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Cosgriff L, Ramanathan A, Iglesia CB. Pelvic Floor Disorders and Sexual Function: A Review. Obstet Gynecol Clin North Am 2024; 51:241-257. [PMID: 38777481 DOI: 10.1016/j.ogc.2024.02.001] [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] [Indexed: 05/25/2024]
Abstract
Pelvic floor disorders can result in laxity, hypertonicity or spasm, all of which can impact sexual function. It is important for clinicians to understand this impact in order to appropriately counsel and treat their patients.
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Affiliation(s)
- Lauren Cosgriff
- Department of Obgyn, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Aparna Ramanathan
- Department of Obgyn, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Cheryl B Iglesia
- Department of Obgyn, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC 20010, USA.
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2
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Gaddam NG, Kingsberg SA, Iglesia CB. Sexual Dysfunction and Dyspareunia in the Setting of the Genitourinary Syndrome of Menopause. Clin Obstet Gynecol 2024; 67:43-57. [PMID: 38281169 DOI: 10.1097/grf.0000000000000846] [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: 01/30/2024]
Abstract
Sexual dysfunction is a common consequence of the genitourinary syndrome of menopause (GSM). In this book chapter, we discuss the pathophysiology, prevalence, evaluation, and evidence-based management of sexual dysfunction in patients affected by GSM. Additionally, we present an algorithm to guide clinicians in the management and treatment of sexual dysfunction in this setting based on available evidence and best practices.
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Affiliation(s)
- Neha G Gaddam
- Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University, Washington, DC
| | - Sheryl A Kingsberg
- Department of OBGYN, University Hospitals Cleveland Medical Center
- Departments of Reproductive Biology, Psychiatry and Urology, Case Western Reserve University School of Medicine
| | - Cheryl B Iglesia
- Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center
- Department of OB/GYN and Urology, Georgetown University School of Medicine, Cleveland, Ohio
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Spruijt M, Kerkhof M, Rombouts M, Brohet R, Klerkx W. Efficacy of botulinum toxin A injection in pelvic floor muscles in chronic pelvic pain patients: a study protocol for a multicentre randomised controlled trial. BMJ Open 2023; 13:e070705. [PMID: 37419648 PMCID: PMC10335469 DOI: 10.1136/bmjopen-2022-070705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/15/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Chronic pelvic pain (CPP) is a common multifactorial condition affecting 6%-27% of women aged 18-50 years worldwide. The aim of this randomised controlled trial (RCT) is to investigate the efficacy and safety of botulinum toxin A (BTA) injection compared with placebo injections in the pelvic floor muscles in women with CPP to improve pain, function and quality of life. METHODS AND ANALYSIS This is a study protocol for a multicentre, double-blinded placebo controlled RCT conducted in five gynaecology departments across the Netherlands. A total of 94 women over 16 years, with at least 6 months of CPP without anatomical cause and pelvic floor hypertonicity refractory to first-line pelvic floor physical therapy will be included. Participants will be randomised equally to BTA or placebo, both following physical therapy and (re-)education on the pelvic floor at 4, 8, 12 and 26 weeks after intervention. Multiple validated questionnaires focusing on pain, quality of life and sexual function will be collected at baseline and during all follow-up visits. Statistical analysis includes mixed models for repeated measurements. ETHICS AND DISSEMINATION Ethical approval (NL61409.091.17) was obtained from Radboud University Medical Research Ethics Committee (MREC) and Central Committee on Research involving human Subjects (CCMO). The findings will be presented through international conferences and peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER EudraCT number (2017-001296-23), CCMO/METC number: NL61409.091.17.
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Affiliation(s)
- Melle Spruijt
- Department of Gynaecology, St Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gynaecology, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
| | - Manon Kerkhof
- Department of Gynaecology, Curilion Clinics, Haarlem, The Netherlands
| | - Marian Rombouts
- Department of Physical Therapy, Radboud Universiteit, Nijmegen, The Netherlands
| | - Richard Brohet
- Department of Data Science, Isala Zwolle, Zwolle, The Netherlands
| | - Wenche Klerkx
- Department of Gynaecology, St Antonius Hospital, Nieuwegein, The Netherlands
- Department of Gynaecology, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
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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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Banaei M, Kariman N, Ozgoli G, Nasiri M, Roozbeh N, Zare F. Sexual function among women with vaginismus: a biopsychosocial approach. J Sex Med 2023; 20:298-312. [PMID: 36755511 DOI: 10.1093/jsxmed/qdac049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/11/2022] [Accepted: 12/08/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Vaginismus is known as a type of sexual pain disorder. Regarding the multifactorial nature of vaginismus, the biopsychosocial model is one of the best models to describe this sexual disorder. AIM The present research was conducted to study the determinants of sexual function in women with and without vaginismus based on the biopsychosocial model. METHODS This case-control study was conducted in Iran on 420 women with and without primary vaginismus who met the inclusion criteria. All eligible people were included in the research once their eligibility was verified and their informed permission was acquired; convenience and purposive sampling techniques were used continually. Data collection tools included the demographic and obstetric information form and multiple published scales and questionnaires. Structural equation modeling with LISREL 9.2 software (Scientific Software International) was used to evaluate the determinants of the sexual function of vaginismus. OUTCOMES Participants rated their determinants of sexual function based on the biopsychosocial model. RESULTS The mean ages of the case and control groups were 27.67 and 28.44 years, respectively. The direct, indirect, and total effects of the dimensions of sexual health on sexual function and the diagnostic score of vaginismus of the women with vaginismus were significant (P < .001). Furthermore, based on the results, the diagnostic score of vaginismus in women with vaginismus was significantly affected by the direct, indirect, and cumulative impacts of vaginal penetration cognition and fear of sex (P = .016, P = .005). Women with and without vaginismus were able to accept the models' excellent fit. CLINICAL IMPLICATIONS This study helps inform health planners and policy makers about the sexual function of women with vaginismus, the factors related to this disorder, and the multidimensional nature of this sexual problem. STRENGTHS AND LIMITATIONS This study attempted to offer a more comprehensive and complete view of present knowledge via surveying different aspects of sexual health and by means of valid and reliable tools and path analysis. The study's merits include the use of the biopsychosocial model to evaluate sexual function in women with vaginismus, the use of a variety of questionnaires to compare women with and without vaginismus, and the size of the sample. The research was limited by the fact that electronic sampling was conducted because of the COVID-19 epidemic. CONCLUSION Based on the findings of the present study for the group of women with vaginismus, the direct, indirect, and overall effects of the majority of dimensions of sexual health were significantly correlated with sexual function and vaginismus.
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Affiliation(s)
- Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, 7916613885, Iran
| | - Nourossadat Kariman
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 1996835119, Iran
| | - Giti Ozgoli
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 1996835119, Iran
| | - Maliheh Nasiri
- Department of Biostatistics, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, 1996835119, Iran
| | - Nasibeh Roozbeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, 7916613885, Iran
| | - Fatemeh Zare
- Midwifery Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 6135715794, Iran
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da Silva Lara LA, Rufino AC, Oliveira FF, Rossato S, Borges CS, Reis RM. Female sexual dysfunctions: an overview on the available therapeutic interventions. Minerva Obstet Gynecol 2022; 74:249-260. [PMID: 35147017 DOI: 10.23736/s2724-606x.22.04966-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
INTRODUCTION There are different types of female sexual dysfunctions (FSDs), and FSD in general has a high prevalence worldwide. Studies of FSD should consider it as a multifactorial disorder that has biological, psychological, environmental, and relational aspects. In this review we discuss the available therapeutic interventions for FSD. EVIDENCE ACQUISITION For the current narrative review the PubMed database was searched to identify all publications up to 30 March 2021 that were systematic reviews and meta-analyses which examined therapeutic interventions for FSDs based on the diagnostic classifications of ICD-10 and ICD-11. EVIDENCE SYNTHESIS Thirty systematic reviews and meta-analyses were included in this review. Hormone therapy (HT) and testosterone are effective to improve sexual desire in menopausal women. In these women HT and ospemiphene may improve pain during intercourse. Flibanserin may improve sexual desire and may reduce desire-related distress in premenopausal women. Bremelanotide is effective to improve desire, arousal, and orgasm scores. Evidence are still limited on the efficacy of psychoactive drugs, phosphodiesterase type 5 (PDE5), oxytocin, herbal drugs, and tibolone to treat FSDs. Psychological interventions such as cognitive-behavior therapy, mindfulness training, sensate focus, bibliotherapy are effective for the management of several different FSDs. CONCLUSIONS The management of FSDs may require multidisciplinary and interdisciplinary approaches. Pharmacological and nonpharmacological interventions appears to have potential as a treatment for FSDs, but there are currently no gold standards regarding recommended treatment modalities, and the duration, frequency, and intensity of therapy sessions.
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Affiliation(s)
- Lucia A da Silva Lara
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil -
| | - Andrea C Rufino
- Faculty of Medicine, State University of Piauí, Piauí, NE, Brazil
| | - Flávia F Oliveira
- Endometriosis Sector, Faculty of Medicine, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Serena Rossato
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Charles S Borges
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Rosana M Reis
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
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Hutchison D, Ali M, Zillioux J, Ortiz NM, Smith R, Rapp DE. Pelvic Floor Muscle Training in the Management of Female Pelvic Floor Disorders. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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McEvoy M, McElvaney R, Glover R. Understanding vaginismus: a biopsychosocial perspective. SEXUAL AND RELATIONSHIP THERAPY 2021. [DOI: 10.1080/14681994.2021.2007233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria McEvoy
- Department of Psychology, Waterford Institute of Technology, Waterford, Ireland
| | - Rosaleen McElvaney
- Department of Psychotherapy, Dublin City University, Dublin, Ireland
- Department of Psychotherapy, Children’s Health at Connolly, Dublin, Ireland
| | - Rita Glover
- Department of Psychotherapy, Dublin City University, Dublin, Ireland
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Do women with vaginismus have a lower threshold of pain? Eur J Obstet Gynecol Reprod Biol 2021; 258:189-192. [PMID: 33450709 DOI: 10.1016/j.ejogrb.2020.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Vaginismus and dyspareunia are together categorized as a genito-pelvic pain and penetration disorder. We aimed to evaluate the threshold of pain and the pain sensitivity in women with vaginismus. STUDY DESIGN In this prospective case-control study; 32 women with vaginismus and 29 healthy women were enrolled. Sociodemographic Information Form, Female Sexual Function Index (FSFI), Pain Beliefs Questionnaire (PBQ), Revised Fibromyalgia Impact Questionnaire (FIQR), The Lamont Scale of Vaginismus were applied. Threshold of pain was measured with algometer in terms of Newton (N). RESULTS The pain thresholds vaginismus and control group were as follows; left posterior superior iliac crest (40.3 N, 84.9 N respectively;p < 0.001), right posterior superior iliac crest (42.9 N, 76.1 N respectively;p = 0.007), left lateral trochanter (42.0 N, 69.8 N respectively; p = 0.015), right lateral trochanter (43.8 N, 75.3 N respectively; p = 0.003), left anterior superior iliac spine (29.2 N, 51.2 N respectively; p = 0.003), left insertion of gracilis muscle (27.3 N, 45.2 N respectively; p = 0.038), left medial vastus muscle (37.0 N, 52.4 N respectively; p = 0.025) and the pain thresholds were significantly lower in the vaginismus patients. CONCLUSION Women with vaginismus have a lower threshold of pain, and the pain threshold decreases in higher grades of vaginismus. The pain may aggravate the avoiding behavior of women from sexual intercourse.
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Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol 2020; 31:485-493. [PMID: 31609735 DOI: 10.1097/gco.0000000000000584] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To describe the principles of pelvic floor physical therapy (PFPT), review the evidence for PFPT as a treatment for pelvic floor dysfunction, and summarize the current recommendations for PFPT as a first-line conservative treatment option for pelvic floor disorders. RECENT FINDINGS Pelvic floor dysfunction can cause voiding and defecation problems, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain. PFPT is a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction. Based on the available evidence, PFPT with or without supplemental modalities can improve or cure symptoms of urinary incontinence, POP, fecal incontinence, peripartum and postpartum pelvic floor dysfunction, and hypertonic pelvic floor disorders, including pelvic floor myofascial pain, dyspareunia, vaginismus, and vulvodynia. Currently, there is conflicting evidence regarding the effectiveness of perioperative PFPT before or after POP and urinary incontinence surgery. SUMMARY PFPT has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders. Standards of PFPT treatment protocols, however, vary widely and larger well designed trials are recommended to show long-term effectiveness.
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Female Sexual Dysfunction: ACOG Practice Bulletin Clinical Management Guidelines for Obstetrician-Gynecologists, Number 213. Obstet Gynecol 2020; 134:e1-e18. [PMID: 31241598 DOI: 10.1097/aog.0000000000003324] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Female sexual dysfunction encompasses various conditions that are characterized by reported personal distress in one or more of the following areas: desire, arousal, orgasm, or pain (). Although female sexual dysfunction is relatively prevalent, women are unlikely to discuss it with their health care providers unless asked (), and many health care providers are uncomfortable asking for a variety of reasons, including a lack of adequate knowledge and training in diagnosis and management, inadequate clinical time to address the issue, and an underestimation of the prevalence (). The purpose of this document is to provide an overview of female sexual dysfunction, to outline updated criteria for diagnosis, and to discuss currently recommended management strategies based on the best available evidence.
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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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Aljuraifani R, Stafford RE, Hall LM, Hodges PW. Activity of Deep and Superficial Pelvic Floor Muscles in Women in Response to Different Verbal Instructions: A Preliminary Investigation Using a Novel Electromyography Electrode. J Sex Med 2019; 16:673-679. [PMID: 30926516 DOI: 10.1016/j.jsxm.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Verbal instructions are used clinically to encourage activation of the pelvic floor muscles (PFM). Whether separate layers of PFM activate differently in response to instructions remains unknown. AIM To test the hypotheses that (i) instructions that aimed to bias activity of a specific muscle layer would increase activation of the targeted layer to a greater extent than the other layer, (ii) activity of individual PFM layers would differ between instructions, and (iii) PFM activity would be symmetrical for all instructions. METHOD PFM electromyography (EMG) was recorded using custom-designed surface electrodes in 12 women without PFM dysfunction. The electrode included 4 pairs of recording surfaces orientated to measure EMG from deep and superficial PFM on each side. 3 submaximal contractions were performed for 5 seconds in response to 7 verbal instructions. Root-mean-squared EMG amplitude was calculated for 1 second during the period when participants most closely matched the target activation level. A repeated-measures anova was used to test whether PFM EMG differed between instructions and between regions. The EMG increase of individual muscles relative to that of the reference muscle [deep/right PFM] was compared to no change with t-tests for single samples. MAIN OUTCOME MEASURE PFM EMG amplitude. RESULTS Superficial PFM EMG was greater than deep PFM for all instructions (P = .039). 2 instructions induced the greatest amplitude of EMG for the superficial PFM: "squeeze the muscles around the vaginal opening as if to purse lips of your mouth" and "draw the clitoris in a posterior direction" (P = .036). Asymmetry was found in the deeper PFM in 3 instructions designed to bias the superficial PFM. STRENGTH & LIMITATIONS This preliminary study recorded activation of deep and superficial PFM layers in females with a custom-designed novel electrode. Some cross-talk of recording between muscle layers is possible but unlikely to impact the major findings. CONCLUSION Verbal instructions used to teach PFM contractions can influence their pattern of activity. This study provides preliminary evidence that, in a selection of verbal instructions, the superficial PFM activates more than the deep PFM, and that the deep PFM can have asymmetrical activation. Aljuraifani R, Stafford RE, Hall LM, et al. Activity of Deep and Superficial Pelvic Floor Muscles in Women in Response to Different Verbal Instructions: A Preliminary Investigation Using a Novel Electromyography Electrode J Sex Med 2019;16:673-679.
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Affiliation(s)
- Rafeef Aljuraifani
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia; Princess Noura bint Abdulrahman, Riyadh, Saudi Arabia
| | - Ryan E Stafford
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Leanne M Hall
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Paul W Hodges
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia.
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Stein A, Sauder SK, Reale J. The Role of Physical Therapy in Sexual Health in Men and Women: Evaluation and Treatment. Sex Med Rev 2019; 7:46-56. [PMID: 30503726 DOI: 10.1016/j.sxmr.2018.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/26/2018] [Accepted: 09/16/2018] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Many conditions of pelvic and sexual dysfunction can be addressed successfully through pelvic floor physical therapy (PFPT) through various manual therapy techniques, neuromuscular reeducation, and behavioral modifications. The field of pelvic rehabilitation, including sexual health, continues to advance to modify these techniques according to a biopsychosocial model. AIM To provide an update on peer-reviewed literature on the role of PFPT in the evaluation and treatment of pelvic and sexual dysfunctions in men and women owing to the overactive and the underactive pelvic floor. METHODS A literature review to provide an update on the advances of a neuromusculoskeletal approach to PFPT evaluation and treatment. MAIN OUTCOME MEASURE The use and advancement of PFPT methods can help in successfully treating pelvic and sexual disorders. RESULTS PFPT for pelvic muscle overactivity and underactivity has been proven to be a successful option for pelvic and sexual dysfunction. Understanding the role of the organs, nerves, fascia, and musculoskeletal system in the abdomino-pelvic and lumbo-sacro-hip region and how pelvic floor physical therapists can effectively evaluate and treat pelvic and sexual health. It is important for the treating practitioner to know when to refer to PFPT. CONCLUSION Neuromusculoskeletal causes of pelvic floor disorders affect a substantial proportion of men, women, and children and PFPT is a successful and non-invasive option. Pelvic floor examination by healthcare practitioners is essential in identifying when to refer to PFPT. Use of a biopsychosocial model is important for the overall well-being of each patient. Further research is needed. Stein A, Sauder SK, Reale J. The role of physical therapy in sexual health in men and women: Evaluation and treatment. Sex Med Rev 2019;7:46-56.
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Affiliation(s)
- Amy Stein
- Beyond Basics Physical Therapy, LLC, New York, NY, USA.
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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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Spoelstra SK, Weijmar Schultz WCM, Reissing ED, Borg C, Broens PM. The distinct impact of voluntary and autonomic pelvic floor muscles on genito-pelvic pain/penetration disorder. SEXUAL AND RELATIONSHIP THERAPY 2018. [DOI: 10.1080/14681994.2018.1442568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Symen K. Spoelstra
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Willibrord C. M. Weijmar Schultz
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elke D. Reissing
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Charmaine Borg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Paul M.A. Broens
- Department of Surgery, Anorectal Physiology Laboratory, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Arnouk A, De E, Rehfuss A, Cappadocia C, Dickson S, Lian F. Physical, Complementary, and Alternative Medicine in the Treatment of Pelvic Floor Disorders. Curr Urol Rep 2017; 18:47. [DOI: 10.1007/s11934-017-0694-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lindau ST, Abramsohn EM, Baron SR, Florendo J, Haefner HK, Jhingran A, Kennedy V, Krane MK, Kushner DM, McComb J, Merritt DF, Park JE, Siston A, Straub M, Streicher L. Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist. CA Cancer J Clin 2016; 66:241-63. [PMID: 26784536 PMCID: PMC4860140 DOI: 10.3322/caac.21337] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 12/15/2022] Open
Abstract
Answer questions and earn CME/CNE Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists' findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns. CA Cancer J Clin 2016;66:241-263. © 2016 American Cancer Society.
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Affiliation(s)
- Stacy Tessler Lindau
- Director, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
- Associate Professor, Department of Medicine-Geriatrics, University of Chicago, Chicago, IL
- MacLean Center on Clinical Medical Ethics, University of Chicago, Chicago, IL
- Associate Professor, Comprehensive Cancer Center, University of Chicago, Chicago, IL
| | - Emily M Abramsohn
- Researcher and Project Manager, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Shirley R Baron
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Clinical Associate, Program in Integrative Sexual Medicine for Women and Girls With Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Judith Florendo
- Doctor of Physical Therapy, Florendo Physical Therapy, Chicago, IL
- Clinical Associate, Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Hope K Haefner
- Professor, Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI
| | - Anuja Jhingran
- Professor, Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanessa Kennedy
- Assistant Professor, Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, CA
| | - Mukta K Krane
- Assistant Professor, Department of Surgery, University of Washington, Seattle, WA
| | - David M Kushner
- Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jennifer McComb
- Assistant Clinical Professor, The Family Institute at Northwestern University, Evanston, IL
| | - Diane F Merritt
- Professor, Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, WA University School of Medicine, St. Louis, MO
| | - Julie E Park
- Associate Professor, Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Amy Siston
- Clinical Associate, Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago, IL
| | - Margaret Straub
- Physician's Assistant, Radiation Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
| | - Lauren Streicher
- Associate Professor, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL
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Macey K, Gregory A, Nunns D, das Nair R. Women's experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study. BMC WOMENS HEALTH 2015; 15:49. [PMID: 26091883 PMCID: PMC4475318 DOI: 10.1186/s12905-015-0201-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/18/2015] [Indexed: 12/03/2022]
Abstract
Background Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes ‘performance-based’ sexuality which may be detrimental. Despite this, little has been done to seek women’s views about their treatment. This study set out to explore women’s experiences of vaginismus treatment with vaginal trainers, and to use their voices to propose guidelines for improving treatment. Methods 13 women who had used vaginal trainers for vaginal penetration difficulties diagnosed as vaginismus were recruited through a specialist clinic, university campuses, and online forums. The women took part in semi-structured individual interviews (face-to-face/telephone/Skype), which were audio-recorded, transcribed verbatim and analysed using Thematic Analysis. Results Four superordinate themes were elicited and used to draft ‘better treatment’ guidelines. Themes were: (1) Lack of knowledge, (2) Invalidation of suffering by professionals, (3) Difficult journey, and (4) Making the journey easier. This paper describes themes (3) and (4). Difficult Journey describes the long and arduous ‘Journey into treatment’, including difficulties asking for help, undergoing physical investigations and negotiating ‘the system’ of medical referrals. It also describes the sometimes demoralising process of ‘being in treatment’, which includes emotional and practical demands of treatment. Making the journey easier highlights the importance of and limits to ‘partner support’. ‘Professional support’ comprises personal qualities of professionals/therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. ‘Peer support/helping each other’ describes the importance of supportive vaginimus networks and sharing tips with other women. Conclusions Accessing effective treatment for vaginal penetration difficulties is difficult. The practical and emotional demands of using vaginal trainers may be underestimated by professionals, resulting in inadequate provision of support and information in practice. At times vaginal trainers may be prescribed to women who are unlikely to benefit from this treatment in isolation. Core communication skills like non-judgemental listening are important for supporting women through treatment. However professionals also need greater specialist knowledge, which in turn requires more detailed research. New ways to disseminate specialist knowledge and suggestions for further research are discussed. Electronic supplementary material The online version of this article (doi:10.1186/s12905-015-0201-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kat Macey
- Clinical Psychology, University of Nottingham, Nottingham, UK. .,Clinical Psychology, Division of Psychiatry & Applied Psychology, University of Nottingham, YANG Fujia Building, B Floor, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK.
| | - Angela Gregory
- Chandos Clinic, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - David Nunns
- Division of Obstetrics & Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Roshan das Nair
- Clinical Psychology, University of Nottingham, Nottingham, UK. .,Dept. of Clinical Psychology & Neuropsychology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Areskoug-Josefsson K, Gard G. Sexual Health as a Part of Physiotherapy: The Voices of Physiotherapy Students. SEXUALITY AND DISABILITY 2015. [DOI: 10.1007/s11195-015-9403-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Bortolami A, Vanti C, Banchelli F, Guccione AA, Pillastrini P. Relationship Between Female Pelvic Floor Dysfunction and Sexual Dysfunction: An Observational Study. J Sex Med 2015; 12:1233-41. [DOI: 10.1111/jsm.12882] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
PURPOSE OF REVIEW To analyze literature on sexual pain disorders and to review and summarize the articles published throughout 2013 which contribute to the current knowledge on this subject. RECENT FINDINGS By age 40, 7.8% of women reported vulvar pain. Diagnostic and Statistical Manual of Mental Disorders, fifth edition, has combined vaginismus and dyspareunia into the same diagnostic label. The research reviewed in this article seems to differently point toward two conditions, focusing on different aspects both on the etiological and on the treatment area. Higher levels of partner-perceived self-efficacy and lower levels of partner catastrophizing were associated with less pain intensity in women with entry dyspareunia, independent of women's pain perception and self-efficacy. Alexithymia and fear were found to be important etiological factors in vaginismus. SUMMARY The present findings did not provide clear evidence in support of the superiority of any treatment and highlight the need for randomized, placebo-controlled trials that compare treatments in the future. A lot of work remained to be done to understand such a complex and multifaceted disturbance as genital sexual pain, but the articles examined showed that we are slowly adding more knowledge on the etiological cause and treatment models for such conditions.
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Berzuk K. The Pelvic Floor Muscle: the Link Between Bladder, Bowel, and…Sex? A Review of Current Pelvic Therapy Approaches for Diagnosis and Treatment of Sexual Disorders. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Molaeinezhad M, Salehi M, Borg C, Yousefy A, Latifnejad Roudsari R, Salehi P, Shafiei K, Merghati Khoei E. Marriage consummated for 32 Iranian women using therapist-aided exposure therapy: a brief report. SEXUAL AND RELATIONSHIP THERAPY 2014. [DOI: 10.1080/14681994.2014.915304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cherner RA, Reissing ED. A comparative study of sexual function, behavior, and cognitions of women with lifelong vaginismus. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1605-14. [PMID: 23733151 DOI: 10.1007/s10508-013-0111-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 02/28/2013] [Accepted: 03/04/2013] [Indexed: 05/03/2023]
Abstract
Vaginismus is classified as a sexual dysfunction, yet limited research is available on the sexual function and behavior of women with this condition. Comparing women with lifelong vaginismus to women with lifelong dyspareunia and women with no pain during intercourse, this study explored sexual function, anxiety, and behavior along with cognitions related to vaginal penetration. A total of 152 women completed an online survey that included a series of validated questionnaires. Main findings indicated that, relative to both comparison groups, women in the vaginismus group reported a more limited range of sexual behavior across the lifespan and more maladaptive cognitions related to fear of losing control of one's body and the situation during penetration. Compared to the no-pain group, both symptomatic groups reported more difficulties across several indicators of sexual function, more limited sexual behavior in the past year and past month, and more maladaptive cognitions related to vaginal penetration. However, women with vaginismus reported more sexual desire and less difficulty with lubrication compared to women with dyspareunia. Numerous sexual problems extending beyond vaginal penetration difficulties were confirmed, suggesting a need for broader treatment approaches not limited to the experience of vaginal penetration. Results were discussed as they relate to the fear-avoidance model of vaginismus.
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Affiliation(s)
- Rebecca A Cherner
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier (4010), Ottawa, ON, K1N 6N5, Canada
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