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Padoa A, Tomashev R, Brenner I, Golan A, Igawa MS, Lurie I, Reicher Y, Talmon A, Ginzburg K. Obstetric outcome and emotional reactions to childbirth in women with dyspareunia: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2023; 288:7-11. [PMID: 37413830 DOI: 10.1016/j.ejogrb.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/04/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To assess obstetrical outcomes, perceptions of childbirth experience and emotional adjustment, in women with dyspareunia. STUDY DESIGN In this cross-sectional study, 440 women were recruited within 48 h postpartum in the maternity ward of a large medical center, during the period of April 2018- August 2020. Self-report questionnaires were administered which addressed demographic and reproductive background, dyspareunia, perceptions of control during labor (Labor Agentry Scale), perceived professional support (Intrapartum Care Scale), and maternal adjustment, implicated in perinatal dissociation (Peritraumatic Dissociative Experiences Questionnaire), acute stress disorder (ASD) symptoms (Stanford Acute Stress Reaction Questionnaire), bonding (Mother-to-Infant Bonding Scale), anticipated maternal self-efficacy (Maternal Self-Efficacy Scale) and well-being (Positive and Negative Affect Schedule, Edinburgh Postnatal Depression Scale). Obstetrical information was retrieved from clinical files and included pregnancy complications, week and mode of delivery, nature of labor onset, analgesia during delivery, birthweight, perineal tears. RESULTS The dyspareunia group included 71 women (18.3%) and the comparison group 317 (81.7%). Demographic data were similar among groups. No difference was observed in nature of labor onset, type of analgesia, route of delivery, perineal tears. More participants with dyspareunia had premature delivery versus comparisons (14.1% vs 5.6%, p = 0.02). Women with dyspareunia reported lower levels of control (p = 0.01) and perceived support during childbirth (p < 0.001), higher levels of perinatal dissociation (p < 0.001) ASD symptoms (p < 0.001), depression (p = 0.02), negative affect (p < 0.001), and reported lower levels of maternal bonding (p < 0.001) and anticipated maternal self-efficacy (p = 0.01). CONCLUSION Dyspareunia was associated with more premature deliveries, parameters of emotional distress during childbirth and poorer maternal adjustment following childbirth. Perinatal caregivers should be cognizant of such cognitive and emotional reactions in women with dyspareunia, so as to assess for a history of dyspareunia in pregnant women and provide adequate support during pregnancy and delivery.
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Affiliation(s)
- Anna Padoa
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Roni Tomashev
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Brenner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Lev-Hasharon Medical Center, Pardesiya, Israel
| | - Ayelet Golan
- Department of Obstetrics and Gynecology, Shamir-Assaf Harofeh Medical Center, Tsrifin, Israel
| | - May Shir Igawa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Lurie
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yael Reicher
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beersheba, Israel; Ben Gurion University of the Negev, Beersheba, Israel
| | - Anat Talmon
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel; Department of Psychology, Stanford University, Stanford, CA, USA
| | - Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Reingold OH, Goldner L. "It was wrapped in a kind of normalcy": The lived experience and consequences in adulthood of survivors of female child sexual abuse. CHILD ABUSE & NEGLECT 2023; 139:106125. [PMID: 36870267 DOI: 10.1016/j.chiabu.2023.106125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Survivors' surveys on the frequency of sexual offenses committed by women indicated a prevalence rate of 9.9 % to 11.6 %. Nevertheless, only a few studies have explored the long-term consequences of abuse on survivors. OBJECTIVES Examine the lived experiences and the long-term consequences of child sexual abuse committed by women. PARTICIPANTS Fifteen adult participants who experienced child sexual abuse conducted by female offenders participated in the study. METHODS The Interpretive Phenomenological Approach was applied to semi-structured interviews. RESULTS Three central themes emerged: types of abuse, characteristics of the perpetrator, and consequences of abuse. Most survivors experienced direct or indirect forms of sexual abuse committed by their mothers. In most cases, the offenders masked their abuse in caregiving, disciplinary or playful behavior. The survivors perceived their mothers as narcissistic, controlling, hostile, and having tremendous difficulties with separation. The survivors reported the need to engage in extensive negative long-lasting psychopathologies, which they attributed partly to having been invalidated and silenced by society. Many participants expressed fears of re-enacting the survivor or perpetrator role, which has led to difficulties in various relationships. They described an altered perception of their bodies as shameful and repulsive, manifesting in self-harm, eating disorders, and the elimination of signs of femininity. CONCLUSION This complex form of sexual abuse hampers the internalization and the construction of positive feminine, masculine, and parental identities.
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Affiliation(s)
- Ortal Herzig Reingold
- School of Creative Arts Therapies, Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Limor Goldner
- School of Creative Arts Therapies, Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
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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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Deliktas Demirci A, Kabukcuoglu K. “Being a Woman” in the Shadow of Vaginismus: The Implications of Vaginismus for Women. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082215666190917153811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction:
Vaginismus includes some psychological conditions such as fear of pain
and avoidance from penetration. There is little knowledge about the effects of vaginismus.
Objective:
The present study aims to present the bio-psychosocial consequences of vaginismus in
women life.
Methods:
The method of the present study is a review, which is conducted on the available resources.
All relevant studies were included to present effects of vaginismus on the women.
Results:
Women who have vaginismus have many problems with self-identity, psychological and
reproductive lives. Most of the effects of vaginismus lead to another deep effect on women. Women
with vaginismus mostly describe themselves negatively. This negative self-perception affects
women’s self-esteem levels which cause psychiatric disorders. The psychiatric disorders have been
associated with vaginismus as a reason and result. It is stated in the studies that the general anxiety
and, penetration specific anxiety are related to vaginismus. This result reflects that women with
vaginismus have more anxiety about penetration. Women with vaginismus encounter reproductive
problems, who are more likely to encounter increased cesarean section and fertility problems, they
are reluctant to seek health care services, especially due to fear of the gynaecological examination.
Conclusion:
Although vaginismus is a common problem, there is little information about the effects
of vaginismus on women. Vaginismus causes psychiatric disorders and reproductive problems. The
researchers should examine how women live with vaginismus. It is also suggested that psychotherapy
techniques should include couples interventions and, researchers should examine psychological
health of women deeply.
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Alon R, Shimonovitz T, Brecher S, Shick-Nave L, Lev-Sagie A. Delivery in patients with dyspareunia-A prospective study. Eur J Obstet Gynecol Reprod Biol 2019; 237:131-136. [PMID: 31035120 DOI: 10.1016/j.ejogrb.2019.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 03/19/2019] [Accepted: 04/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Despite the high prevalence of dyspareunia, published data focused on childbirth is scarce. This study aimed to evaluate the prevalence of dyspareunia in a random primiparae parturient population, characterize their features, and describe associated perinatal outcomes. STUDY DESIGN In this prospective observational study we approached primiparous women admitted to our labor ward. Women were asked to complete an interview, based on self-report of dyspareunia symptoms. Obstetrical outcomes were obtained and compared between women with (exposed) and without (controls) dyspareunia. Midwives completed a questionnaire regarding patients' cooperation, pain level, pelvic floor hypertonicity, difficulty with vaginal examinations and perceived anxiety level. RESULTS One hundred seventy-three women completed a detailed questionnaire querying dyspareunia symptoms. Of them, 41.6% (n = 72) reported a certain degree of dyspareunia. Exposed women did not differ in demographic or clinical characteristics as compared to controls. Of the exposed group, 40.3% reported primary dyspareunia, 25.4% secondary dyspareunia, and 34.3% could not recall its beginning. Only 34.3% had consulted a practitioner regarding this problem. Rates of vaginal deliveries, vacuum deliveries, and cesarean deliveries were comparable (p = 0.845). There were no differences between the two groups in rates of analgesia usage, epidural anesthesia, episiotomy, and second stage duration. However, the severity of dyspareunia correlated with the incidence of perineal tears (66.7% in patients with severe dyspareunia, and 41.1% in controls, p = 0.011). Logistic regression analysis revealed that dyspareunia was independently associated with perineal tears (p = 0.029). Higher rates of anxiety and pelvic floor hypertonicity were reported in patients reporting severe dyspareunia (≥3/10 times). CONCLUSION Dyspareunia is common among primiparous women, and these patients are more likely to suffer perineal tears and anxiety during delivery.
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Affiliation(s)
- Revital Alon
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Tzvika Shimonovitz
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Sharon Brecher
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Liat Shick-Nave
- Department of Physical Therapy, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Ahinoam Lev-Sagie
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel.
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Tourrilhes E, Veluire M, Hervé D, Nohuz E. [Obstetric outcome of women with primary vaginismus]. Pan Afr Med J 2019; 32:160. [PMID: 31303929 PMCID: PMC6607310 DOI: 10.11604/pamj.2019.32.160.16083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/12/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction Dysfonction importante, le vaginisme est un problème tant individuel que du couple qui peut altérer la relation sexuelle. Il peut influencer le pronostic obstétrical. Le but de cette étude était de déterminer si les caractéristiques cliniques du vaginisme ont une incidence sur le processus de l’accouchement. Méthodes Etude rétrospective multicentrique incluant des patientes affectées par un vaginisme primaire, ayant donné naissance à terme à un premier enfant vivant, entre 2005 et 2015. Résultats Sur les 19 patientes inclues dans l’étude, nous avons constaté 9 grossesses prolongées, 14 mises en travail spontanées (dont 8 à terme atteint), 3 césariennes en dehors du travail et 2 déclenchements artificiels. Parmi les 16 femmes ayant eu un travail, nous avons dénombré 4 césariennes, 5 accouchements par voie basse avec forceps et 7 par voie basse spontanée. Parmi les 12 accouchements par voie basse, 9 épisiotomies ont été pratiquées, 7 femmes ont présenté des déchirures périnéales spontanées seules ou associées à une épisiotomie, aucune lésion périnéale de type 3 ou 4, ni de périnées intacts n’ont été recensés. Le poids moyen des nouveau-nés était de 3380g±332 (2870g-3970g, 47e percentile). Conclusion La proportion d’accouchements dystociques et la morbidité périnéale étaient notablement élevées, ce qui parait comparable avec la plupart des données de la littérature. Il est possible que les composantes psychologiques et comportementales du vaginisme, (mécanisme de peur-évitement, anxiété) aient favorisé les grossesses prolongées, les césariennes, les dystocies mécaniques et les lésions périnéales. Des études complémentaires sont nécessaires afin de mieux cerner le vaginisme et ses implications obstétricales.
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Affiliation(s)
- Elise Tourrilhes
- Service de Gynécologie Obstétrique, Centre Hospitalier de Fougères, Fougères, France
| | - Marie Veluire
- Service de Gynécologie Obstétrique, Hôpital Privé d'Athis-Mons, Caron, 91200 Athis Mons, France
| | - David Hervé
- Service de Gynécologie Obstétrique, Hôpital Privé d'Athis-Mons, Caron, 91200 Athis Mons, France
| | - Erdogan Nohuz
- Université Clermont-Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France.,Service de Gynécologie Obstétrique, Centre Hospitalier de Thiers, Route du Fau, 63300 Thiers, France
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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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Tenfelde S, Tell D, Brincat C, Fitzgerald CM. Musculoskeletal Pelvic Pain and Sexual Function in the First Year After Childbirth. J Obstet Gynecol Neonatal Nurs 2018; 48:59-68. [PMID: 30503526 DOI: 10.1016/j.jogn.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To characterize sexual function in women with and without musculoskeletal pelvic pain during the first year after childbirth. DESIGN Cross-sectional descriptive study. SETTING Outpatient women's health clinic in a Midwestern U.S. academic medical center. PARTICIPANTS Women who gave birth to singleton infants within the past year. METHODS Women were recruited from various outpatient settings. We obtained baseline demographic variables and used selected components from the Wilson and Cleary Health-Related Quality of Life model. Participants completed questionnaires related to sexual health, pain symptoms, and general quality of life. They were asked to indicate their pain on a pain diagram and to quantify it with the use of a numeric rating scale (NRS). Examiners used validated examination techniques to assess pelvic floor muscle tenderness, strength, and pelvic girdle pain. Participants who reported pelvic pain and had at least one positive physical examination finding were classified in the pain group. RESULTS Forty-five participants completed the study, and 20 participants were in the pain group. Most participants with pain had pelvic girdle pain (n = 15) and pelvic floor myofascial pain (n = 20). Participants with pain reported less sexual satisfaction (t[43] = 2.84, p = .007) and reduced quality of life (t[36] = 5.25, p < .001) compared with participants without pain. CONCLUSION Participants who experienced musculoskeletal pelvic pain in the first year after childbirth were significantly more likely to report problems with sexual function compared with their counterparts without pain.
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Gachon B. [Cesarean section and perineal protection: CNGOF Perineal Prevention and Protection in Obstetrics Guidelines]. ACTA ACUST UNITED AC 2018; 46:968-985. [PMID: 30377093 DOI: 10.1016/j.gofs.2018.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The endpoint was to assess the interest of planned cesarean section in primary and secondary obstetrical perineal prevention. METHODS This is a review of the literature about the impact of the mode of delivery in urinary incontinence (UI), anal incontinence (AI), pelvic organ prolapse (POP), sexual disorders de novo or prior to delivery and history of obstetric anal sphincter injuries (OASI). RESULTS The studies about UI, AI and sexual disorders report a potential protective impact of cesarean section but with a possible selection bias and an inadequate comparability of the groups. Randomized trials do not report any protective effect of planned cesarean section for these 3 disorders. The literature about POP reports a higher risk for the women who delivered vaginally but still with a possible selection bias et there is no randomized trial for this outcome. About the secondary prevention of OASI, there is no evidence in the literature for a benefit of a systematic planned cesarean section for all women. For symptomatic women, the mode of delivery has to be discussed individually. In secondary prevention of UI, AI, POP and sexual disorders, there is no evidence in the literature for a benefit of planned cesarean section even if there is a history of surgical procedure for the disorder. CONCLUSION Planned cesarean section is not recommended in order to prevent primary or secondary obstetrical perineal disorders except for symptomatic OASI for whom an individual discussion about the mode of delivery is recommended.
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Affiliation(s)
- B Gachon
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
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Smith KB, Basson R, Sadownik LA, Isaacson J, Brotto LA. Antenatal Vulvar Pain Management, Labour Management, and Postpartum Care of Women With Vulvodynia: A Survey of Physicians and Midwives. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:579-587. [PMID: 29731205 DOI: 10.1016/j.jogc.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine maternity providers' recommendations for pregnant women with vulvodynia regarding management of vulvar pain and postpartum care, and to examine if, and how, a woman's chronic vulvar pain affects providers' examination and management during labour. METHODS This research was part of a larger study that invited physicians and midwives to answer a questionnaire regarding pregnancy and childbirth care in women with vulvodynia. To achieve the current objectives, the questionnaire included both dichotomous (yes or no) and open-ended items. The current sample (n = 116) consisted of 75 physicians and 41 midwives. RESULTS Over 60% of the sample reported making recommendations for vulvar pain management during pregnancy, and 32.8% of providers reported making special postpartum care recommendations for women with vulvodynia. Differences between physicians and midwives were noted for some of these recommendations. For example, to manage vulvar pain, only physicians recommended the use of/change in medications (P <0.001) and only midwives recommended complementary medicines (P = 0.02) and the use of lubricants (P = 0.006) and made recommendations for sexual well-being (P = 0.02). The majority of the sample (75%) reported that a woman having vulvodynia affected labour examination and management; providers most frequently reported minimizing exams and early use of epidural. Over 80% of midwives and 54% of physicians minimized exams during labour for women with vulvodynia (P= 0.01). CONCLUSION Further research is needed to understand the optimal provision of care for pregnant and postpartum women with vulvodynia. We advocate for increased education of vulvodynia aimed at providers of antenatal, labour, and postnatal care.
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Affiliation(s)
- Kelly B Smith
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC.
| | - Rosemary Basson
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC; Department of Psychiatry, University of British Columbia, Vancouver, BC
| | - Leslie A Sadownik
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC
| | - Jordanna Isaacson
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC
| | - Lori A Brotto
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC
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Ray-Griffith SL, Wendel MP, Stowe ZN, Magann EF. Chronic pain during pregnancy: a review of the literature. Int J Womens Health 2018; 10:153-164. [PMID: 29692634 PMCID: PMC5901203 DOI: 10.2147/ijwh.s151845] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The majority of the reviews and studies on chronic pain in pregnancy have primarily focused on the pharmacological and non-pharmacological treatment options. The purpose of our review was to identify evidence-based clinical research for the evaluation and management of preexisting chronic pain in pregnancy, chronic pain associated with pregnancy, and chronic pain in relation to mode of delivery. METHODS A literature search was undertaken using the search engines PubMed, CINAHL, EBSCOhost, and Web of Science. Search terms used included "chronic pain" AND "pregnant OR pregnancy" OR "pregnancy complications" from inception through August 2016. RESULTS The basis of this review was the 144 articles that met inclusion criteria for this review. Based on our review of the current literature, we recommend 7 guidelines for chronic pain management during and after pregnancy: 1) complete history and physical examination; 2) monitor patients for alcohol, nicotine, and substance use; 3) collaborate with patient to set treatment goals; 4) develop a management plan; 5) for opioids, use lowest effective dose; 6) formulate a pain management plan for labor and delivery; and 7) discuss reproductive health with women with chronic pain. CONCLUSION The management of chronic pain associated with pregnancy is understudied. Obstetrical providers primarily manage chronic pain during pregnancy. Some general guidelines are provided for those health care providers until more information is available.
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Affiliation(s)
- Shona L Ray-Griffith
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael P Wendel
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Inter-relationships between sexual abuse, female sexual function and childbirth. Midwifery 2015; 31:1087-95. [DOI: 10.1016/j.midw.2015.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 06/13/2015] [Accepted: 07/20/2015] [Indexed: 12/31/2022]
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Johnson NS, Harwood EM, Nguyen RHN. "You have to go through it and have your children": reproductive experiences among women with vulvodynia. BMC Pregnancy Childbirth 2015; 15:114. [PMID: 25976086 PMCID: PMC4518563 DOI: 10.1186/s12884-015-0544-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 05/01/2015] [Indexed: 11/10/2022] Open
Abstract
Background Vulvodynia is a potentially debilitating chronic pain condition affecting the vulva (external genitalia) in women, with typical age of onset during the early-to mid-reproductive years. Yet, virtually nothing is known about the thoughts, feelings and experience of vulvodynia patients regarding conception, pregnancy and delivery; including the effect that a hallmark symptom, dyspareunia (painful sex), can have on a couple’s physical and emotional ability to conceive. We sought to describe these experiences and beliefs among women with vulvodynia who were pregnant or who recently had delivered a child. Methods The study used in-depth, qualitative exploratory interview methods to gain a deeper understanding of these experiences for 18 women with vulvar pain who were recruited from an existing, nationally-sampled prospective pregnancy cohort study. Results Four major themes were reported by our participants. Women described their reaction to pain as volatile at first, and, over time, more self-controlled, regardless of medical treatment; once the volatility became more stable and overall severity lessened, many women began planning for pregnancy. Techniques described by women to cope with pain around pregnancy included pain minimization, planning pregnancy-safe treatment and timing intercourse around ovulation. Regardless of the degree to which interaction with health care providers before pregnancy were positive, most participants developed mistrustful attitudes toward future dealings with health care systems and providers. Nearly all women described anxiety regarding how pregnancy may change pain symptoms, yet described being hopeful. Conclusions Women described strategies regarding reproduction such as finding a personally acceptable level of pain before planning pregnancy, and a resilience that allowed them to achieve their reproductive goals despite pain and perceived lack of assistance from healthcare providers. Therefore, future research should assess the benefits of increased psychosocial support from partners and professionals who may assist in improving resilience.
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Affiliation(s)
- Nora S Johnson
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, USA.
| | - Eileen M Harwood
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, USA.
| | - Ruby H N Nguyen
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, USA.
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14
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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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15
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16
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Schvartzman R, Bertotto A, Schvartzman L, Wender MCO. Pelvic floor muscle activity, quality of life, and sexual function in peri- and recently postmenopausal women with and without dyspareunia: a cross-sectional study. JOURNAL OF SEX & MARITAL THERAPY 2014; 40:367-378. [PMID: 24279742 DOI: 10.1080/0092623x.2013.864363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pelvic floor alterations during menopausal years, resulting from aging and hormonal decline, may lead to several forms of sexual dysfunction. Dyspareunia-pain during sexual intercourse-is among the most frequent. Nevertheless, few studies so far have evaluated pelvic floor muscle function in postmenopausal women with dyspareunia. The authors thus carried out a cross-sectional study to assess myoelectric activity in pelvic floor muscles in peri- and postmenopausal women with and without dyspareunia receiving routine care at an outpatient clinic. In addition, sexual function (using the Female Sexual Function Index) and quality of life (using the Cervantes Scale) were assessed. Fifty-one peri- and postmenopausal women between 45 to 60 years of age (M = 52.1, SD = 4.9) were evaluated, 27 with and 24 without dyspareunia. There were no statistically significant differences in resting muscle activity, maximal voluntary contraction, and sustained contraction between women with and without dyspareunia. There were statistically significant between-group differences on the Cervantes Scale (p =.009) and in all Female Sexual Function Index domains except desire and satisfaction (arousal, p =.019; lubrication, p =.030; orgasm, p =.032; pain, p <.001; desire, p =.061; satisfaction, p =.081), indicating that women with dyspareunia experience worse quality of life and less satisfactory sexual function as compared with women without dyspareunia.
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Affiliation(s)
- Renata Schvartzman
- a Graduate Program in Medical Sciences , Universidade Federal do Rio Grande do Sul , Porto Alegre , Brazil
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17
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Basson R, Smith KB. Incorporating Mindfulness Meditation into the Treatment of Provoked Vestibulodynia. CURRENT SEXUAL HEALTH REPORTS 2013. [DOI: 10.1007/s11930-013-0008-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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