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1.
Pan Afr Med J ; 32: 160, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303929

RESUMO

Introduction: Vaginismus is a severe dysfunction and a problem which can interfere with woman's and couple's sex life. It may influence the obstetric outcome. This study aims to determine if the clinical features of vaginismus can impact childbirth experience. Methods: We conducted a retrospective multicenter study involving patients affected by primary vaginismus, having given birth to their first child (who had reached term), between 2005 and 2015. Results: Out of 19 patients included in the study, 9 had prolonged pregnancies, 14 had spontaneous labor (including 8 at term), 3 had cesarean section before going into labor and 2 had labor induction. Among the 16 women who experienced labor, 4 had cesarean section, 5 had vaginal delivery with the help of forceps and 7 had spontaneous vaginal delivery. Among the 12 women who had vaginal delivery, 9 underwent episiotomy, 7 had spontaneous perineal tear alone or in combination with episiotomy. No 3rd and 4th degree perineal injury or intact perineum were found. The average birth weight for babies was 3380 g ± 332 (2870 g-3970g, 47th percentile). Conclusion: The rates of labour dystocia and perineal morbidity were significantly high. These data were comparable to most of the data in the literature. It is likely that the psychological and behavioral aspects of vaginismus (fear-avoidance and anxiety-inducing mechanism) have favoured prolonged pregnancies, cesarean sections, mechanical dystocias and perineal injuries. Additional studies are necessary to better identify vaginismus and its obstetrical implications.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Resultado da Gravidez , Gravidez Prolongada/epidemiologia , Vaginismo/complicações , Adulto , Cesárea/estatística & dados numéricos , Distocia/epidemiologia , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Períneo/lesões , Gravidez , Estudos Retrospectivos , Adulto Jovem
2.
Ceska Gynekol ; 84(3): 233-239, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324116

RESUMO

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


Assuntos
Coito , Dispareunia/etiologia , Qualidade de Vida , Vaginismo/psicologia , Dispareunia/psicologia , Feminino , Humanos , Vaginismo/diagnóstico , Vaginismo/terapia
3.
Turk Psikiyatri Derg ; 30(1): 9-15, 2019.
Artigo em Turco | MEDLINE | ID: mdl-31170302

RESUMO

OBJECTIVE: In patients with vaginismus, the Lack of knowledge on rates of depression and anxiety disorders is noteworthy. The aim of the present study was to investigate the prevalance of anxiety disorders and major depression and to examine the relationship of these  omorbidities with sexual functions in women diagnosed with lifelong vaginismus.  METHOD: One hundred and fourty-four women who were diagnosed with vaginismus were recruited for the study. Depression and anxiety disorders section of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) were administered to the participants.  RESULTS: At least one comorbid anxiety disorder and/or depression was found in 79.86 % of the cases. The most common comorbid disorder was specific phobia (63.9%). This was followed by major depression (35.4%), social anxiety disorder (13%), panic disorder (10%), obsessive compulsive disorder (5%) and generalized anxiety disorder (2%). On GRISS, mean avoidance score was higher in patients with comorbid depression and non-communication score was higher in patients with comorbid panic disorder when compared to patients with no comorbidity.  CONCLUSION: The prevalence of depression and anxiety disorders, especially spesific phobia, was higher in patients with vaginismus than the general population. Both high comorbidity of these psychiatric disorders and disruption of functions in all domains of sexuality emphasize the importance of holistic approach in evaluation of these patients.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Sexualidade , Vaginismo/psicologia , Adulto , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Prevalência , Escalas de Graduação Psiquiátrica , Turquia/epidemiologia , Adulto Jovem
4.
J Sex Marital Ther ; 45(8): 667-672, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31007150

RESUMO

Although Vaginismus, or an involuntary contraction of the vaginal muscles, is one of the reasons sexual intercourse difficulty is relatively common in Iran, few studies have addressed it. This research is a single-case type (AB) design. Initially, a pretest was taken from all participants. The number of sessions was estimated between 4 and 6 sessions, and the duration of each session was 45-60 minutes. Couple therapy sessions were conducted by an individual with a PhD in sexual and reproductive health. An FSFI questionnaire was completed before counseling, just after counseling, and 4 weeks after the last counseling session. During each session, the therapist reviewed the homework assignments of the previous session regarding emotions, thoughts, and experiences, and at the end of each session, the therapist answered the couples' questions. We introduce and follow up on five casesof couples who suffer from Vaginismus. The mean age for females was 29.5, and for males it was 32. The mean length of marriage was more than 5 years. The FSFI score of participants improved from baseline (A) after intervention (B). The study would appear to show that this treatment format may be a cost effective intervention for couples presenting with Genito-pelvic pain/penetration disorder (Vaginismus).


Assuntos
Coito/psicologia , Terapia de Casal/métodos , Vaginismo/terapia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Casamento , Índice de Gravidade de Doença , Comportamento Sexual/psicologia , Vagina/fisiopatologia , Vaginismo/fisiopatologia
5.
Int Urogynecol J ; 30(7): 1071-1081, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30617506

RESUMO

INTRODUCTION AND HYPOTHESIS: Botulinum toxin (BoNT) is increasingly used for pain, especially with muscle spasm. We describe our methodology for BoNT treatment of chronic pelvic pain (CPP) in women and place it in the context of the literature on techniques for this use. METHODS: Databases were searched using terms "botulinum toxin," "pelvic pain," and "vaginismus." Reports on vaginismus/vulvodynia/vestibulodynia (included if pelvic floor muscles were injected) were grouped as "vaginismus/vulvar pain disorders" (V/VPD). We analyzed the type of report, condition, toxin serotype/brand, dose/dilution, muscle selection, guidance technique, and anesthesia. Publications from the same authors without unique information were combined for specific analyses. RESULTS: Thirty-eight reports had analyzable information; many lacked complete information. Most were open-label prospective reports; there were four technical reports, one randomized comparison of doses and one placebo-controlled study of efficacy. Pelvic floor muscles were approached transvaginally, transperineally or transgluteally. BoNT brand/dose/dilution varied widely. Muscle localization techniques included anatomical landmarks only, electromyography, electrical stimulation with/without ultrasound, and fluoroscopy/CT scanning. Papers discussing analgesia utilized general anesthesia, conscious sedation with/without topical/local anesthesia, topical/local agent alone or pudendal block before or after injection. Cumulatively, 58-100% of patients with CPP and 71-100% of those with V/VPD improved. Serious adverse events (transient fecal incontinence/constipation, urinary incontinence/retention) were more frequent with higher doses. CONCLUSIONS: BoNT can be safely and tolerably injected into pelvic floor muscles in women as an out-patient procedure. This study identifies methodological factors to be considered in future studies and the critical need for high-quality clinical trials for this emerging treatment.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Dor Pélvica/tratamento farmacológico , Vaginismo/tratamento farmacológico , Doenças da Vulva/tratamento farmacológico , Toxinas Botulínicas Tipo A/efeitos adversos , Dor Crônica/tratamento farmacológico , Relação Dose-Resposta a Droga , Feminino , Humanos , Injeções , Fármacos Neuromusculares/efeitos adversos , Estudos Prospectivos , Espasmo/tratamento farmacológico , Resultado do Tratamento
6.
J Sex Marital Ther ; 45(1): 73-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30044690

RESUMO

The objective of this case-control study was to identify psychosocial factors associated with vaginismus. One hundred twenty women were recruited and interviewed at the Institute of Human Sexuality, 40 with lifelong vaginismus, and 80 controls without vaginismus. Participants were matched for age, education, and date of admission. Women afraid of losing control during intercourse had 29.6 times greater likelihood of developing vaginismus (p < 0.01), as well as those afraid of suffering pain (p < 0.001) or being physically damaged (tearing) (p < 0.01). There is evidence that women have higher likelihood of vaginismus if they present fears of pain, injuries, bleeding, fear of losing control, and having a panic attack if they engage in sex with penetration.


Assuntos
Coito/psicologia , Dispareunia/psicologia , Medo/psicologia , Vaginismo/psicologia , Adulto , Estudos de Casos e Controles , Dispareunia/complicações , Dispareunia/prevenção & controle , Feminino , Humanos , Inquéritos e Questionários , Vaginismo/complicações , Vaginismo/prevenção & controle
7.
Int Urogynecol J ; 30(11): 1821-1828, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30506183

RESUMO

INTRODUCTION AND HYPOTHESIS: Most patients suffering from vaginismus feel sinful, anxious, and incompetent, with reduced self-confidence. This study was aimed at comparing the effectiveness of the physiotherapy of pelvic floor muscles as a standard treatment and local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus. METHODS: In this randomized clinical trial (RCT), the study population included women with primary vaginismus referred to the Sexual Health and Gynecologic Clinics of Imam Khomeini Hospital during 2013-2014. They were diagnosed according to DSM-5 criteria and underwent treatments with botulinum injection (intervention group) and physiotherapy as the current treatment (control group). The participants' primary and secondary outcomes were measured based on successful intercourse and sexual functioning of each group. RESULTS: The results indicated that the overall standard physiotherapy, along with other measurements, such as functional electrical stimulation and desensitization, could effectively improve the patients' Female Sexual Function Index compared with botulinum treatment. At the end of the study, it was found that 20 and 26 patients out of the 30 and 28 patients in the intervention and control groups managed to have successful intercourse respectively (P = 0.014). Also, sexual dysfunction frequencies were seen to be decreased by 26.6% and 50% in the mentioned groups respectively (p = 0.008 and p < 0.001). CONCLUSIONS: Considering the higher efficacy of physiotherapy procedures compared with those of the desensitization and electrical stimulation techniques, this therapeutic method should be considered the first-line treatment of vaginismus (IRCT2016061828486N1).


Assuntos
Toxinas Botulínicas/administração & dosagem , Terapia Cognitivo-Comportamental , Terapia por Estimulação Elétrica , Diafragma da Pelve , Vaginismo/terapia , Adulto , Terapia Combinada , Feminino , Humanos , Injeções Intralesionais , Adulto Jovem
8.
J Sex Med ; 15(12): 1752-1764, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30446469

RESUMO

INTRODUCTION: Although vaginismus is a condition with a great impact on psychosexual well-being, the evidence on the efficacy of interventions is lacking. AIM: To review all information on vaginismus treatment, including data from randomized clinical trials (RCTs) and observational studies. METHODS: A systematic search was conducted of MEDLINE, EMBASE, PsycINFO, and ClinicalTrials.gov. 2 Independent meta-analyses of RCTs and observational studies were performed. For RCTs, only those having no treatment as the comparator were considered eligible. MAIN OUTCOME MEASURE: The primary outcome was the success rate (number of successes/total sample) in the completion of sexual intercourse. RESULTS: 43 Observational studies (n = 1,660) and 3 RCTs (n = 264) were included in the final analyses, respectively. In the meta-analysis of RCTs, the use of psychological interventions showed a trend toward a significantly better result vs waiting list control (OR 10.27 [95% CI 0.79-133.5], P = .075). The combination of the results obtained from the observational studies showed that treating vaginismus is associated with the completion of sexual penetrative intercourse in 79% of cases, independently of the therapy used (success rate 0.79 [0.74-0.83]). When only moderate- or strong-quality studies were considered, the success rate was 0.82 (0.73-0.89). As for the different definitions of vaginismus, studies with unconsummated marriage as the inclusion criterion showed the worst success rate (0.68). The origin of vaginismus (primary, secondary, or both), its duration, the mean age of the participants, the involvement of the partner in the intervention, or the geographic setting did not exert a significant effect on the outcome. Studies enrolling women with unconsummated marriage showed a significantly worse success rate. CLINICAL IMPLICATIONS: No approach is superior to the others in allowing the achievement of penetrative intercourse in women with vaginismus. STRENGTH & LIMITATIONS: Only studies specifically enrolling patients with vaginismus were selected, and analyses were performed on an intention-to-treat approach. The main limitations are the small number of trials in the meta-analysis of RCTs and the lack of a comparison group in the meta-analysis of observational studies, which cannot rule out a placebo effect. Due to the limited evidence available, great caution is required in the interpretation of results. Further well-designed trials, with more appropriate outcomes than penetrative sex, are required. CONCLUSION: The meta-analysis of RCTs documented a trend toward higher efficacy of active treatment vs controls, whereas the meta-analysis of observational studies indicated that women with vaginismus benefit from a range of treatments in almost 80% of cases. Maseroli E, Scavello I, Rastrelli G, et al. Outcome of Medical and Psychosexual Interventions for Vaginismus: A Systematic Review and Meta-Analysis. J Sex Med 2018;15:1752-1764.


Assuntos
Coito/psicologia , Vaginismo/psicologia , Vaginismo/terapia , Adaptação Psicológica , Dispareunia/psicologia , Dispareunia/terapia , Feminino , Humanos , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Parceiros Sexuais
9.
Rev Bras Ginecol Obstet ; 40(12): 787-793, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30428492

RESUMO

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


Assuntos
Dispareunia , Dor Pélvica , Vaginismo , Vulvodinia , Dispareunia/diagnóstico , Dispareunia/etiologia , Dispareunia/terapia , Feminino , Humanos , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Dor Pélvica/terapia , Vaginismo/diagnóstico , Vaginismo/etiologia , Vaginismo/terapia , Vulvodinia/diagnóstico , Vulvodinia/etiologia , Vulvodinia/terapia
10.
Sex Med Rev ; 6(4): 535-547, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29678473

RESUMO

INTRODUCTION: Muslim women are an increasingly underserved population in the United States and worldwide. Diagnosis and treatment of female sexual dysfunction bring unique challenges because of the conservative nature of those practicing the religion. Several cultural and religious codes of conduct affect sexual behavior and the dysfunction that can ensue. AIM: To assess and describe the types of sexual dysfunction that have been found in Muslim women internationally and encourage a better understanding of their issues to enhance health care delivery. METHODS: A comprehensive review of the literature through Ovid and PubMed was performed in search of articles reviewing female sexual dysfunction, Muslim women, and Islam. MAIN OUTCOME MEASURES: A brief explanation and review of the interpretations of sexuality within Islam are discussed. The link is made between conservative sexual relations and interpretations and the types of sexual dysfunction experienced. Female sexual dysfunction is explored in relation to how female chastity is extolled and how cultural procedures continue despite the ethical and health concerns related to them. RESULTS: Most Muslim women experience sexual dysfunction similar to other women, including arousal, desire, and orgasmic disorders related to organic and psychologic factors. Sexual pain disorders might be more prevalent in this population, particularly concerning unconsummated marriage. There are special concerns related to maintaining virginity and preserving the hymen until marriage. Female genital cutting, practiced by some Muslim countries, has potential sexual consequences. CONCLUSION: Understanding Islamic views on sexuality and how they can affect sexual dysfunction in Muslim women is critical in opening lines of communication with patients and approaching female sexual dysfunction impartially. Although some issues that arise might introduce ethical dilemmas for the provider, having the cultural competence to address these issues will facilitate improved health care delivery. Rahman S. Female Sexual Dysfunction Among Muslim Women: Increasing Awareness to Improve Overall Evaluation and Treatment. Sex Med Rev 2018;6:535-547.


Assuntos
Islamismo , Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Dispareunia , Feminino , Humanos , Comportamento Sexual/etnologia , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/etnologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Fisiológicas/terapia , Disfunções Sexuais Psicogênicas/etnologia , Disfunções Sexuais Psicogênicas/psicologia , Disfunções Sexuais Psicogênicas/terapia , Vaginismo
11.
Rev. Hosp. Ital. B. Aires (2004) ; 38(1): 31-33, mar. 2018.
Artigo em Espanhol | LILACS | ID: biblio-1046195

RESUMO

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


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


Assuntos
Humanos , Feminino , Adulto , Relações Médico-Paciente , Estresse Psicológico/psicologia , Vaginismo/psicologia , Fadiga/diagnóstico , Papel do Médico , Delitos Sexuais/psicologia , Estresse Psicológico/terapia , Sertralina/uso terapêutico , Vaginismo/diagnóstico , Medicina de Família e Comunidade , Fadiga/terapia , Conforto do Paciente
12.
JBRA Assist Reprod ; 22(1): 35-41, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29257632

RESUMO

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


Assuntos
Necessidades e Demandas de Serviços de Saúde , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Técnicas de Reprodução Assistida , Vaginismo/epidemiologia , Vaginismo/terapia , Populações Vulneráveis/estatística & dados numéricos , Adulto , Dispareunia/epidemiologia , Dispareunia/terapia , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Infertilidade Feminina/etiologia , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Técnicas de Reprodução Assistida/estatística & dados numéricos , Falha de Tratamento , Vaginismo/complicações
13.
Curr Drug Targets ; 19(8): 916-926, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28228081

RESUMO

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


Assuntos
Dispareunia/fisiopatologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Vaginismo/fisiopatologia , Animais , Dor Crônica/fisiopatologia , Dispareunia/psicologia , Feminino , Humanos , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Vaginismo/psicologia
14.
J Sex Med ; 14(11): 1392-1402, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29110807

RESUMO

BACKGROUND: Evidence concerning the determinants of vaginismus (V), in particular medical conditions, is inconclusive. AIM: To investigate, in a cohort of subjects consulting for female sexual dysfunction, whether there is a difference in medical and psychosocial parameters between women with V and women with other sexual complaints. METHODS: A series of 255 women attending our clinic for female sexual dysfunction was consecutively recruited. V was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Lifelong and acquired V cases were included. OUTCOMES: Patients underwent a structured interview and physical, gynecologic, laboratory, and clitoral ultrasound examinations; they completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire, the Female Sexual Distress Scale-Revised (FSDS), and the Body Uneasiness Test. RESULTS: V was diagnosed in 20 patients (7.8%). Women with V were significantly younger than the rest of the sample (P < .05). No differences were found for traditional risk factors such as a history of sexual abuse, relational parameters, or gynecologic diseases or for newly investigated parameters (ie, neurologic, hormonal, and metabolic alterations). Women with V showed significantly higher histrionic-hysterical symptoms and traits (as detected by MHQ-H score; P < .05) compared with subjects with other sexual complaints. When the scores of all MHQ subscales were simultaneously introduced in a logistic model, the association between V and MHQ-H score was confirmed (P = .013). Women with V also showed higher FSFI pain and FSDS total scores, even after adjusting for age (P < .05). In an age-adjusted model, FSDS total score increased as a function of the years of duration of V (P = .032) but not as a function of its severity. All observations were confirmed in a case-control study (ratio = 1:3). CLINICAL IMPLICATIONS: Our data demonstrate that some novel contributors of V should be investigated, namely histrionic-hysterical traits. This psychological comorbidity could offer valuable insights for intervention and managing complications. STRENGTHS AND LIMITATIONS: This is the first study to assess the role of many metabolic and hormonal parameters as potential determinants of V. The main limitation is its exploratory and cross-sectional nature; our data need to be confirmed in larger, more systematic analyses. CONCLUSION: V was associated with histrionic-hysterical traits, FSFI pain domain, and sex-related distress. A history of abuse, relational parameters, gynecologic diseases, and hormonal and metabolic alterations do not seem to play a role in the development of V. Maseroli E, Scavello I, Cipriani S, et al. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med 2017;14:1392-1402.


Assuntos
Dispareunia/psicologia , Comportamento Sexual/psicologia , Disfunções Sexuais Psicogênicas/psicologia , Vaginismo/psicologia , Adulto , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Dispareunia/complicações , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Fatores de Risco , Disfunções Sexuais Psicogênicas/complicações , Inquéritos e Questionários , Vaginismo/complicações , Adulto Jovem
15.
Afr Health Sci ; 17(3): 632-636, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29085390

RESUMO

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


Assuntos
Coito/psicologia , Casamento , Aconselhamento Sexual , Comportamento Sexual/psicologia , Disfunções Sexuais Psicogênicas/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Vaginismo/etiologia , Vaginismo/terapia , Adulto , Coito/fisiologia , Disfunção Erétil , Feminino , Humanos , Irã (Geográfico) , Masculino , Comportamento Sexual/fisiologia , Disfunções Sexuais Psicogênicas/psicologia , Estresse Psicológico , Vaginismo/psicologia
16.
Turk Psikiyatri Derg ; 28(3): 172-180, 2017.
Artigo em Turco | MEDLINE | ID: mdl-28936816

RESUMO

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


Assuntos
Transtorno Depressivo/psicologia , Disfunções Sexuais Fisiológicas/psicologia , Parceiros Sexuais , Vaginismo/psicologia , Adulto , Terapia Cognitivo-Comportamental , Transtorno Depressivo/complicações , Transtorno Depressivo/terapia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Disfunções Sexuais Fisiológicas/complicações , Disfunções Sexuais Fisiológicas/terapia , Vaginismo/complicações , Vaginismo/terapia
17.
Pan Afr Med J ; 27: 60, 2017.
Artigo em Francês | MEDLINE | ID: mdl-28819482

RESUMO

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


Assuntos
Casamento , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/etiologia , Vaginismo/etiologia , Feminino , Hospitais Militares , Humanos , Marrocos , Disfunções Sexuais Fisiológicas/terapia , Vaginismo/terapia , Adulto Jovem
18.
Diagn. tratamento ; 22(2): 83-87, Abr.-Jun. 2017.
Artigo em Português | LILACS | ID: biblio-833699

RESUMO

A sexualidade humana extrapola os limites da anatomia e fisiologia, e o desempenho sexual depende da integração dos fatores biológico, psicológico, social, cultural, econômico, legal e religioso. A prática da sexologia é bastante complexa, pois deve ser interdisciplinar e envolve o conhecimento multidisciplinar, exigindo do profissional constante atualização nos vários assuntos ligados à saúde e à educação. A abordagem das disfunções sexuais, além de envolver a educação, que visa canalizar a expressão sexual para uma vivência saudável, consta de medidas terapêuticas que visam restaurar a função sexual do indivíduo. A fisioterapia é a modalidade terapêutica utilizada para prevenir, corrigir e aliviar as disfunções de origem anatômica ou fisiológica, reabilitando a integridade de órgãos e sistemas, restaurando o bem-estar físico do indivíduo. A fisioterapia nas disfunções pélvicas atua na prevenção e tratamento das desordens do assoalho pélvico, da pelve e seus órgãos, da coluna lombossacra e do abdômen. Dentre essas disfunções, destacam-se as sexuais femininas: dispareunia, vaginismo, alterações do orgasmo e de interesse/excitação.


Assuntos
Dispareunia , Equipe de Assistência ao Paciente , Fisioterapia , Sexualidade , Vaginismo
19.
Eur J Contracept Reprod Health Care ; 22(2): 152-155, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28256911

RESUMO

CASE REPORT: In this report, we describe the unique case of a 21 year-old woman, gravida 1, para 1, with paroxysmal nocturnal haemoglobinuria (PNH) and Budd-Chiari syndrome, as well as severe vaginismus and cervical stenosis, in need of contraception. Herein, we present the clinical considerations and implications taken to arrive at the right contraceptive choice for the patient. DISCUSSION: Budd-Chiari syndrome is defined by the presence of hepatic venous outflow tract obstruction, which may be due to a number of underlying causes. PNH is a rare, acquired, life-threatening disease characterised by red blood cell destruction (haemolytic anaemia), blood clots (thrombosis) and impaired bone marrow function. PNH is a known underlying cause of Budd?Chiari syndrome. Patients with PNH carry an increased risk of mortality, particularly during pregnancy. As such, pregnancy is absolutely contraindicated in these patients, who require strict contraceptive regimens. However, the presence of both PNH and Budd?Chiari syndrome limits contraceptive choices and poses a contraceptive challenge.


Assuntos
Síndrome de Budd-Chiari/complicações , Anticoncepcionais Orais Combinados/administração & dosagem , Hemoglobinúria Paroxística/complicações , Feminino , Humanos , Vaginismo/complicações , Adulto Jovem
20.
J Sex Med ; 14(2): 238-254, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28161080

RESUMO

INTRODUCTION: Difficulties with vaginal penetration can severely affect a woman's desire to have sexual intercourse, her sexual and general well-being, or her partnership. However, treatment opportunities for vaginismus are scarce. AIM: To evaluate the efficacy of an internet-based guided self-help intervention for vaginismus in a randomized controlled pilot trial. METHODS: Seventy-seven women with vaginismus (primary inclusion criterion = no intercourse ≥ 6 months) were randomly assigned to an intervention group (IG) and a waitlist control group (WCG). The intervention consisted of 10 sessions involving psychoeducation, relaxation exercises, sensate focus, and gradual exposure with dilators. Participants received written feedback on completed sessions from an eCoach. MAIN OUTCOME MEASURES: The primary outcome was successful sexual intercourse. Secondary outcomes were non-intercourse penetration, fear of coitus, sexual functioning, and dyadic coping. Self-reported assessments were scheduled at baseline, 10 weeks, and 6 months. RESULTS: More participants (10 of 40, 34.48%) in the IG had intercourse compared with those in the WCG (6 of 37, 20.69%) at least once at 10 weeks or 6 months (odds ratio = 2.02). The difference was not significant (χ21 = 1.38, P = .38), but in the IG, there was a significant increase in intercourse penetration from baseline to 6 months (d = 0.65). No such increase was found in the WCG (d = 0.21). There were significant between-group effects concerning non-intercourse penetration (self-insertion of a finger or dilator or insertion by the partner) in favor of the IG. Fear of coitus and dyadic coping significantly decreased in the IG. Overall satisfaction with the training was high. CONCLUSION: This randomized controlled trial showed promising effects of an internet-based intervention by increasing participants' ability to have intercourse and non-intercourse penetration while experiencing high treatment satisfaction. The WCG also showed improvement, although participants had vaginismus for an average duration of 6 years. Internet-based interventions could be a treatment modality to complement other methods in stepped care for vaginal penetration difficulties.


Assuntos
Coito/psicologia , Autocuidado/métodos , Terapia Assistida por Computador/métodos , Vaginismo/psicologia , Vaginismo/terapia , Adaptação Psicológica , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Internet , Dor , Projetos Piloto , Autorrelato , Comportamento Sexual/psicologia , Parceiros Sexuais
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