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Estevez SL, Gellman C, Ghofranian A, Alkon-Meadows T, Hernandez-Nieto C, Gounko D, Lee JA, Copperman AB, Friedenthal J. Obstetric outcomes of nulliparous women with pelvic pain undergoing fertility treatment. Reprod Biomed Online 2024; 49:103913. [PMID: 38897134 DOI: 10.1016/j.rbmo.2024.103913] [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: 10/28/2023] [Revised: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 06/21/2024]
Abstract
RESEARCH QUESTION Is there any association between pelvic pain and primary caesarean delivery for patients undergoing assisted reproductive technology (ART) treatment? DESIGN Retrospective cohort study of nulliparous patients with singleton pregnancies who underwent ART treatment and achieved a live birth between 2012 and 2020. Cases included patients diagnosed with pelvic pain. A 3:1 ratio propensity-score-matched population of patients without a history of pelvic pain was included as the control group. Comparative statistics were performed using chi-squared test and Student's t-test. A multivariate regression analysis was conducted to evaluate the association between pelvic pain and mode of delivery. RESULTS One hundred and seventy-four patients with pelvic pain were compared with 575 controls. Patients with pelvic pain reported a significantly longer duration of infertility compared with controls (18.98 ± 20.2 months versus 14.06 ± 14.06 months; P = 0.003). Patients with pelvic pain had a significantly higher rate of anxiety disorders (115 ± 21.9 versus 55 ± 31.6; P = 0.009) and use of anxiolytics at embryo transfer (17 ± 3.2 versus 12 ± 6.9; P = 0.03) compared with controls. In addition, patients with pelvic pain had a higher rate of primary caesarean delivery compared with controls (59.8% versus 49.0%; P = 0.01). After adjusting for multiple variables, a significant association was found between pelvic pain and increased odds of primary caesarean delivery (adjusted OR 1.48, 95% CI 1.02-2.1). CONCLUSION Patients with pelvic pain have significantly higher odds of primary caesarean delivery compared with patients without a history of pelvic pain. The infertility outpatient setting may be uniquely positioned to identify patients at risk for undergoing primary caesarean delivery, and could facilitate earlier intervention for pelvic floor physical therapy during the preconception and antepartum periods.
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Affiliation(s)
- Samantha L Estevez
- Department of Obstetrics, Gynaecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, USA; Reproductive Medicine Associates of New York, New York, USA.
| | - Caroline Gellman
- Department of Obstetrics, Gynaecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Atoosa Ghofranian
- Department of Obstetrics, Gynaecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | - Dmitry Gounko
- Reproductive Medicine Associates of New York, New York, USA
| | - Joseph A Lee
- Reproductive Medicine Associates of New York, New York, USA
| | - Alan B Copperman
- Department of Obstetrics, Gynaecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, USA; Reproductive Medicine Associates of New York, New York, USA
| | - Jenna Friedenthal
- Department of Obstetrics, Gynaecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, USA; Reproductive Medicine Associates of New York, New York, USA
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Maldonado M, Nardi AE, Sardinha A. The Role of Vaginal Penetration Skills and Vaginal Penetration Behavior in Genito-Pelvic Pain/Penetration Disorder. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:816-828. [PMID: 36951274 DOI: 10.1080/0092623x.2023.2193587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Vaginal penetration skills and behavior are considered different aspects of vaginal penetration. Nevertheless, these terms are used interchangeably in most genito-pelvic pain/penetration disorder (GPPPD) intervention studies, possibly impacting the assessment and selection of intervention outcomes. This is the first theoretical essay on the relevance of nonsexual vaginal penetration skills in understanding and treating GPPPD symptoms, mainly for patients with vaginismus complaints. We aim to provide avenues for further empirical research and new perspectives for assessing, preventing, and treating GPPPD symptoms. We highlight the conceptual boundaries, overlaps, and commonalities between vaginal penetration skills and vaginal penetration behavior and the implications for measuring and selecting GPPPD treatment outcomes. We then briefly explain vaginal penetration skills as a self-learning process and review the impact of fear, anxiety, and cognitive factors on GPPPD symptoms. We also outline the role of the nonsexual genital self-exploration skills in later penetration behavior and offer implications for a new GPPPD patient-centered treatment approach.
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Affiliation(s)
- Mariana Maldonado
- Sexual Dysfunction Nucleus in the Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Antonio Egidio Nardi
- Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Aline Sardinha
- Sexual Dysfunction Nucleus in the Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Xi Y, Xia T, Colonnello E, Wang C, Lai Y, Zhang Y. Unconsummated marriage among Chinese couples: a retrospective study. Sex Med 2023; 11:qfac003. [PMID: 37007856 PMCID: PMC10065181 DOI: 10.1093/sexmed/qfac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
Unconsummated marriage (UCM) is a significant problem among couples who are unable to achieve successful sexual intercourse and penovaginal penetration, and the etiology and clinical characteristics of UCM in Chinese couples remain unknown.
Aim
In a retrospective analysis of patients with UCM, we investigated clinical characteristics and treatment outcomes among Chinese couples with UCM.
Methods
During the period from January 2019 to May 2021, we examined 127 consecutive couples with unconsummated marriage. The couples were evaluated separately by andrologists and gynecologists, and combined treatments were conducted by therapists.
Outcomes
We calculated the distribution of etiologies of UCM in Chinese couples.
Results
Among the couples whose data were evaluated, 93 couples visited the andrologist first and 34 couples visited the gynecologist first. The most common complaints associated with sexual dysfunction were erectile dysfunction (ED) in male patients and vaginismus and dyspareunia in female patients. Unconsummated marriage among Chinese couples was caused primarily by female factors (55.8%). With couple-oriented treatment conducted by sexual therapists, the success rate was 67.7%.
Clinical Translation
If a couple is diagnosed with UCM, both the husband and wife should be treated individually receive guidance from a sex therapist toward successful sexual intercourse.
Strengths and Limitations
This is to our knowledge the first report regarding the etiology of UCM in Chinese couples. Here we report our routine diagnostic and therapeutic workups. However, we were not able to perform hormonal and imaging studies of the female partners. Moreover, patients presenting with UCM who visited our department without a partner were not included in the statistics.
Conclusions
Unconsummated marriage among Chinese couples may be caused byfactors affecting both the husband and wife or the husband and wife individually; however, factors affecting women are the predominant causes of UCM. Lack of knowledge about sex-related issues, as well as cultural beliefs, play an important role. A preliminary evaluation by an andrologist and a gynecologist, followed by couple treatment conducted by the sex therapist, is highly `recommended to treat UCM effectively.
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Affiliation(s)
- Yu Xi
- The Third Affiliated Hospital of Sun Yat-sen University Department of Infertility and Sexual Medicine, , Guangzhou, China
| | - Tingting Xia
- The Third Affiliated Hospital of Sun Yat-sen University Center of Reproductive Medicine, , Guangzhou, China
| | - Elena Colonnello
- Sapienza University of Rome Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, , Rome, Italy
- University of Tor Vergata Department of Systems Medicine, , Rome, Italy
| | - Chunlin Wang
- The Third Affiliated Hospital of Sun Yat-sen University Department of Infertility and Sexual Medicine, , Guangzhou, China
| | - Yufen Lai
- The Third Affiliated Hospital of Sun Yat-sen University Department of Infertility and Sexual Medicine, , Guangzhou, China
| | - Yan Zhang
- The Third Affiliated Hospital of Sun Yat-sen University Department of Infertility and Sexual Medicine, , Guangzhou, China
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Damagum FM, Garko AA. Successful management of penetration disorder: A holistic approach to an age-old problem. Niger J Clin Pract 2023; 26:125-127. [PMID: 36751834 DOI: 10.4103/njcp.njcp_249_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Penetration disorder, formerly referred to as vaginismus, is the recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration. It is a common female psychosexual problem and is a cause of significant personal and relationship distress. In this report, we describe the successful treatment of vaginismus in a 28-year-old woman by using a combination of different interventions. This involved providing sexual education, psychotherapy, serial dilation using graded plastic dilators, sensate-focused therapy, and anti-anxiety medication.
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Affiliation(s)
- F M Damagum
- Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - A A Garko
- Department of Psychiatry, Aminu Kano Teaching Hospital, Kano, Nigeria
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Tajik M, Shahali S, Shadjoo K. The co-effect of sensate focus technique and sexual position changing on sexual function of women who use medical treatment for endometriosis. J OBSTET GYNAECOL 2022; 42:3706-3711. [PMID: 36541405 DOI: 10.1080/01443615.2022.2158316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endometriosis is one of the most common chronic diseases of women. This study aimed to investigate the effect of sensate focus technique and sexual position changing on sexual function of women who used medical treatment for endometriosis. This clinical trial study was performed on 80 women who used medical treatment for endometriosis. Women were randomly assigned to two groups: in the intervention group, 2 h of verbal educational session were held and at the end of the session, an instruction booklet about sensate focus technique was given to them, the control group received routine treatment. The sexual function and the dyspareunia of the participants were evaluated after 4 and 8 weeks. Eight weeks after the intervention, the mean total score of sexual function in the intervention group was significantly improved compared to before the intervention (p < 0.001). The mean score of sexual pain in the follow-up periods in the intervention group was significantly different compared to before the intervention and control groups (p < 0.001). The sensate focus technique and sexual position change simultaneously improve sexual function in women with endometriosis who used medication.Trial registration: Approval number from Iranian Registry of Clinical Trials: IRCT2200617047812N1 (Registration date: 2020-11-05).Impact StatementWhat is already known on this subject? The role of endometriosis in the genesis of sexual dysfunction in women has been mentioned in several articles. Researches have shown that some sexual positions put less pressure on parts of the pelvis that contain endometrial tissue. The sensate focus technique can improve sexual dysfunction, including hypoactive sexual desire disorder (HSDD) and female sexual arousal disorder (FSAD), orgasm, dyspareunia, and vaginismus.What do the results of this study add? Have a positive effect on sexual function and dyspareunia in women with endometriosis undergoing medical treatment and improve their sexual function.What are the implications of these findings for clinical practice and/or further research? Medical staff recommended becoming familiar with these techniques to teach sensate focus and sexual position changing to women with endometriosis to improve their sexual function.
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Affiliation(s)
- Maryam Tajik
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Shadab Shahali
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Khadijeh Shadjoo
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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Obstetric outcomes of 297 women treated for vaginismus. Eur J Obstet Gynecol Reprod Biol 2022; 276:134-138. [PMID: 35901523 DOI: 10.1016/j.ejogrb.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Vaginismus is a disease characterized by vaginal spasms that impede sexual penetration and lead to sexual dysfunction. The association between this disease and infertility is quite well acknowledged. This paper aims to assess the obstetric outcomes and patient characteristics of vaginismus-treated women. STUDY DESIGN This cross-sectional research comprised 297 vaginismus patients who were effectively treated. METHODS The following information was collected: age, degree of education, occupation, length of marriage, and obstetric history (primigravida, multigravida, and previous abortions). Following pregnancy, the following data were collected: The results of pregnancy, obstetrics, and neonatology, such as maternal age, gestational age, and birth weight. As obstetrical outcomes, miscarriage, early delivery, hypertension, and fetal loss were recorded. In addition, the mode of delivery (cesarean section vs vaginal birth), reasons for selecting it, analgesic techniques, and potential problems during or after delivery were evaluated. RESULTS The mean maternal age was 29.2 ± 4.7 years, and the pregnancy rate was 86.86% (n = 258). 258 individuals were reported to have had at least one term pregnancy and delivery. In the feedback for vaginismus, no recurrence was reported 16 weeks after hospital release. CONCLUSION Vaginismus patients should be treated prior to being deemed infertile, and other fertility treatments should be attempted. Moreover, the caesarean delivery rates of individuals with treated vaginismus are the same as those of the general population. Vaginal delivery after vaginismus treatment seems to be safe, with no increased perineal morbidity or vaginismus recurrence.
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Ramanathan V, Gautham K, Ramasubramaniam UM. Common Pitfalls in the Management of Vaginismus in Couples With Subfertility in India. JOURNAL OF PSYCHOSEXUAL HEALTH 2022. [DOI: 10.1177/26318318221089600] [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] Open
Abstract
Vaginismus is described as an involuntary pelvic muscular spasm that occurs due to “fear of pain” associated with vaginal penetration which prevents a woman from experiencing penovaginal sexual intercourse despite her wish to do so. In the context of heterosexual couples with subfertility, untreated vaginismus may result in unconsummated marriage and/or reduced quality of sex life and/or can affect a woman’s perception about her potential of femininity and motherhood. Though vaginismus is an easily diagnosable and treatable condition in many instances, it often gets ignored or inadequately/inappropriately managed. There is paucity of practice-informed clinical data on management of vaginismus in couples with subfertility that is contextualized to the Indian setting. The present viewpoint is based on real-world clinical scenarios who presented as couples to a tertiary fertility center with unconsummated marriage as their chief complaint. The intent of this viewpoint is not only to highlight the common pitfalls in the management of vaginismus but also showcase a clinically proven interdisciplinary management approach for assessment and management of vaginismus and any associated sexual problems.
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Affiliation(s)
- Vijayasarathi Ramanathan
- The University of Sydney, Sydney, Australia
- Bloom Fertility & Healthcare, Chennai, Tamil Nadu, India
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8
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Ben Amar W, Feki N, Zribi M, Ennouri H, Khemakhem Z, Hammemi Z, Maatoug S. Particularités de l’expertise médico-légale en matière de non-consommation du mariage. SEXOLOGIES 2020. [DOI: 10.1016/j.sexol.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Seal BN, Meston CM. The Impact of Body Awareness on Women’s Sexual Health: A Comprehensive Review. Sex Med Rev 2020; 8:242-255. [DOI: 10.1016/j.sxmr.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/03/2018] [Accepted: 03/04/2018] [Indexed: 01/23/2023]
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10
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Wahl KJ, Orr NL, Lisonek M, Noga H, Bedaiwy MA, Williams C, Allaire C, Albert AY, Smith KB, Cox S, Yong PJ. Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study. Sex Med 2020; 8:274-281. [PMID: 32061579 PMCID: PMC7261667 DOI: 10.1016/j.esxm.2020.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/19/2019] [Accepted: 01/01/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Deep dyspareunia is a cardinal symptom of endometriosis, and as many as 40% of people with this condition experience comorbid superficial dyspareunia. Aim To evaluate the relationship between sexual pain and infertility concerns among women with endometriosis. Methods This is a cross-sectional study conducted at a university-based tertiary center for endometriosis. 300 reproductive-aged participants in the prospective Endometriosis Pelvic Pain Interdisciplinary Cohort (ClinicalTrials.gov Identifier: NCT02911090) with histologically confirmed endometriosis were included (2013–2017). Main Outcome Measure The total score on the infertility concerns module of the Endometriosis Health Profile-30 categorized into 5 groups (0, 1–4, 5–8, 9–12, 13–16). Results The odds of infertility concerns did not increase with severity of deep dyspareunia (odds ratio = 1.02, 95% CI: 0.95–1.09, P = .58). However, the odds of infertility concerns increased with severity of superficial dyspareunia (odds ratio = 1.09, 95% CI: 1.02–1.16, P = .011); this relationship persisted after adjusting for endometriosis-specific factors, infertility risk factors, reproductive history, and demographic characteristics (adjusted odds ratio [AOR] = 1.14, 95% CI: 1.06–1.24, P < .001). Other factors in the model independently associated with increased infertility concerns were previous difficulty conceiving (AOR = 2.09, 95% CI 1.04–4.19, P = .038), currently trying to conceive (AOR = 5.23, 95% CI 2.77–9.98, P < .001), nulliparity (AOR = 3.21, 95% CI 1.63–6.41, P < .001), and younger age (AOR = 0.94, 95% CI: 0.89–0.98, P = .005). Conclusion Severity of superficial dyspareunia, but not deep dyspareunia, was associated with increased odds of infertility concerns among women with endometriosis. Strengths of the study included the use of a validated measure of infertility concerns and disaggregation of sexual pain into deep and superficial dyspareunia. Limitations included the setting of a tertiary center for pelvic pain, which affects generalizability to fertility clinic and primary care settings. Women experiencing introital dyspareunia, who can have difficulties with achieving penetrative intercourse, may be concerned about their future fertility and should be counselled appropriately. Wahl KJ, Orr NL, Lisonek M, et al. Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study. Sex Med 2020;8:274–281.
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Affiliation(s)
- Kate J Wahl
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Natasha L Orr
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Lisonek
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver, BC, Canada
| | - Heather Noga
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Christina Williams
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Allaire
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Arianne Y Albert
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada
| | - Kelly B Smith
- BC Center for Vulvar Health, Gordon and Leslie Diamond Health Care Center, Vancouver, BC, Canada
| | - Susan Cox
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul J Yong
- Center for Pelvic Pain and Endometriosis, BC Women's Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; BC Center for Vulvar Health, Gordon and Leslie Diamond Health Care Center, Vancouver, BC, Canada.
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Female Sexual Dysfunction: A Systematic Review of Outcomes Across Various Treatment Modalities. Sex Med Rev 2019; 7:223-250. [DOI: 10.1016/j.sxmr.2017.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/27/2017] [Accepted: 12/28/2017] [Indexed: 01/23/2023]
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Achour R, Koch M, Zgueb Y, Ouali U, Ben Hmid R. Vaginismus and pregnancy: epidemiological profile and management difficulties. Psychol Res Behav Manag 2019; 12:137-143. [PMID: 30881157 PMCID: PMC6419599 DOI: 10.2147/prbm.s186950] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Vaginismus affects up to 1% of the female population and often represents a physical manifestation of an underlying psychological problem. Our objective was to investigate the psychosomatic impact of vaginismus in pregnant women and evaluate the quality of their therapeutic care in Tunisia. Methods We included pregnant patients with vaginismus who presented at our obstetric emergency department between October 2016 and March 2017. All patients were interviewed by one expert psychiatrist and gynecologist using a standardized questionnaire. The State-Trait Anxiety Inventory (STAI) was used to determine anxiety and depression levels. Patients were prospectively followed until their postpartum period and were interviewed by the same experts after delivery. Sixteen weeks after hospital discharge, we contacted all patients via phone. All the information was simultaneously recorded in written form. Results Twenty pregnant patients with vaginismus were included (85% primary, 15% secondary). Most women described a conservative family background (70%) in which they received little or no sexual education (60%). All women described a feeling of anxiety and anger immediately before sexual intercourse and 40% have never sought medical consultation regarding their vaginismus before. Only 50% reported regular follow-up visits during their pregnancy (without vaginal examination), whereas 25% reported irregular follow-up visits with subjectively bad experiences during attempts of vaginal examinations. Conclusion Pregnant women with vaginismus are at risk of non-follow-up during their pregnancy due to underlying feelings of shame and experienced lack of understanding by medical staff. Obstetricians should carefully and attentively approach pregnant women with vaginismus in order to ensure adequate medical care during pregnancy.
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Affiliation(s)
- Radhouane Achour
- Emergency Department of Gynecology and Obstetrics, Maternity and Neonatology Center of Tunis, Faculty of Medicine of Tunis, El Manar University of Tunis, Tunis, Tunisia,
| | - Marianne Koch
- Department of Obstetrics and Gynecology, Medical University of Vienna Austria
| | - Yosra Zgueb
- Psychiatry Department, Razi Hospital, Faculty of Medicine of Tunis, El Manar University of Tunis, Tunis, Tunisia
| | - Uta Ouali
- Psychiatry Department, Razi Hospital, Faculty of Medicine of Tunis, El Manar University of Tunis, Tunis, Tunisia
| | - Rim Ben Hmid
- Emergency Department of Gynecology and Obstetrics, Maternity and Neonatology Center of Tunis, Faculty of Medicine of Tunis, El Manar University of Tunis, Tunis, Tunisia,
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Abstract
AbstractVaginismus in one of the most frequent causes of non-consummation of marriage, and of infertility, in Arab-Muslim societies. Cognitive behavioural therapy (CBT) proved to be effective, but it is important to consider the cultural context of the patient attending CBT for vaginismus. The aim of our study was therefore to draw attention to the belief systems and behaviours linked to female sexuality and couple relationship in the Arab-Muslim culture. We present a series of four patients representative of the local culture and show how treatment strategies were adapted to fit these behaviours and belief systems, as well as environmental factors. We found that excessive closeness of family members, allowing the family to be intrusive and exercising pressure on the couple, a strict education which highly values virginity, transmits fear of ‘the male’ and fear of sex, and which links sex with pain, were the common denominator of all patients of our case series. We adapted the classical CBT strategies for vaginismus to our cultural context. The educational component was enlarged. Cognitive techniques were used to modify specific traditional beliefs. The integration of the family, and not only of the partner, into the treatment process proved uniquely beneficial for the patients.
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14
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Outcome of Medical and Psychosexual Interventions for Vaginismus: A Systematic Review and Meta-Analysis. J Sex Med 2018; 15:1752-1764. [DOI: 10.1016/j.jsxm.2018.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 01/02/2023]
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15
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Eldridge KF, Giraldi A. Communication About Sexual Matters With Women Attending a Danish Fertility Clinic: A Descriptive Study. Sex Med 2017; 5:e196-e202. [PMID: 28823315 PMCID: PMC5562493 DOI: 10.1016/j.esxm.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/15/2017] [Accepted: 06/27/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Several studies have shown that sexuality is an important aspect of life. Nevertheless, sexual matters are only rarely discussed between patients and doctors. Other studies have suggested that women undergoing fertility treatment compose a group of patients with low satisfaction in their sexual life. Aim To investigate how women at a fertility clinic desire and experience communication about sexual matters with doctors and to investigate the sexual function of these women. Methods A cross-sectional self-administered questionnaire survey of women attending a Danish fertility clinic over 4 months was performed. Descriptive statistics were calculated and presented as frequencies. Main Outcome Measure Communication about sexual matters with doctors included the women’s comfort, preferred and actual frequency of discussion, and initiation of the conversation. Sexual function included participants’ sexuality during the past year including certain sexual difficulties. Results Of the 201 participating women in the survey, most felt comfortable discussing sexual matters with doctors and preferred gynecologists for such discussions. There was a greater desire for communication than what was actually experienced by the women, and most wanted to initiate the conversation themselves. The women were less satisfied with their sexual life compared with a national control group, and they experienced sexual difficulties more often. Conclusion There is an unmet desire of women in fertility treatment for discussing sexual matters, and greater communication on this subject needs to be clinically implemented. Eldridge KE, Giraldi A. Communication About Sexual Matters With Women Attending a Danish Fertility Clinic. A Descriptive Study. Sex Med 2017;5:e196–e202.
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Affiliation(s)
- Katrine Fiil Eldridge
- Sexological Clinic, Division of Sexological Research, Rigshospitalet Section 7411, Copenhagen, Denmark.
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ciocca G, Limoncin E, Mollaioli D, Gravina GL, Carosa E, Di Sante S, Gianfrilli D, Lombardo F, Lenzi A, Jannini EA. SIAMS survey on sexological screening during the assisted reproductive technologies in Italy. J Endocrinol Invest 2015; 38:999-1005. [PMID: 25894866 DOI: 10.1007/s40618-015-0286-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The assessment of sexual function is fundamental to the Assisted Reproductive Technology (ART). Nevertheless, it is still not a common clinical routine among infertility centres. The aim of this survey is to describe the main aspects of sexological screening that are considered in Italian centres of ART. METHODS After the consensus of the Italian Society of Andrology and Sexual Medicine (SIAMS), a mailing list of reproductive medicine centres was created. Then, we sent a questionnaire concerning the essential characteristics of sexological screening. The respondents to compilers of the questionnaire sent back the information from their centres, and an analysis of absolute frequencies and percentages was performed. RESULTS First, 16 centres completed and returned the questionnaire, while 5 ignored the invitation. The main findings concerned the wide use consideration of vardenafil 10 mg (68.7%; 11/16) for the treatment of erectile dysfunction in comorbidity with reproductive problems, the diffuse administration of International Index of Erectile Function (68.2%; 11/16) and Structured Interview for the Erectile Dysfunction (50%; 8/16) as psychometric tools and lesser use of Female Sexual Function Index (31.2%; 5/16) for the evaluation of female sexuality in the infertile couple. CONCLUSIONS To conclude, we noticed a major focus on male sexuality and the eventual treatment or evaluation of sexual dysfunction compared to female sexuality. This aspect highlights an important issue for clinical practice to strongly consider and eventually reinforce. In this regard, improvement of the assessment and treatment of possible female sexual problems in reproductive medicine seems necessary.
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Affiliation(s)
- G Ciocca
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Klein V, Koops T, Lange C, Briken P. Sexual history of male partners of women with the diagnosis vaginismus. SEXUAL AND RELATIONSHIP THERAPY 2015. [DOI: 10.1080/14681994.2015.1025183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Muammar T, McWalter P, Alkhenizan A, Shoukri M, Gabr A, Bin AA. Management of vaginal penetration phobia in Arab women: a retrospective study. Ann Saudi Med 2015; 35:120-6. [PMID: 26336017 PMCID: PMC6074138 DOI: 10.5144/0256-4947.2015.120] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Vaginal penetration phobia is a common and distressing problem world.wide. It interferes with vaginal penetrative sexual relations, and leads to unconsummated marriage (UCM). This problem may be heightened in Arab women, due to cultural taboos about pain and bleeding, that may be associated with the first coital experience after marriage. Data about this problem is scarce in Arab societies. The aim of this study was to evaluate the response of these women and their husbands to an individualized, psychotherapeutic assessment and treatment to resolve this problem. DESIGN AND SETTINGS Retrospective descriptive in a general gynecology community setting over a 6-year period. METHODS The study involved a retrospective sequential cohort of 100 Arab couples with UCM due to the woman's VPP. They were evaluated by a female gynecologist in out patient clinics. Data was collected through chart review, and telephone interviews. Final analysis was performed on 100 Arab couples, who satisfied the inclusion criteria. They were followed up to assess their response to an individualized, structured treatment protocol. The treatment combined sex education with systematic desensitization, targeting fear and anxiety as.sociated with vaginal penetration. RESULTS A total of 96% of the studied group had a successful outcome after an average of 4 sessions. Penetrative intercourse was reported by the tolerance of these women; further pregnancy was achieved in 77.8 % of the infertile couples. CONCLUSION Insufficient knowledge of sexual intercourse is a major contributor to the development of VPP in the sampled population. It appears that they respond well to an individualized, structured treatment protocol as described by Hawten 1985 (regardless of other risk factors associated with vaginismus).
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Affiliation(s)
- Tarfah Muammar
- Dr. Tarfah Muammar, MBC 62 Department of Family Medicine and Polyclinic,, King Faisal Specialist Hospital and Research Centre,, PO Box 33544, Riyadh 11211, Saudi Arabia, T: 966 11 4647272, F: 966 11 4423005,
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Möller L, Josefsson A, Bladh M, Lilliecreutz C, Sydsjö G. Reproduction and mode of delivery in women with vaginismus or localised provoked vestibulodynia: a Swedish register-based study. BJOG 2014; 122:329-34. [DOI: 10.1111/1471-0528.12946] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 12/31/2022]
Affiliation(s)
- L Möller
- Division of Obstetrics and Gynecology; Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University, Linköping Sweden
| | - A Josefsson
- Division of Obstetrics and Gynecology; Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University, Linköping Sweden
| | - M Bladh
- Division of Obstetrics and Gynecology; Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University, Linköping Sweden
| | - C Lilliecreutz
- Division of Obstetrics and Gynecology; Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University, Linköping Sweden
| | - G Sydsjö
- Division of Obstetrics and Gynecology; Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University, Linköping Sweden
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Nabil Mhiri M, Smaoui W, Bouassida M, Chabchoub K, Masmoudi J, Hadjslimen M, Chaieb N, Rebai N, Masmoudi S, Bahloul A. Unconsummated marriage in the Arab Islamic world: Tunisian experience. SEXOLOGIES 2013. [DOI: 10.1016/j.sexol.2013.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nabil Mhiri M, Smaoui W, Bouassida M, Chabchoub K, Masmoudi J, Hadjslimen M, Chaieb N, Rebai N, Masmoudi S, Bahloul A. Le mariage non consommé dans le monde arabo-islamique : l’expérience tunisienne. SEXOLOGIES 2013. [DOI: 10.1016/j.sexol.2013.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rosenbaum TY, Padoa A. Managing Pregnancy and Delivery in Women with Sexual Pain Disorders (CME). J Sex Med 2012; 9:1726-35; quiz 1736. [DOI: 10.1111/j.1743-6109.2012.02811.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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