"It's all my fault": a qualitative study of how heterosexual couples experience living with vulvodynia.

INTRODUCTION: Vulvodynia, a chronic genital pain disorder with a high lifetime prevalence among women, has a significant negative impact on both women and their partners. Although there is a growing body of literature on the experiences of women with vulvodynia, there has been little research on the condition's implications for partners and romantic relationships. The aim of this study is to explore how heterosexual couples experience living with vulvodynia. MATERIAL AND METHODS: Eight Norwegian women diagnosed with vulvodynia by gynecologists were recruited with their partners (couples aged 19-32 years). Data was collected via individual semi-structured interviews and analyzed using inductive thematic analysis. RESULTS: Three main themes were identified in the analysis: Mysterious disorder, Social exclusion and Sexual expectations. The results show that the couples struggle with understanding the pain, as well as navigating their social and sexual lives. We discuss these findings in light of a new theoretical model: the fear-avoidance-endurance model of vulvodynia. CONCLUSIONS: Heterosexual couples living with vulvodynia experience communication difficulties with partners, health professionals, and their social network. This sustains avoidance and endurance behavior, increasing pain and dysfunction over time and giving rise to feelings of powerlessness and loneliness. Social expectations regarding male and female sexuality also promote guilt and shame for both parties in couples affected by vulvodynia. Our results suggest that heterosexual couples living with vulvodynia, as well as health professionals treating them, should be helped to communicate more effectively in order to break vicious circles of maladaptive avoidance and endurance behavior.

If I stop, then what am I supposed to do? The experiences of sexual intimacy of women who live with provoked vestibulodynia.

We explored the experiences of sexual intimacy in women living with provoked vestibulodynia (PVD), a chronic pain condition where pain at the vaginal opening is triggered by touch. We conducted in-depth interviews with nine women who had suffered from PVD. Our findings reveal that their ability to trust and accept themselves is essential to how they cope when pain disrupts their freedom to have sexual intercourse. The tendency to endure painful intercourse and not tell the partner is driven by fear of rejection and conflict. Those who are able to overcome their fear, experience deeper intimacy and more sexual pleasure.

The Tampon Test as a Primary Outcome Measure in Provoked Vestibulodynia: A Mixed Methods Study.

BACKGROUND: Provoked vestibulodynia (PVD) is characterized by severe pain, often induced by penetrative sex. This may lead to women abstaining from sexual intercourse, hence the recording of pain intensity levels in PVD research is often challenging. The standardized tampon test was designed as an alternative outcome measure to sexual intercourse pain and has frequently been used in clinical studies. AIM: The aim of this mixed methods study is to evaluate the tampon test as a primary outcome measure for an upcoming randomized clinical trial for women with PVD. METHODS: An explanatory sequential design was applied, integrating quantitative and qualitative methods. In phase one, pain intensity levels were evaluated with the tampon test amongst 10 women, aged 18-33, with PVD. The test was repeated on day 1, 7 and 14. Pain intensity was rated on the Numerical Rating Scale (NRS), (0-10), 10 being worst possible pain. In phase two, the participants' experiences with the test were explored with semi-structured interviews using a descriptive and inductive qualitative design. All participants were recruited from the Vulva Clinic, Oslo University Hospital, Norway. OUTCOMES: The tampon test data and interviews were brought together to see how the interviews could refine and help to explain the quantitative findings. RESULTS: The tampon test data demonstrated large intra- and inter-individual variability. Median tampon pain intensity was 4.5 (min=1.7; max=10; Q1=2.5; Q3=6). Many experienced the test as an inadequate representation of pain during intercourse as it was less painful, different in nature and conducted in an entirely different context. Four participants had a mean score of four or lower on the NRS, whilst concurrently reporting high levels of pain during sexual intercourse. CLINICAL IMPLICATIONS: The findings indicate that the tampon test may underestimate severity of pain among some women with PVD. Participants with low pain scores would be excluded from studies where the tampon test is part of the trial eligibility criteria, even though severe pain was experienced during sexual intercourse. Large intra-individual variability in pain scores also reduces the test's ability to register clinical meaningful changes and hence necessitates repeated measurements per assessment time point. CONCLUSION: Although the tampon test has many advantages, this study indicates several potential problems with the application of the test as a primary outcome measure in PVD. In our opinion the test is most useful as a secondary outcome, preferably undertaken repeatedly in order to increase precision of the pain estimation. Kaarbø MB, Danielsen KG, Haugstad GK, et al. The Tampon Test as a Primary Outcome Measure in Provoked Vestibulodynia: A Mixed Methods Study. J Sex Med 2021;18:1083-1091.

Group-based multimodal physical therapy in women with chronic pelvic pain: A randomized controlled trial.

INTRODUCTION: Chronic pelvic pain in women is a complex condition, and physical therapy is recommended as part of a broader treatment approach. The objective of this study was to compare structured group-based multimodal physical therapy in a hospital setting (intervention group) with primary-care physical therapy (comparator group) for women with chronic pelvic pain. MATERIAL AND METHODS: Women aged 20-65 years with pelvic pain ≥6 months and referred for physical therapy were eligible. The primary outcome measure was change in the mean pelvic pain intensity from baseline to 12 months, measured using the numeric rating scale (0-10). Secondary outcomes were changes in scores of "worst" and "least" pain intensity, health-related quality of life, movement patterns, pain-related fear of movements, anxiety and depression, subjective health complaints, sexual function, incontinence, and obstructed defecation. The differences between the groups regarding change in scores were analyzed using the independent t test and Mann-Whitney U test. Sensitivity analysis of the primary outcome was performed with a linear regression model adjusted for the baseline value. A P value <.05 was considered statistically significant. RESULTS: Of the 62 women included, 26 in the intervention group and 25 in the comparator group were available after 12 months for data collection and analysis. The difference between the groups for change in the mean pain intensity score was -1.2 (95% CI -2.3 to -0.2; P = .027), favoring the intervention group. The intervention group showed greater improvements in respiratory patterns (mean difference 0.9; 95% CI 0.2-1.6; P = .015) and pain-related fear of movements (mean difference 2.9; 95% CI -5.5 to -0.3; P = .032), and no significant differences were observed between the groups for the other secondary outcomes. CONCLUSIONS: Although the reduction in the mean pelvic pain intensity with group-based multimodal physical therapy was significantly more than with primary-care physical therapy, the difference in the change between the groups was less than expected and the clinical relevance is uncertain.

"Will I ever be a true woman?" An exploration of the experiences of women with vestibulodynia.

In this study we explored the experiences of Norwegian women living with vestibulodynia, a chronic disease affecting young women all over the world. Using a phenomenological approach we conducted in-depth interviews with eight women who had struggled with vestibulodynia for several years. Our findings reveal that their efforts to fulfill their partners' sexual desires as well as their own represented an encompassing ongoing process. In addition, we highlight the interrelationship between the intensity of vulvar pain experienced by individual women and decisions women make about prioritizing their own sexual needs.

A conceptual model for managing sexual pain with somatocognitive therapy in women with provoked vestibulodynia and implications for physiotherapy practice.

Somatocognitive therapy is a multimodal physiotherapy treatment developed in the early 2000s to alleviate the burden of chronic pelvic pain. In recent years, somatocognitive therapy has been further developed to treat women with provoked vestibulodynia. This prevalent gynecological pain condition is a subgroup of chronic pelvic pain and the most common form of vulvodynia. Provoked vestibulodynia is a neglected multifactorial pain condition of unknown cause, adversely affecting women's sexual life, relation to their partners and their psychological health. Pain is located at the vulvar vestibule and is provoked by touch or pressure such as sexual intercourse. In the management of sexual pain, somatocognitive therapy combines bodily exploration, pain education, cognitive coping strategies and structured homework to improve sexual function and reduce pain. To support these processes, developing a sound therapeutic alliance with the patient is essential. The aim of this article is to provide a conceptual model for managing provoked vestibulodynia with somatocognitive therapy, including a theoretical rational for this treatment. We base our conceptual model on the biopsychosocial model, i.e., considering the complex interplay of biomedical, emotional/cognitive, psychosexual and interpersonal factors in provoked vestibulodynia management. In addition, implications for practice and a detailed description of somatocognitive therapy for provoked vestibulodynia will be provided, to allow replication in clinical practice and in clinical trials.

Treating gynecological pain: key factors in promoting body awareness and movement in somatocognitive therapy (SCT). A case study of a physiotherapy student´s treatment approaches.

BACKGROUND: Longstanding gynecological pain affects large numbers of women in the Western world. Somatocognitive therapy (SCT), a hybrid of cognitive psychotherapy and physiotherapy, is an evidence-based approach that has been successfully applied in the treatment of women suffering from such disorders, for example chronic pelvic pain (CPP) and provoked vestibulodynia (PVD), both demanding pain conditions. The curriculum of Oslo Metropolitan University's Mensendieck physiotherapy bachelor's program includes SCT training for the management of PVD. PURPOSE: The purpose of this study is to describe and explore the content of a SCT session based on a body and mind approach as performed by a physiotherapy student at a student outpatient clinic. METHODS: A video-based case study of the student-patient encounter was undertaken midway through an SCT treatment course and subjected to content analysis. FINDINGS: Three categories illustrating the learning process of body awareness, associated with the three-phase SCT were identified: 1) demystifying genital and chronic pain; 2) concentration, and body and mind experiences; and 3) patience, persistence, and willingness to change. CONCLUSION: The observation of the somatocognitive therapy session illustrates the value of an empathic relationship with the patient, in order to encourage her to explore body sensations and become familiar with the vulvar area. The therapy engages the patient in understanding pain mechanisms, thus educating her to overcome the fear of pain.

Feasibility and acceptability of somatocognitive therapy in the management of women with provoked localized vestibulodynia-ProLoVe feasibility study.

BACKGROUND: Provoked vestibulodynia (PVD) is a prevalent chronic pain condition especially among young women. Pain is localized to the vulvar vestibule and is provoked by touch or pressure, such as penetrative intercourse. PVD can have profound consequences, adversely affecting a woman's sexual life, relation to her partner, and her psychological health. There is an urgent need for well-designed randomized clinical trials (RCTs) to identify the most effective interventions for this neglected women's health condition. AIMS: The primary aim of this study is to assess the feasibility of undertaking a full-scale RCT of somatocognitive therapy (SCT), a multimodal physiotherapy intervention, for women with PVD. The secondary aim is to evaluate the implementation and acceptability of SCT and its potential treatment effectiveness in PVD. In the full-scale RCT, SCT will be compared to standard PVD treatment. METHODS: A multimethod feasibility study with a single-arm before-after trial and qualitative interviews. Ten women with PVD, aged 18-33 were recruited from the Vulva Clinic at Oslo University Hospital. The intervention took place at Oslo Metropolitan University. Participants were assessed at baseline, post-treatment, and the 8-month follow-up with the tampon test and self-report questionnaires. The main feasibility outcomes were evaluation of recruitment rate, adherence to assessment tools, and follow-up rate. The participants' experiences with the primary outcome and the intervention were explored with semi-structured interviews. RESULTS: Ten out of 18 eligible patients were recruited over 11 weeks. None were lost to follow-up. Adherence to self-report questionnaires was excellent. Adherence to tampon tests and to the reporting of treatments was good, whereas adherence to the 14-day diary was poor. No adverse events were reported. The tampon test was suboptimal as a primary outcome. SCT was found to be an acceptable treatment, based on Global Perceived Effect scores and the participants' experiences. CONCLUSION: The findings suggest that it is feasible to deliver a full-scale RCT of the SCT intervention for women with PVD. Some changes are suggested to optimize the protocol, such as increasing recruitment sites, change of primary outcome measures, and adding a booster session. TRIAL REGISTRATION: ClinicalTrials.gov NCT04208204 . Retrospectively registered on December 23, 2019.

Coping Patterns and Emotional Distress in Patients With Chronic Obstructive Lung Disease Who Are Undergoing Lung Transplant Evaluation.

OBJECTIVES: Living with severe lung disease like chronic obstructive pulmonary disease (COPD) is a very stressful situation. The way patients cope may impact their symptoms of anxiety and depression and physical function as well. We studied how ways of coping are associated with levels of emotional distress and lung function in patients with COPD being evaluated for lung transplantation. METHODS: Sixty-five (mean age 57 years, 46% females) patients completed the General Health Questionnaire-30 (GHQ-30) assessing emotional distress and the Ways of Coping Questionnaire. Measurements of lung function and 6-minute walk test were included. RESULTS: Seventeen (26%) patients had elevated emotional distress. Logistic regression of chronic GHQ score with gender, age, body mass index, lung function, and coping scales as covariates showed that escape avoidance and self-controlling coping and forced vital lung capacity were significantly associated with high emotional distress. Odds ratio of emotional distress increased with 5.2 per tertile (P = .011) in escape avoidance coping score. Moreover, we revealed that emotionally distressed patients cope with their current situation by refusing to believe the current situation and taking their distress out on other people. CONCLUSION: Among patients with COPD, a high level of emotional distress was uniquely associated with escape-avoidance coping and lung function. Future work should ascertain whether coping style predicts distress or whether distress increases the use of escape-avoidance coping. Nevertheless, our findings indicate that if either element is present, health care professionals should be attentive to the need for interventions to improve patients' well-being.

Characteristics of women with chronic pelvic pain referred to physiotherapy treatment after multidisciplinary assessment: a cross-sectional study.

Background and aims Chronic pelvic pain (CPP) in women is a complex condition that can seriously impact health and quality of life. Clinical guidelines for CPP place great demands on healthcare professionals, as they require both specialized knowledge about the pelvic area and knowledge of the mechanisms of chronic pain. To ensure best possible assessment and treatment of these women it is important to bring about more knowledge of the special CPP features. The purpose of this paper is to describe the characteristics of women with CPP evaluated at the University Hospital of North Norway, and further referred to physiotherapy. The frequency of having a history of abuse or previous pelvic surgery will also be reported, and analyses performed to investigate if subjective health status differs between women with and without these experiences. Methods We collected cross-sectional data from 62 women with CPP aged 20-65 (mean age 38.0), referred to physiotherapy after assessment by medical specialists. Data were collected by semi-structured interviews for demographic variables and medical history, and self-administered questionnaires on pain intensity, sexual function, urinary incontinence (UI), anal incontinence (AI), obstructed defecation syndrome (ODS), subjective health complaints (SHC) and symptoms of anxiety and depression. Results Pain duration of more than 10 years was reported by 42%, mean pain score was 4.7/10, and analgesics were used weekly by 48%. Previous pelvic or abdominal surgery was reported by 71%, and sick leave >12 weeks the last year by 34%. Reduced sexual desire was reported by 78%, dyspareunia by 73%, UI by 54%, AI by 23%, and obstructed defecation syndrome (ODS) by 34%. More than 90% reported musculoskeletal or pseudoneurologic complaints. Anxiety and depression scores defined as requiring treatment were reported by 40%. Abuse was reported by 50%, and associated with significantly more reports of ODS (p=0.02), more SHC (p=0.02) and higher anxiety scores (p=0.009). Analgesic use and sick leave were significantly higher both among women with a history of abuse (p=0.04 and p=0.005) and among those with previous surgery (p=0.04 and p=0.02). Women with previous surgery reported significantly lower pain intensity during intercourse than those without previous surgery (p=0.008). Conclusions Women with CPP have complex symptoms and high scores for both physical and psychological complaints. Women exposed to abuse have especially high scores related to analgesic use, sick leave, ODS, anxiety and SHC. Women with previous surgery report more analgesic use and sick leave, and lower pain intensity during intercourse, than those without previous surgery. Implications This study illustrates the complexity of CPP and highlights the need for health professionals to have specialized knowledge of the possible features of the condition. Previous abuse seems to be more associated with poor scores on several health outcomes than surgery, but this needs to be investigated further.

Somatocognitive therapy of women with provoked vulvodynia: a pilot study.

BACKGROUND AND AIMS: Provoked vestibulodynia (PVD) is a common persistent pain state among women in the Western world, causing dyspareunia, psychological distress and challenges against fertility. Therapies aimed at relieving pain (physiotherapy) and psychological distress (psychotherapy) are often recommended, sometimes in multimodal combinations. We have previously developed somatocognitive therapy (SCT) as a multimodal intervention, administered by a physiotherapist, to a different group of patients with gynecological pain, i.e. chronic (unprovoked) pelvic pain (CPP, also referred to as low abdominal pain). In a randomized, controlled study this intervention was shown to reduce pain experience and improve motor function or body awareness. Here we present the results of a clinical follow-up pilot study with 30 women with PVD, applying SCT administered by third year bachelor students in physiotherapy. Main outcome was pain experience, secondary outcomes were psychological distress and motor functions of the patients. METHODS: Thirty women diagnosed with PVD were recruited from a tertiary university hospital clinic of gynecology, and included in the follow-up pilot study at an out-patient physiotherapy clinic. Each patient participated in 10-14 therapy sessions over 6 weeks. The students were supervised by an experienced physiotherapist with extensive background in this clinical area, who also performed two clinical sessions with each of the patients at the end of the treatment period. Before therapy, the patients were evaluated for pain experience (visual analogue scale of pain, VAS), psychological distress (Tampa scale of kinesiophobia, TSK) and General Health Questionnaire (GHQ-30) as well as body function (standardized Mensendieck test, SMT). Statistical analyzes were performed by using the average ± standard deviation, statistical significance of changes calculated by means of the t-test. RESULTS: Average pain score before therapy were 7.77 ± 1.98, after 6 weeks of intervention 4.17 ± 2.07 and at 6 months' follow-up 1.66 ± 1.08 (average ± standard deviation), changes being significant below p < 0.01 level. Secondary outcome variables assessing psychological distress and sub optimal motor patterns were also significantly improved. For example, anxiety and depression scores were reduced by approximately 40%, and respiration pattern score improved by almost 80%. CONCLUSIONS: Multimodal somatocognitive therapy reduced levels of pain and psychological distress, and improved motor functions in women with PVD after 6 weeks of interventions. All variables were further improved at 6 months' follow-up. Thus, somatocognitive therapy may be a useful treatment option for patients with PVD. However, there are limitations to this study, since there was no control group, and suboptimal blinding during assessment of the data. IMPLICATIONS: Somatocognitive therapy may be a useful tool when treating PVD patients. More studies, in particular RCTs, should be performed to further evaluate this intervention and corroborate the results from this pilot study.

Recovering from provoked vestibulodynia: Experiences from encounters with somatocognitive therapy.

Although provoked vestibulodynia (PVD) represents a significant challenge for many young women in the Western world, little is known about how these women experience therapeutic efforts. The aim of this paper is to enhance our knowledge of the way that the therapeutic process is experienced by women with PVD undergoing somatocognitive therapy (SCT). The study enhances insight into this recently developed therapy through a detailed description of the physiotherapy approach. The empirical data are based on interviews with six women who participated in SCT. The empirical data analysis is guided by thematic analysis. Our findings demonstrate how the women experience SCT as a bodily process of wholeness. The process of wholeness relates to new experiences in the women's own bodies, awareness of muscular and mental tension and relaxation, breathing patterns, and perceptions focusing on pain. The findings are presented as three interrelated themes: 1) sensitizing the body as an interconnected unit; 2) incorporating the painful pubic region into the body; and 3) developing a new understanding of oneself. The women who participated in this study found that SCT contributed significantly to the process of their recovery from PVD.

Somatocognitive therapy in the management of chronic gynaecological pain. A review of the historical background and results of a current approach.

Historic background and development of our somatocognitive approach Mensendieck physiotherapy of the Oslo School is a tradition of physiotherapy founded by the American physician Bess Mensendieck, a contemporary and fellow student of Sigmund Freud at the Paris School of Neurology. It builds on the principles of functional anatomy and the theories of motor learning. We have further developed the theory and practice from this physiotherapy tradition, challenged by the enormous load of patients with longstanding, incapacitating pain on western health care systems, by seeking to incorporate inspirational ideas from body oriented dynamic psychotherapy and cognitive psychotherapy. We developed somatocognitive therapy as a hybrid of physiotherapy and cognitive psychotherapy by focusing on the present cognitive content of the mind of the patient, contrary to a focus on analysis of the subconscious and interpretation of dreams, and acknowledging the important role of the body in pain-eliciting defense mechanisms against mental stress and negative emotions. The core of this somatocognitive therapy (1) To promote awareness of own body, (2) graded task assignment related to the motor patterns utilized in daily activities, (3) combined with an empathic attitude built on dialogue and mutual understanding, and emotional containment and support. The goal is for the patient to develop coping strategies and mastery of own life. In addition, (4) manual release of tensed muscles and applied relaxation techniques are important. Methods and results of an illustrative study One area in particular need of development and research is sexual pain disorders. We have applied this somatocognitive therapy in a randomized, controlled intervention study of women with chronic pelvic pain (CPP).Wesummarize methods and results of this study. Methods 40 patients with CPP were included in a randomized, controlled intervention study. The patients were randomized into (1) a control group, receiving treatment as usual (Standard Gynecological Treatment, STGT) and (2) a group receiving STGT + Mensendieck Somatocognitive Therapy (MSCT). The patients were assessed by means of Visual Analogue Scale of Pain (VASP), Standardized Mensendieck Test (SMT) for analysis of motor patterns (posture, movement, gait, sitting posture and respiration), and General Health Questionnaire (GHQ-30) assessing psychological distress, at baseline (inclusion into study), after three months of out-patient therapy and at 1 year follow-up. RESULTS: The women averaged 31 years, pain duration 6.1 years, average number of previous surgical procedures 1.8 per women. In the STGT group, no significant change was found, neither in pain scores, motor patterns or psychological distress during the observation period. In the group receiving STGT + MSCT, significant reduction in pain score and improvement in motor function were found at the end of therapy, and the significant improvement continued through the follow-up (64% reduction of pain scores, and 80% increase in the average score for respiration, as an example of motor pattern improvement). GHQ scores were significantly improved for anxiety and coping (p < 0.01). Conclusions Somatocognitive therapy is anewapproach that appears to be very promising in the management of chronic gynecological pain. Short-term out-patient treatment significantly reduces pain scores and improves motor function. Implications Chronic pelvic pain in women is a major health care problem with no specific therapies and poor prognosis. A novel, somatocognitive approach has documented positive effects. It is now studied by other clinical researchers in order to reinforce its evidence base.

The Standardised Mensendieck Test as a tool for evaluation of movement quality in patients with nonspecific chronic low back pain.

BACKGROUND AND AIMS: Nonspecific chronic low back pain is a multifactorial biopsychosocial health problem where accurate assessments of pain, function and movement are vital. There are few reliable and valid assessment tools evaluating movement quality, hence the aim was to investigate nonspecific chronic low back pain patients' movement patterns with the Standardised Mensendieck Test. METHODS: Twenty patients (mean age=41, SD=9.02) with nonspecific chronic low back pain were examined with the Standardised Mensendieck Test whilst being videotaped and compared with 20 healthy controls. A physiotherapist, blinded to participant's group belonging, scored Standardised Mensendieck Test videos according to the standardised manual. Associations between movement quality, fear of movement and re(injury) i.e. kinesiophobia and pain intensity were also investigated. RESULTS: Patients scored significantly poorer than the controls in all 5 Standardised Mensendieck Test domains (p<0.001). The biggest difference was observed with regard to movement pattern domain. In women we also found a difference in the respiration pattern domain. CONCLUSIONS: The Standardised Mensendieck Test was able to detect significant differences in quality of movement between patients and healthy controls. These results indicate that the Standardised Mensendieck Test may be a valuable examination tool in assessment and treatment of nonspecific chronic low back pain patients. Further, longitudinal studies should investigate whether poor movement and respiration patterns are important factors in nonspecific chronic low back pain, e.g. as predictors and/or mediators of therapeutic effects.

Pain, psychological distress and motor pattern in women with provoked vestibulodynia (PVD) - symptom characteristics and therapy suggestions.

BACKGROUND AND AIMS: Provoked vestibulodynia (PVD) represent a longstanding pain syndrome that affects large numbers of women worldwide. However, no standardized guidelines for PVD treatment exist. In a cross-sectional pilot study we examined 30 PVD patients on multidimensional parameters including pain, psychological distress and quality of movement, in order to obtain a broader understanding of the somatic and psychological symptoms in PVD, and for the future to develop better interventions. Additionally, we compare the findings to previously published results regarding the same parameters in women with chronic pelvic pain (CPP). METHODS: Thirty women with PVD recruited from a tertiary care university clinic of gynecology were assessed for demographic data, pain intensity (VAS), psychological distress (GHQ-30 and Tampa scale of Kinesophobia) and quality of movement (standardized Mensendieck test, SMT). RESULTS: Average age of the PVD women was 24.7±3.60 years, 60% of them were in permanent relationships, all were nulliparous, none had been subjected to surgical procedures, 100% were working full or part time and 90% were educated to at least undergraduate level. Mean VAS score was 7.77±1.97 (mean±SD), kinesiophobia 24.4±3.95 and anxiety domain of GHQ-30 9.73±4.06. SMT scores were particularly low for the domains of respiration and gait (less than 50% of optimal scores). CONCLUSIONS: PVD women display reduced quality of movement, especially for gait and respiration patterns, increased level of anxiety and high average pain scores. These findings are similar to what we have previously reported in CPP patients. However, in contrast to CPP group, PVD women are on average younger, have higher work participation, higher education level and have not been subjected to surgical procedures. IMPLICATIONS: Since PVD women display similar, although somewhat less severe, symptom profile than CPP, we suggest that a multidimensional approach to treatment, such as "somatocognitive therapy" should be investigated in this group as it has previously been shown to be promising in treatment of CPP.

Posture, movement patterns, and body awareness in women with chronic pelvic pain.

OBJECTIVE: Chronic pelvic pain (CPP) is a common cause of infirmity but is still poorly understood. We studied the clinical characteristics, including body awareness, of 60 women with this diagnosis compared to those of healthy controls in an effort to understand its pathophysiology and to develop a more efficient treatment protocol. METHODS: After prior gynecologic and psychometric evaluation, the women were examined with the Standardized Mensendieck Test to evaluate posture and movement patterns. Pain history and pain score were obtained, and patterns of muscular density, elasticity, and tenderness were determined by palpation. The body awareness of patients was assessed through clinical evaluation. RESULTS: Seventy percent of the patients had a history of trauma or infection of the genitourinary region. The average pain score (+/-S.D.) on a scale from 0 to 10 was 6.01+/-1.60. Nearly all patients had a dissociative pattern, with a lack of contact and control of large body regions. All scores for posture and movement patterns were significantly worse in patients than in healthy women. CONCLUSION: A specific pattern of pain, posture, movement, muscle pathology, and reduced awareness of one's own body was found in women with CPP. These findings may increase our understanding of, and may point toward new treatment strategies for, this disease.

Reliability and validity of a standardized Mensendieck physiotherapy test (SMT).

A standardized test was developed to evaluate posture, movement, gait, sitting posture, and respiration of patients with psychosomatic disorders, based on the Mensendieck principles of observation and analysis of motor function. To validate the test and to make a comprehensive body examination of a defined group of patients, it was applied in a study of women with chronic pelvic pain (CPP, ICD10 F45.4). Fifteen women with CPP and 15 matched, healthy controls were examined. Test subjects were video recorded and scored by three experienced Mensendieck physical therapists, blinded with respect to the selection of subjects. Scores from 0 (for least functional movement) to 7 (optimal function) were assigned to each test person according to a test manual. High intraclass correlations (ICC1.1 [corrected] ranging from 0.82 to 0.97) were found among the testers. The standardized Mensendieck test (SMT) discriminated well between women with CPP and the controls (sensitivity 0.9, specificity 0.7, mean values). The CPP patients scored significantly lower than the controls in all subtests (p < 0.01). The largest difference in scores were found for gait (patients 2.70 +/- 0.11, vs. control, 5.60 +/- 0.09) and respiration (patients 2.88 +/- 0.14, vs. control, 5.63 +/- 0.10). The results indicate that, in the hands of experienced Mensendieck therapists, the SMT is a reliable tool, demonstrating a good discriminative validity. Furthermore, it may turn out to be a useful instrument in the evaluation of patients with somatoform disorders. It may also point toward a possible therapeutic treatment approach to patients with CPP.

Psychiatric disorders and psychological distress in patients undergoing evaluation for lung transplantation: a national cohort study.

OBJECTIVE: We sought to investigate type and prevalence of psychiatric disorders and psychological distress in patients being evaluated for lung transplantation. METHODS: One hundred eighteen patients were assessed [74% with chronic obstructive pulmonary disease (COPD)] with the MINI Neuropsychiatric Interview, the General Health Questionnaire (GHQ), and Hospital Anxiety Depression Scale (HADS). Spirometry and the 6-min walk test (6MWT) assessed lung function with data subject to multivariate regression analyses. RESULTS: Current and lifetime prevalence for mental disorders were 41.5% and 61.0% respectively, with anxiety (39.8% of patients), mood disorders (11.8%), and subsyndromal disorders (8.7%) identified. 15% of patients reported feelings of panic during the last week, 9% reported hopelessness, and 3% felt that life was not worth living. Statistically significant correlates were derived for HADS-depression with lung function (P=.0012) and 6MWT (P=.030) for the entire group (P=.012), and with lung function (P=.030) for COPD patients (P=.045), for whom higher chronic GHQ-scores correlated with poorer lung function (P=.009). In multivariate regression analysis, history of mental disorder was strongest predictor of current distress. CONCLUSIONS: Our findings underline the importance of assessing past, current, and sub-syndromal psychiatric disorders in addition to levels of distress in transplant candidates, with prospective studies needed to investigate impact on long-term outcome after transplantation.

Treating gynecological pain: the experiences of bachelor students in physiotherapy performing somatocognitive therapy.

BACKGROUND: Longstanding gynecological pain affects large numbers of women in the Western world. In recently published studies, we have found that a hybrid of physiotherapy and cognitive psychotherapy called somatocognitive therapy (SCT) ameliorates physical symptoms and psychological distress. In this paper, we report on the experiences of undergraduate physiotherapy students performing the therapy to patients with provoked vestibulodynia (PVD). AIM: The study aimed to investigate the nature of the collaborative interaction between female physiotherapy students and patients with PVD, focusing on critical factors for the students' learning of professional skills through SCT applied on patients suffering from an especially demanding pain condition. METHODS: In a qualitative study design, data were collected from two group interviews with four female students in pairs, and subjected to a thematic analysis. RESULTS: We found that students perceive the patient encounter as critical incidents in the sense of strong emotional encounters. From the data material, there emerged a four-step process ranging from distance to proximity, highlighting factors that influence the development of professional skills. The four steps are defined respectively as: (1) the students' prejudices; (2) identification and empathy; (3) senses of responsibility in the therapeutic relationship and (4) collaborative engagement for change. COMMENTS: Contrary to expectations, the students experienced the application of this combined approach (SCT) as an interesting and rewarding way of working with patients, and that they had achieved skills and a sufficient set of tools to cope with the challenges that patients with longstanding gynecological pain represent.