1
|
Queiroz JF, Aquino ACQ, Sarmento ACA, Siqueira BB, Medeiros HD, Falsetta ML, Maurer T, Gonçalves AK. Psychosocial Factors Associated With Vulvodynia. J Low Genit Tract Dis 2024; 28:264-275. [PMID: 38697126 DOI: 10.1097/lgt.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
OBJECTIVES We set out to identify the psychosocial factors associated with vulvodynia and the effects on sexuality, mental health, and quality of life. MATERIALS AND METHODS PubMed, LILACS, Embase, CINAHL, Web of Science, Scopus, and PsycINFO were searched in August 2023. Two authors selected and extracted the data independently. The risk of bias was assessed using the Newcastle-Ottawa Scale for Observational Studies. To rank the strength of evidence, the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) approach was utilized. RESULTS A total of 3,182 articles were identified. Twenty-two observational studies (8 cohorts and 14 case-controls) met the eligibility criteria and were included, comprising 2,624 patients. Vulvodynia has been associated with psychological factors (anxiety and depression) and social factors (childhood exposure to physical and sexual abuse, posttraumatic stress, and domestic abuse). Concerning sexual function, the most frequent outcomes were dyspareunia and sexual dysfunction. Only one study assessed quality of life, which showed that women with chronic vulvar pain had greater difficulty performing physical activities and experienced negative moods and feelings. The assessment of the risk of bias showed that the average quality of studies was good to excellent. However, the studies failed to select the nonexposed cohort or control group to describe the results, and often, the study population was rather small, which made it impossible to carry out a meta-analysis. CONCLUSIONS The certainty of evidence for the associations between anxiety and depression, vulvodynia, and sexual functioning suggests that combating these factors could improve overall quality of life in vulvodynia patients.
Collapse
Affiliation(s)
- Janice F Queiroz
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Antonio C Q Aquino
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | | | - Beatriz B Siqueira
- Faculty of Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Heitor D Medeiros
- Faculty of Medicine, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Megan L Falsetta
- Departments of Obstetrics and Gynecology and Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY
| | - Tracey Maurer
- Department of Obstetrics and Gynecology, University of Vermont Health Network, Colchester, VT
| | | |
Collapse
|
2
|
Padoa A, Tomashev R, Brenner I, Golan A, Igawa MS, Lurie I, Reicher Y, Talmon A, Ginzburg K. Obstetric outcome and emotional reactions to childbirth in women with dyspareunia: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2023; 288:7-11. [PMID: 37413830 DOI: 10.1016/j.ejogrb.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/04/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To assess obstetrical outcomes, perceptions of childbirth experience and emotional adjustment, in women with dyspareunia. STUDY DESIGN In this cross-sectional study, 440 women were recruited within 48 h postpartum in the maternity ward of a large medical center, during the period of April 2018- August 2020. Self-report questionnaires were administered which addressed demographic and reproductive background, dyspareunia, perceptions of control during labor (Labor Agentry Scale), perceived professional support (Intrapartum Care Scale), and maternal adjustment, implicated in perinatal dissociation (Peritraumatic Dissociative Experiences Questionnaire), acute stress disorder (ASD) symptoms (Stanford Acute Stress Reaction Questionnaire), bonding (Mother-to-Infant Bonding Scale), anticipated maternal self-efficacy (Maternal Self-Efficacy Scale) and well-being (Positive and Negative Affect Schedule, Edinburgh Postnatal Depression Scale). Obstetrical information was retrieved from clinical files and included pregnancy complications, week and mode of delivery, nature of labor onset, analgesia during delivery, birthweight, perineal tears. RESULTS The dyspareunia group included 71 women (18.3%) and the comparison group 317 (81.7%). Demographic data were similar among groups. No difference was observed in nature of labor onset, type of analgesia, route of delivery, perineal tears. More participants with dyspareunia had premature delivery versus comparisons (14.1% vs 5.6%, p = 0.02). Women with dyspareunia reported lower levels of control (p = 0.01) and perceived support during childbirth (p < 0.001), higher levels of perinatal dissociation (p < 0.001) ASD symptoms (p < 0.001), depression (p = 0.02), negative affect (p < 0.001), and reported lower levels of maternal bonding (p < 0.001) and anticipated maternal self-efficacy (p = 0.01). CONCLUSION Dyspareunia was associated with more premature deliveries, parameters of emotional distress during childbirth and poorer maternal adjustment following childbirth. Perinatal caregivers should be cognizant of such cognitive and emotional reactions in women with dyspareunia, so as to assess for a history of dyspareunia in pregnant women and provide adequate support during pregnancy and delivery.
Collapse
Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Roni Tomashev
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Brenner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Lev-Hasharon Medical Center, Pardesiya, Israel
| | - Ayelet Golan
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
| | - May Shir Igawa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Lurie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yael Reicher
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beersheba, Israel; Ben Gurion University of the Negev, Beersheba, Israel
| | - Anat Talmon
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel; Department of Psychology, Stanford University, Stanford, CA, USA
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Mohammadzadeh Z, Khakbazan Z, Rad M, Farnam F. Comparison of pain catastrophizing and anxiety in patients with dyspareunia and healthy women: a cross-sectional study. J Med Life 2023; 16:220-226. [PMID: 36937475 PMCID: PMC10015566 DOI: 10.25122/jml-2022-0234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/09/2023] [Indexed: 03/21/2023] Open
Abstract
Despite the prominent role of cognitive-affective variables, such as pain catastrophizing and anxiety in chronic pain, little is known about their relationship with dyspareunia. This study compared pain-catastrophizing and anxiety in reproductive-aged women with and without dyspareunia. A controlled cross-sectional study was conducted on 398 married women in Iran selected by convenience sampling. Sampling was performed both online and in person. Data were collected using a checklist designed for the study, including background characteristics, self-reported dyspareunia, and two standard questionnaires: the Pain Catastrophizing Scale (PCS) and the Spielberger State-Trait Anxiety Inventory-6 (STAI-6). Results showed that 49.5% of the women reported dyspareunia in the previous six months, with a reduced figure of 42% and 31% when using more specific criteria for dyspareunia. Women with dyspareunia had significantly higher scores for pain catastrophizing and anxiety than the control group without dyspareunia. Pain-catastrophizing was associated with aversion to genital contact and body image dissatisfaction. Anxiety was correlated with age, marriage duration, and sexual abuse. Managing anxiety and catastrophizing thoughts may help dyspareunia patients better cope with pain.
Collapse
Affiliation(s)
- Zahra Mohammadzadeh
- Reproductive Health and Midwifery Department, Tehran University of Medical Sciences, Tehran, Iran
- Social Security Organization, East Azerbaijan Treatment Management, Tabriz, Iran
| | - Zohreh Khakbazan
- Reproductive Health and Midwifery Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Rad
- Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Farnaz Farnam
- Reproductive Health and Midwifery Department, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Farnaz Farnam, Reproductive Health and Midwifery Department, Tehran University of Medical Sciences, Tehran, Iran. E-mail: ;
| |
Collapse
|
4
|
Rivera S, Flood A, Dykstra C, Herbenick D, DeMaria AL. Genital Self-Image, Sexual Function, and Quality of Life Among Individuals with Vulvar and Non-Vulvar Inflammatory Dermatoses. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3965-3979. [PMID: 35900677 PMCID: PMC9332093 DOI: 10.1007/s10508-022-02353-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/30/2022] [Accepted: 05/08/2022] [Indexed: 05/10/2023]
Abstract
Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to impact on genital self-image. A 20-min web-based survey was distributed September-November 2020 through social media ads, support groups, and online research recruitment services. Individuals in the USA over age 18 who were assigned female at birth and self-reported having been diagnosed with an inflammatory dermatosis were eligible. The primary outcome was the Female Genital Self-Image Scale (FGSIS). Secondary outcomes included the Female Sexual Function Index (FSFI), the Skindex-16 (a skin-related quality of life measure), the PROMIS Global-10 (assessing global physical/mental health), and sexual behavior histories. Participants (n = 348) reported mean age of 43.1 ± 15.5 (range = 19-81). Nearly one-third (n = 101; 29.0%) reported VID, 173 (50%) had NVID, and 74 (21%) experienced both vulvar and non-vulvar symptoms; they were analyzed as part of the VID group. The mean FGSIS score among participants with VID was 16.9 ± 4.1 and was significantly (p < .01) lower than that of participants with NVID (M = 21.2 ± 4.3), indicating lower genital self-image. Mental health (as measured by PROMIS-Global 10) was also impaired in VID. Rates of sexual dysfunction were high in both groups (> 60%). Findings suggest that in VID, lower genital self-image is correlated with poorer sexual function, quality of life, and global physical and mental health. Additional recommendations for VID management are proposed.
Collapse
Affiliation(s)
- Sydney Rivera
- Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, USA.
| | - Anna Flood
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Chandler Dykstra
- Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
5
|
Stout ME, Hawkins MAW. Temporal Relationships Between Pain During Intercourse (PDI), Loneliness, and Depressive Symptoms Among Women. Sex Med 2021; 9:100444. [PMID: 34649130 PMCID: PMC8766269 DOI: 10.1016/j.esxm.2021.100444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Painful sex can lead to increased psychological distress, including major depressive disorder, and the experience of loneliness may explain this association. Aims We aimed to investigate loneliness as a mediator between painful sex and depressive symptoms and hypothesized that women who experienced greater pain during intercourse (ie, more severe and more frequent pain) would endorse higher rates of loneliness and, in turn, higher rates of depressive symptoms at a 6-month follow-up. Methods Participants were 148 adults who were assigned female at birth (78.4% white, 77% partnered, 31.14 ± 10.9 years old) and completed an online, anonymous survey including the Female Sexual Function Index (FSFI), UCLA Loneliness Scale-3 (ULS), and demographic information. Main Outcome Measure Depressive symptoms, measured via the Patient Health Questionnaire-8 (PHQ8) at baseline (T1) and 6-month follow-up (T2) were used as the outcomes of the present study. Results Painful sex and ULS at T1 were significantly correlated with each other and with PHQ8 at T1 (r = 0.590). However, change in PHQ8 from T1 to T2 was not significantly correlated with ULS (r = 0.024) or any other key study variables, indicating that that ULS was not a significant mediator of the relationship between painful sex at T1 and change in PHQ8 (standardized indirect effect = 0.011; 99% CI = −0.114 to 0.188). Conclusion These findings are consistent with previous studies highlighting that painful sex is related to depressive symptoms through loneliness cross-sectionally, suggesting that future treatments for depressive symptoms among women who experience painful sex might target loneliness. Stout ME, Hawkins MAW. Temporal Relationships Between Pain During Intercourse (PDI), Loneliness, and Depressive Symptoms Among Women. Sex Med 2021;9:100444.
Collapse
Affiliation(s)
- Madison E Stout
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Misty A W Hawkins
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA.
| |
Collapse
|
6
|
Alizadeh A, Farnam F. Coping with dyspareunia, the importance of inter and intrapersonal context on women's sexual distress: a population-based study. Reprod Health 2021; 18:161. [PMID: 34321034 PMCID: PMC8320204 DOI: 10.1186/s12978-021-01206-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently known as the genito-pelvic pain/penetration disorder (GPPPD), Dyspareunia is considered a negative factor affecting a couple's sexual health. This paper analyzes pain in Dyspareunia cases and determines protective factors causing lower levels of sexual distress among patients. METHODS In a population-based cross-sectional study conducted in 2017, the cluster quota sampling technique was adopted to randomly select 590 Iranian married women aged 18-70 years from 30 health centers. The research tools included demographic data, a sexual distress scale, and Binik's GPPPD questionnaire. RESULTS In this study, the prevalence of self-report Dyspareunia, confirmed moderate Dyspareunia, and confirmed severe Dyspareunia (based on Binik's proposed criteria) were 33 %, 25.8 %, and 10.5 %, respectively. Interestingly, 32 (34 %) out of 94 women who experienced severe pain based on Binik's criteria reported no sexual distress. Compared to women with distress, they also had more positive body images, higher self-confidence, higher levels of sexual satisfaction, and more intimacy in their relationships (P = 0.000). In contrast, 8.5 % of the participants reported significant sexual distress even without confirmed Dyspareunia. CONCLUSIONS Improving intrapersonal characteristics such as self-confidence and body image as well as interpersonal factors such as sexual satisfaction and intimacy with a spouse can effectively treat Dyspareunia by alleviating sexual distress. The partner's role in female pain and distress management would be more critical than previously thought.
Collapse
Affiliation(s)
- Ameneh Alizadeh
- Department of Reproductive Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnaz Farnam
- Department of Reproductive Health, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
7
|
Fergus KB, Cohen AJ, Cedars BE, Rowen TS, Patino G, Breyer BN. Risk Factors for Sexual Pain Among Physically Active Women. Sex Med 2020; 8:501-509. [PMID: 32439324 PMCID: PMC7471064 DOI: 10.1016/j.esxm.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Sexual pain is common among women but little is known about associations with exercise and physical activity. AIM To determine the prevalence of sexual pain among physically active women and to evaluate cycling and other potential risk factors. METHODS This is a secondary data analysis of a study on the urinary and sexual wellness of physically active women recruited through sporting clubs and targeted social media advertising. We used multivariable logistic regression to assess the role of cycling and exercise in reporting any, frequent, or severe sexual pain, controlling for demographic, relationship, and health risk factors. MAIN OUTCOME MEASURE Sexual pain, including frequency and severity, was measured using the Female Sexual Function Index. RESULTS A total of 2,039 women were included, with 1,097 (54%) reporting any level of sexual pain, 364 (18%) experiencing frequent pain, and 378 (19%) reporting severe pain. Less than 5% of women reported diabetes or hypertension, and the cohort had a median body mass index of 23.3 (interquartile range 21.4-25.7). Increasing age and body mass index were protective against any sexual pain, as was cycling (odds ratio [OR] 0.73 [95% CI 0.59-0.90]). Participants who reported being "moderately satisfied" (OR 0.53 [95% CI 0.31-0.91]) or "very satisfied" (OR 0.33 [95% CI 0.19-0.56]) with their emotional closeness to a sexual partner had decreased odds of any sexual pain. CONCLUSION Experiencing any sexual pain is common in physically active women, with a prevalence of over 50%; however, weekly energy expenditure from exercise was not associated with sexual pain. Cycling participation and higher levels of emotional closeness and intimacy were associated with less pain. Patients between the ages of 18 and 30 years who were normal or underweight incurred the highest risk of sexual pain. Fergus KB, Cohen AJ, Cedars BE, et al. Risk Factors for Sexual Pain Among Physically Active Women. Sex Med 2020;8:501-509.
Collapse
Affiliation(s)
- Kirkpatrick B Fergus
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Andrew J Cohen
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Benjamin E Cedars
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Tami S Rowen
- Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, CA, USA
| | - German Patino
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Hospital San Ignacio, Bogota, Colombia
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA.
| |
Collapse
|
8
|
Patanwala I, Lamvu G, Mizera M, Fisk M, Blanton E. Learning restrictive sexual values may be associated with dyspareunia. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026519900108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The primary objective of this study is to assess whether the degree of religiosity or certain moral teachings are associated with dyspareunia. Methods: A cross-sectional survey with 24 questions was designed that incorporated the previously validated Duke Religiosity Index questionnaire, medical and sexual history, and demographic information. The index measures organizational, non-organizational, and intrinsic religiosity. Participants were recruited from Ob/Gyn and Family Medicine clinics and from a large university in our community. Results: A total of 901 surveys were included in final analysis. Among our study population, the prevalence of dyspareunia was 19.4%. Participants were categorized by the presence or absence of the primary outcome, dyspareunia. There were no differences in the scores of organized religiosity, p = 0.73 (2.98 ± 0.47 vs 3.04 ± 1.55), non-organized religiosity, p = 0.57 (2.62 ± 1.71 vs 2.82 ± 1.82), or intrinsic religiosity p = 0.64 (10.53 ± 3.63 vs 10.47 ± 4.06) in women with and without dyspareunia, respectively. No associations were found between dyspareunia and a participant’s current or childhood religious affiliation. However, women who were taught “sex is bad” while growing up had a higher rate of dyspareunia compared to those who were not taught this belief, (27.0% vs 15.3%, p < 0.001). Similar results were found in women who were taught to “wait until marriage to have sex”; 21.6% experienced dyspareunia while only 13.2% of those who were not taught to wait experienced dyspareunia (p = 0.005). Conclusions: While degree of religiosity was not shown to be associated with dyspareunia, women who learned certain restrictive sexual values were at higher risk of experiencing painful intercourse.
Collapse
Affiliation(s)
- Insiyyah Patanwala
- Department of Obstetrics & Gynecology, Florida Hospital, Orlando, FL, USA
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Georgine Lamvu
- Division of Surgery, Gynecology Section, Veteran Affairs Medical Center, Orlando, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Megan Mizera
- College of Medicine, University of Central Florida, Orlando, FL, USA
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Matthew Fisk
- Department of Obstetrics & Gynecology, Florida Hospital, Orlando, FL, USA
| | - Emily Blanton
- Department of Obstetrics & Gynecology, Florida Hospital, Orlando, FL, USA
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
9
|
Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities. Sex Med Rev 2019; 8:3-17. [PMID: 30928249 DOI: 10.1016/j.sxmr.2018.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Dyspareunia has been traditionally divided into superficial (introital) dyspareunia and deep dyspareunia (pain with deep penetration). While deep dyspareunia can coexist with a variety of conditions, recent work in endometriosis has demonstrated that coexistence does not necessarily imply causation. Therefore, a reconsideration of the literature is required to clarify the pathophysiology of deep dyspareunia. AIMS To review the pathophysiology of deep dyspareunia, and to propose future research priorities. METHODS A narrative review after appraisal of published frameworks and literature search with the terms (dyspareunia AND endometriosis), (dyspareunia AND deep), (dyspareunia AND (pathophysiology OR etiology)). MAIN OUTCOME VARIABLE Deep dyspareunia (present/absent or along a pain severity scale). RESULTS The narrative review demonstrates potential etiologies for deep dyspareunia, including gynecologic-, urologic-, gastrointestinal-, nervous system-, psychological-, and musculoskeletal system-related disorders. These etiologies can be classified according to anatomic mechanism, such as contact with a tender pouch of Douglas, uterus-cervix, bladder, or pelvic floor, with deep penetration. Etiologies of deep dyspareunia can also be stratified into 4 categories, as previously proposed for endometriosis specifically, to personalize management: type I (primarily gynecologic), type II (nongynecologic comorbid conditions), type III (central sensitization and genito-pelvic pain/penetration disorder), and type IV (mixed). We also identified gaps in the literature, such as lack of a validated patient-reported questionnaire or an objective measurement tool for deep dyspareunia and clinical trials not powered for sexual outcomes. CONCLUSION We propose the following research priorities for deep dyspareunia: deep dyspareunia measurement tools, inclusion of the population avoiding intercourse due to deep dyspareunia, nongynecologic conditions in the generation of deep dyspareunia, exploration of sociocultural factors, clinical trials with adequate power for deep dyspareunia outcomes, partner variables, female sexual response, pathways between psychological factors and deep dyspareunia, and personalized approaches to deep dyspareunia. Orr N, Wahl K, Joannou A, et al. Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities. Sex Med Rev 2020;8:3-17.
Collapse
|
10
|
Abril-Requena A, García-Torres F, Alós FJ. Sexual dysfunction and phobic anxiety in breast cancer survivors. Psychooncology 2018; 28:195-197. [PMID: 30225895 DOI: 10.1002/pon.4894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 11/12/2022]
Affiliation(s)
| | - Francisco García-Torres
- Department of Psychology, University of Cordoba, Cordoba, Spain.,IMIBIC Health Research Institute, Cordoba, Spain.,Reina Sofía University Hospital of Cordoba, Cordoba, Spain
| | - Francisco J Alós
- Department of Psychology, University of Cordoba, Cordoba, Spain.,IMIBIC Health Research Institute, Cordoba, Spain.,Reina Sofía University Hospital of Cordoba, Cordoba, Spain
| |
Collapse
|
11
|
Swenson CW, DePorre JA, Haefner JK, Berger MB, Fenner DE. Postpartum depression screening and pelvic floor symptoms among women referred to a specialty postpartum perineal clinic. Am J Obstet Gynecol 2018; 218:335.e1-335.e6. [PMID: 29229409 DOI: 10.1016/j.ajog.2017.11.604] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/26/2017] [Accepted: 11/30/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Postpartum depression and pelvic floor disorders are both common conditions that affect women; however, the association between the 2 has yet to be determined. OBJECTIVE The aims of our study are to: (1) determine the prevalence of a positive postpartum depression screen in a specialty postpartum perineal clinic, and (2) identify risk factors for postpartum depression in this population. STUDY DESIGN A retrospective chart review was performed of 294 women referred to a specialty postpartum perineal clinic at the University of Michigan from March 30, 2012, through May 3, 2016. Women who completed a new patient intake form, including the Edinburgh Postnatal Depression Scale, were included. The prevalence of a positive Edinburgh Postnatal Depression Scale screen (≥10) was determined. Bivariate analyses were used to compare demographics, delivery characteristics, referral indications, and postpartum pelvic floor symptoms between women with and without a positive Edinburgh Postnatal Depression Scale screen. Significant variables identified in the analyses were then used to perform logistic regression to identify factors independently associated with a positive Edinburgh Postnatal Depression Scale screen. RESULTS In all, 15.6% (46/294) of women had a positive postpartum depression screen. Average age was 30.6 ± 4.8 years, average body mass index was 28.9 ± 5.06 kg/m2, 68.0% (200/294) were Caucasian, 79.6% (234/294) were primiparous, and 86.0% (245/285) were breast-feeding. Using multivariable logistic regression, women with a positive postpartum depression screen had higher odds of being non-Caucasian (adjusted odds ratio, 2.72; 95% confidence interval, 1.27-5.832; P = .01), having a history of depression and/or anxiety (adjusted odds ratio, 2.77; 95% confidence interval, 1.23-6.24; P = .01), having been referred for pain (adjusted odds ratio, 2.61; 95% confidence interval, 1.24-5.49; P = .01), and reporting urinary incontinence during and after pregnancy (adjusted odds ratio, 3.81; 95% confidence interval, 1.57-9.25; P = .003). CONCLUSION Urinary incontinence during and after pregnancy and referral for pain were pelvic floor symptoms independently associated with a positive postpartum depression screen in women referred to a specialty perineal clinic. Therefore, consideration should be given to depression screening in women presenting with perinatal urinary incontinence and persistent postpartum pain, as these women may be at increased risk of developing postpartum depression.
Collapse
|
12
|
Grauvogl A, Pelzer B, Radder V, van Lankveld J. Associations Between Personality Disorder Characteristics, Psychological Symptoms, and Sexual Functioning in Young Women. J Sex Med 2017; 15:192-200. [PMID: 29276043 DOI: 10.1016/j.jsxm.2017.11.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recently, the etiology of sexual dysfunctions in women has been approached from different angles. In clinical practice and in previous studies, it has been observed that women with sexual problems experience anxiety problems and express more rigid and perfectionistic personality traits than women without these problems. AIM To investigate whether personality disorder characteristics according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) and psychological symptoms are associated with sexual problems in women. METHODS 188 women 18 to 25 years old participated in this cross-sectional study. Questionnaires measuring sexual functioning (Female Sexual Function Index), personality disorder characteristics (Assessment of DSM-IV-TR Personality Disorders Questionnaire), and psychological symptoms (Brief Symptom Inventory and Center for Epidemiological Studies Depression Scale) were used. OUTCOME The main outcome measure used was sexual functioning assessed by self-report. RESULTS Results, using analysis of variance, indicated that women with sexual problems report significantly more cluster A (specifically schizoid) and C (specifically avoidant and obsessive-compulsive) personality disorder characteristics than women without sexual problems. Furthermore, using multiple regression analyses, higher cluster A (specifically schizoid) and lower cluster B (specifically borderline and antisocial) personality disorder characteristics indicated lower levels of sexual functioning. Psychological symptoms partly mediated the effect of cluster A personality disorder characteristics on sexual functioning. CLINICAL IMPLICATIONS The results of this study indicate that clinical practice should extend its scope by focusing more on improving adaptive personality characteristics, such as extraversion and individualism seen in cluster B personality characteristics, and decreasing the perfectionistic, introvert, and self-doubting characteristics seen in cluster C personality characteristics. STRENGTHS AND LIMITATIONS Because of the correlational design and use of self-report measures, causal relations cannot be established between personality disorder characteristics and sexual functioning. CONCLUSION Overall, the results indicate that personality disorder characteristics can play an important associative role in the development and maintenance of sexual functioning problems in women. Grauvogl A, Pelzer B, Radder V, van Lankveld J. Associations Between Personality Disorder Characteristics, Psychological Symptoms, and Sexual Functioning in Young Women. J Sex Med 2018;15:192-200.
Collapse
Affiliation(s)
- Andrea Grauvogl
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands.
| | - Britt Pelzer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Veerle Radder
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jacques van Lankveld
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands
| |
Collapse
|
13
|
Bouchoucha M, Devroede G, Mary F, Bon C, Bejou B, Benamouzig R. Both men and women with functional gastrointestinal disorders suffer from a high incidence of sexual dysfunction. Clin Res Hepatol Gastroenterol 2017; 41:e93-e96. [PMID: 28601592 DOI: 10.1016/j.clinre.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/05/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Michel Bouchoucha
- Department of physiology, université Paris V René-Descartes, 15, rue de l'École-de-médecine, 75270 Paris cedex 06, France; Service de gastroentérologie, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny cedex, France.
| | - Ghislain Devroede
- Département de chirurgie, faculté de médecine, CHUS-Hôtel-Dieu, université de Sherbrooke, 580, rue Bowen-Sud, Sherbrooke, J1G2EB Quebec, Canada
| | - Florence Mary
- Service de gastroentérologie, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny cedex, France
| | - Cyriaque Bon
- Service de gastroentérologie, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny cedex, France
| | - Bakthiar Bejou
- Service de gastroentérologie, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny cedex, France
| | - Robert Benamouzig
- Service de gastroentérologie, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny cedex, France
| |
Collapse
|
14
|
LoGiudice JA. Dyspareunia in a Survivor of Childhood Sexual Abuse. J Midwifery Womens Health 2017; 62:215-219. [PMID: 28340508 DOI: 10.1111/jmwh.12608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/28/2016] [Accepted: 01/12/2016] [Indexed: 01/22/2023]
Abstract
Dyspareunia is a frequent chief concern encountered by midwives and other women's health care providers. There are many possible etiologies for dyspareunia, including a history of childhood sexual abuse, and approaching assessment in a holistic manner is necessary to identify the etiology. This case report presents evidence on the importance of screening a woman who presents with dyspareunia in a therapeutic manner to facilitate disclosure of sexual abuse. Best practices for screening for sexual violence, along with recommendations for providing gynecologic care to survivors, are offered. By understanding the long-term sequelae of sexual abuse and through screening all women, midwives and other women's health care providers can facilitate healing and treatment for survivors.
Collapse
|
15
|
|
16
|
Angst J, Hengartner MP, Rössler W, Ajdacic-Gross V, Leeners B. A Swiss Longitudinal Study of the Prevalence of, and Overlap Between, Sexual Problems in Men and Women Aged 20 to 50 Years Old. JOURNAL OF SEX RESEARCH 2015; 52:949-959. [PMID: 26132602 DOI: 10.1080/00224499.2014.1002556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to obtain data on the development and course of sexual problems and their interrelationships by investigating a representative sample of men and women over a period of 30 years. A representative sample of 299 women selected from the complete electoral register and 292 men selected from screening lists for military service in Zurich, Switzerland, answered questions about their sexuality as part of a series of seven interviews between ages 20 (1979) and 50 (2008). Of the initial sample of 591 participants, 43% (57% of them male) were lost to follow-up. Interviews were conducted using the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology (SPIKE), a semistructured interview. Sexual problems were identified on the basis of the study participants' self-appraisal. One-year prevalence rates, lifetime risks, and overlap of functional, emotional, and sexual desire problems in men and women were evaluated. The findings confirmed higher lifetime risks in women than in men for any sexual problem (females 67.0%; males 46.0%) and for functional (39.3%; 22.1%), emotional (35.7%; 15.9%), and sexual desire problems (51.6%; 33.3%). While in general men's sexual problems increased with age, no such association was observed in women. The overlap of all three problems (functional, emotional, and sexual desire) was reported by 16.9% of women but only 5.0% of men. Although there are commonalities, the type but also the development and, in particular, the overlap of sexual problems in women and men are markedly different.
Collapse
Affiliation(s)
- Jules Angst
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital , University of Zurich
| | - Michael P Hengartner
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital , University of Zurich
- b Department of Applied Psychology , Zurich University of Applied Sciences
| | - Wulf Rössler
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital , University of Zurich
- c Institute of Psychiatry, Laboratory of Neuroscience (LIM 27) , University of Sao Paulo
| | - Vladeta Ajdacic-Gross
- a Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital , University of Zurich
| | - Brigitte Leeners
- d Division of Reproductive Endocrinology , University Hospital Zurich
| |
Collapse
|