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Ali M, Fraker J, Sobel T, Vegunta S. Beyond the discomfort: understanding and managing sexual pain in women, a comprehensive case-based discussion. Sex Med Rev 2024:qeae040. [PMID: 38850562 DOI: 10.1093/sxmrev/qeae040] [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: 10/29/2023] [Revised: 04/25/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Sexual pain has a profound impact on individuals, regardless of their sexual orientation or gender identity, and affects women more often than men. It adversely affects both sexual function and interpersonal relationships. Despite its prevalence, sexual pain in women often remains unaddressed and untreated. Various underlying causes contribute to sexual pain, sometimes involving multiple factors. We explore treatment options and offer clinical insights into the evaluation and management of 4 common conditions which cause sexual pain in women. In this article, we use the term "women" to indicate cisgender women. OBJECTIVES Our aim is to highlight the most common clinical scenarios of sexual pain and provide comprehensive discussions on each, to improve patient care and outcomes in the management of sexual pain. METHODS We conducted a comprehensive review of literature and clinical cases to explore the various causes and management strategies for sexual pain in women. We systematically searched databases such as PubMed, Google Scholar, and relevant medical journals. We included peer-reviewed articles, case studies, and clinical trials published between 2000 and 2023. Additionally, we analyzed real-life cases from our clinical practice at our academic institution. RESULTS Our review identified various factors contributing to sexual pain in women, ranging from hormonal imbalances to neuroproliferative and inflammatory conditions affecting the genitourinary system. Each case should be approached individually to offer optimal management strategies accordingly. CONCLUSION The management of sexual pain in women requires a comprehensive approach that addresses the multifactorial nature of the condition. Patient education and counseling play a crucial role in the management of sexual pain, empowering individuals to advocate for their own health and well-being. The collaboration between healthcare providers and patients can improve our understanding and management of this complex condition.
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Affiliation(s)
- Muna Ali
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85260, United States
| | - Jessica Fraker
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85260, United States
| | - Talia Sobel
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85260, United States
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85260, United States
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Fernández-Pérez P, Leirós-Rodríguez R, Marqués-Sánchez MP, Martínez-Fernández MC, de Carvalho FO, Maciel LYS. Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis. BMC Womens Health 2023; 23:387. [PMID: 37482613 PMCID: PMC10364425 DOI: 10.1186/s12905-023-02532-8] [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: 11/10/2022] [Accepted: 07/08/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Dyspareunia is defined as the occurrence of pain during or after sexual intercourse, which directly affects physical, sexual, and mental health. This condition can lead to depression, anxiety, and low self-esteem in women who experience it. OBJECTIVES The aim of this research was to evaluate the effectiveness of physical therapy interventions for the treatment of female dyspareunia. DESIGN A systematic review and meta-analysis was conducted. METHOD Search of publications was conducted in Scopus, Medline, Pubmed, Cinahl and Web of Science. Treatment effects were defined as standardized mean difference and their 95% confidence intervals. Statistical heterogeneity was assessed using Crohan's Q test and quantified using the I2 index. RESULTS Of the 19 articles selected, six applied multimodal physiotherapy treatments; five, electrotherapy; three, Thiele's massage; two, interdisciplinary interventions or pelvic floor muscle training; and one, extracorporeal shockwave therapy. The meta-analysis showed significant results for the variables pain and quality of life with the interventions based on electrotherapy and electrotherapy combined with pelvic floor muscle training. These interventions did not show significant results for the improvement of sexual function. CONCLUSIONS Physiotherapy techniques are effective and procedures have been identified with reliable results in improving pain and quality of life in patients with dyspareunia. One of the most important aspects is the strengthening of the perineal musculature and the application of Transcutaneous Electrical Nerve Stimulation. Furthermore, manual trigger point release therapy and Thiele massage, optimize and guarantee the reduction of pain intensity. PROSPERO REGISTRATION CRD42021236155.
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Affiliation(s)
- Paula Fernández-Pérez
- Nursing and Physical Therapy Department, University of Leon, Astorga Ave, 24401 Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Astorga Ave, 24401 Ponferrada, Spain
| | - Mª Pilar Marqués-Sánchez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Astorga Ave, 24401 Ponferrada, Spain
| | | | | | - Leonardo Y. S. Maciel
- Physical Therapy Department of Lagarto, Universidade Federal de Sergipe, Gov. Marcelo Déda Ave, São José, Lagarto 49400-000 Brazil
- Faculty of Sport, Research Centre in Physical Activity, Health and Leisure (CIAFEL), University of Porto, R. Dr. Plácido da Costa 91, 4200-450 Porto, Portugal
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Abril-Coello R, Correyero-León M, Ceballos-Laita L, Jiménez-Barrio S. Benefits of physical therapy in improving quality of life and pain associated with endometriosis: A systematic review and meta-analysis. Int J Gynaecol Obstet 2022. [PMID: 36571475 DOI: 10.1002/ijgo.14645] [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: 05/31/2022] [Revised: 11/17/2022] [Accepted: 12/17/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess whether non-pharmacologic conservative therapeutic interventions are beneficial in improving pain intensity and quality of life in women with endometriosis compared with placebo. METHODS A systematic review with meta-analysis was designed. A literature search was performed in the following databases: PubMed, PEDro, Embase, CINAHL, Isi Web of Science, Enfispo, and Cochrane. Randomized controlled trials included women with endometriosis treated with conservative treatment versus placebo. The quality of the studies was assessed using the PEDro scale, and the risk of bias of the individual studies was assessed using the Cochrane Risk of Bias tool. For the overall quality of the studies, the GRADE guidelines were used. RESULTS Meta-analysis included six studies. Significant results were obtained for pain intensity (standardized mean difference [SMD] -0.89; 95% confidence interval [CI] -1.21 to -0.57; I2 69%) and concerning quality of life, significant results were only obtained for the sub-variable physical function (SMD -1.49; 95% CI -2.88 to -0.10; I2 95%). No statistically significant differences were found for the rest of the variables analyzed. CONCLUSION Non-pharmacologic conservative therapies are a therapeutic option for women with endometriosis for improving pain intensity and physical function.
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Affiliation(s)
- Rebeca Abril-Coello
- Department of Surgery, Opthalmology, Otorhinolaryngology, and Physiotherapy, Facult of Health Sciences, University of Valladolid, Soria, Spain
| | - Marta Correyero-León
- Department of Surgery, Opthalmology, Otorhinolaryngology, and Physiotherapy, Facult of Health Sciences, University of Valladolid, Soria, Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Soria, Spain
| | - Sandra Jiménez-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, Soria, Spain
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Vegunta S, Kuhle CL, Vencill JA, Lucas PH, Mussallem DM. Sexual Health after a Breast Cancer Diagnosis: Addressing a Forgotten Aspect of Survivorship. J Clin Med 2022; 11:6723. [PMID: 36431200 PMCID: PMC9698007 DOI: 10.3390/jcm11226723] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/12/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
Breast cancer is the most common cancer in women. The life expectancy after a breast cancer diagnosis is improving steadily, leaving many more persons with the long-term consequences of treatment. Sexual problems are a common concern for breast cancer survivors yet remain overlooked in both the clinical setting and the research literature. Factors that contribute to sexual health concerns in breast cancer survivors are biopsychosocial, as are the barriers to addressing and treating these health concerns. Sexual health needs and treatment may vary by anatomy and gender. Multidisciplinary management may comprise lifestyle modifications, medications, sexual health aids such as vibrators, counseling, and referrals to pelvic health physical therapy and specialty care. In this article, we review the contributing factors, screening, and management of sexual difficulties in cisgender female breast cancer survivors. More information is needed to better address the sexual health of breast cancer survivors whose sexual/gender identity differs from that of cisgender women.
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Affiliation(s)
- Suneela Vegunta
- Division of Women’s Health Internal Medicine, Mayo Clinic, 13400 Shea Blvd, Scottsdale, AZ 85259, USA
| | - Carol L. Kuhle
- Menopause and Women’s Sexaul Health Clinic, Mayo Clinic, Rochester, MN 55905, USA
| | - Jennifer A. Vencill
- Menopause and Women’s Sexaul Health Clinic, Mayo Clinic, Rochester, MN 55905, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Pauline H. Lucas
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Dawn M. Mussallem
- Jacoby Center for Breast Health, Mayo Clinic, Jacksonville, FL 32224, USA
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Arcanjo GN, Pires JLVR, Jacinto MEM, Colares JM, Belo LMC, Lima PODP, Vilaça-Alves J. Comparison of the Effect of Osteopathic Manipulations and Exercises on the Myoelectric Activity of the Pelvic Floor: A Randomized Controlled Trial. J Chiropr Med 2022; 21:97-107. [DOI: 10.1016/j.jcm.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 10/18/2022] Open
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Miles K, Miles S. Low Dose, High Frequency Movement Based Dilator Therapy for Dyspareunia: Retrospective Analysis of 26 Cases. Sex Med 2021; 9:100344. [PMID: 33992935 PMCID: PMC8240346 DOI: 10.1016/j.esxm.2021.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION While two-thirds of women will experience dyspareunia and vaginal dilators are often used to treat dyspareunia, outside of a single case report, no study has investigated the potential of low-dose, high frequency movement-based dilator therapy for dyspareunia in premenopausal female patients. AIM To determine the utility of low-dose, high frequency movement-based dilator use for dyspareunia in premenopausal female patients. METHODS Retrospective study of women presenting to outpatient hospital-based pelvic floor physical therapy office in a tertiary care center. All adult premenopausal female patients who were referred to pelvic floor physical therapy for dyspareunia and completed movement-based dilator therapy (MBDT) and met study criteria (n = 26) were included for analysis. MAIN OUTCOME MEASURE Patient change in pain level status using Numeric Pain Rating Scale with intercourse was compared between initial evaluation and time of discharge from pelvic floor physical therapy. RESULTS Among the 26 women who met criteria for this study, the average pain score decreased from 8.3 (SD 2.2) before treatment to 1.3 (SD 2.0) after treatment and was statistically significant (P< .001). Complete resolution of dyspareunia was reported in 58% of patients. Patients completed between 2 and 6 total pelvic floor physical therapy visits (average 3.7, SD1.5), over 0-44 weeks (mean 9.6 weeks, SD 8.3). CONCLUSION Low-dose, high frequency, movement-based dilator therapy significantly reduced or resolved the experience of pain with penetrative vaginal intercourse with dyspareunia. Future prospective studies with larger samples and the inclusion of sexual functional status should be considered to explore the full potential of this modality in treatment of premenopausal patients with dyspareunia. Miles K, Miles S. Low Dose, High Frequency Movement Based Dilator Treatment for Dyspareunia: Retrospective Analysis of 26 Cases. Sex Med 2021;9:100344.
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Affiliation(s)
- Katherine Miles
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD, USA; Uniformed Services University, Bethesda, MD, USA
| | - Shana Miles
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA; Uniformed Services University, Bethesda, MD, USA.
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A Azim K, Happel-Parkins A, Moses A. Epistles of dyspareunia: storying Christian women's experiences of painful sex. CULTURE, HEALTH & SEXUALITY 2021; 23:644-658. [PMID: 32116146 DOI: 10.1080/13691058.2020.1718759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
Dyspareunia is painful attempted or completed vaginal-penile intercourse, and vaginal pain from other forms of touch. Because there is a persistent underlying message of shame and taboo surrounding female sexual pleasure in some Christian-informed cultural contexts, we sought to examine how self-identified Christian women in the Midsouthern USA conceptualise and experience dyspareunia. Data were collected through initial surveys and semi-structured interviews and analysed using incident-to-incident and in-vivo coding. Creative Analytic Practice was used to create composite character narratives from the data, storying five aspects of participants' experiences: (1) ignorance and abstinence at home, church, and school; (2) socially-informed expectations of sex and painful realities; (3) making sense of, coping with, and seeking help for painful sex; (4) validation, diagnosis, and treatment; and (5) sex mis-education and desire for a different future. Findings suggest that participants' understandings of and coping with their sexuality and the accompanying painful sex are shaped by implicit and explicit religious messages they encountered in their family upbringing, schooling, social and religious circles, and interactions with healthcare providers. Health professionals are urged to pre-screen women for symptoms of dyspareunia and include sexual wellness checks as routine procedure, and subsequently refer patients to pelvic health physical therapy when appropriate.
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Affiliation(s)
- Katharina A Azim
- Department of Psychology, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Alison Happel-Parkins
- Department of Counseling, Educational Psychology and Research, University of Memphis, Memphis, TN, USA
| | - Amy Moses
- Sundara Wellness Center, Southaven, TN, USA
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