological results were included in this retrospective study. RESULTS: in 14 patients, the pathological reports revealed Low-Grade Squamous Intraepithelial Lesions (LGSIL) (36.8%) whereas for 21 cases (55.2%), the findings were concordant with vestibulitis. The remaining three patients (7.8%) were diagnosed with lichen simplex chronicus. CONCLUSION: the presence of LGSIL in the surgical specimens of LPV cases is noteworthy. In this group of patients, surgical excision may contribute to the prevention of progression into high-grade lesions. The relationship between Human Papilloma Virus (HPV) infections and LPV should be further investigated.

Effects of predisposing factors on the success and treatment period in vaginismus.

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.

Effects of predisposing factors on the success and treatment period in vaginismus.

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.