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Boero V, Cetera GE, Caia C, Merli CEM, Gramegna G, Pesce E, Barbara G, Ermelinda M, Vercellini P. Beyond vulvodynia: from a correct diagnosis to a multidisciplinary care program. A referral center experience. Arch Gynecol Obstet 2024; 310:1189-1195. [PMID: 38634899 DOI: 10.1007/s00404-024-07496-0] [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: 11/17/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Vulvodynia is a chronic pain condition without an identifiable cause. As such, it is a diagnosis of exclusion, and all other causes of vulvar pain should be excluded. Although a standard treatment for vulvodynia has not been established yet, multidisciplinary care programs appear to be effective. PUROPOSE The aim of this retrospective monocentric study was to analyze the prevalence of vulvodynia among women referred to our institution for a suspected diagnosis and to evaluate the efficacy of a multidimensional treatment plan. The primary outcome was the prevalence of vulvodynia following differential diagnosis. Secondary outcomes included: prevalence of the differential diagnoses, symptom resolution rate following treatment, and the relation between persistence of symptoms and (a) patients' age; (b) coexisting chronic overlapping pain conditions (COPCs). RESULTS After having ruled out all other causes of vulvar pain, only 40.1% of women were considered as affected by vulvodynia. The most frequent differential diagnoses included lower genital tract infections (25.3%), vulvar lichen sclerosus (17.6%) and vulvovaginal atrophy (8.2%). Following a multidisciplinary care program, resolution of symptoms was observed in 13.6% cases, improvement in 64.3% and persistence in 21.9%. We did not find a statistically significant association between persistence of symptoms and age > 38 years (OR 2.10; p = 0.30). Women with one or more COPCs other than vulvodynia had a 75% increased risk of not obtaining a resolution of symptoms (OR 1.75; p = 0.44). CONCLUSION A thorough differential diagnosis and a multidisciplinary care program may represent a first way out of the muddle in the management of these patients.
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Affiliation(s)
- Veronica Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlotta Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | | | - Giada Gramegna
- Obstetric and Gynecological Emergency Unit and SVSeD (Service for Sexual and Domestic Violence), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Pesce
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giussy Barbara
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Monti Ermelinda
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Buhrman M, Hällström H, Fridén A, Kettis Moden E, Grahn G, Carlfjord M, Hjo C, Gasslander N, Bohm-Starke N, McCracken LM. Guided internet-based acceptance and commitment therapy for provoked vestibulodynia: A randomized controlled trial. Eur J Pain 2024; 28:1185-1201. [PMID: 38429870 DOI: 10.1002/ejp.2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Provoked vestibulodynia (PVD) causes suffering in many women's lives due to its impact on relationships, sexual functioning and functioning in other key domains. OBJECTIVE Here, we report a randomized controlled trial conducted to examine whether Acceptance and Commitment Therapy (ACT) with a focus on values-based exposure, delivered online, benefits women with PVD. METHODS Participants (n = 88) were randomized to either guided online ACT for 10 weeks or a wait-list control group. Outcomes were assessed at baseline, post treatment and 1 year later. Analyses were based on intention to treat using linear mixed models. RESULTS There were significant group differences on the primary outcomes, Female Sexual Index and Female Sexual Distress Scale, in favour of online ACT with moderate effect sizes. Differences were also found on several secondary outcomes and therapeutic process measures, all in favour of ACT. No differences were found at post-treatment for depression or anxiety. At the 1-year follow-up, results were maintained and a difference between baseline and follow-up was also found for depression. CONCLUSION/SIGNIFICANCE In summary, a relatively brief, guided, online version of ACT appears to produce benefits for women with PVD and related impacts on daily functioning. 50% to 60% of the women who participated in the treatment reliably improved in sexual functioning and distress.
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Affiliation(s)
- Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Hanna Hällström
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Annika Fridén
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Emma Kettis Moden
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gunnar Grahn
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Maja Carlfjord
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Camille Hjo
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Nils Gasslander
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Nina Bohm-Starke
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institute, Solna, Sweden
- Danderyd Hospital, Stockholm, Sweden
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
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Harlow BL, McGwin G, Sutcliffe S, Fitzgerald CM, Lowder JL, Newman DK, Meister M, Camenga DR, Stapleton A, Chary V, Lukacz ES. Genital Pain and the Spectrum of Bladder-Related Symptoms: Findings from the Prevention of Lower Urinary Tract Symptoms Research Consortium RISE FOR HEALTH Study, USA. Int Urogynecol J 2024:10.1007/s00192-024-05868-3. [PMID: 39002046 DOI: 10.1007/s00192-024-05868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/18/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Women with vulvovaginal or genital pain more commonly experience interstitial cystitis/bladder pain syndrome (IC/BPS) and urinary tract infections. However, the relationship between genital pain and bladder health is lacking. METHODS Women in the Prevention of Lower Urinary Tract Symptoms Consortium's RISE FOR HEALTH population-based study answered questions about bladder health globally, and across nine bladder health domains of holding, efficacy, social-occupation, physical activity, intimacy, travel, emotion, perception, and freedom. Bladder function was assessed across six indices including urinary frequency, sensation, continence, comfort, emptying, and dysbiosis (e.g., urinary tract infections). Participants were grouped by no pain beyond transitory events (i.e., minor headaches, toothaches, or sprains), nongenital-related pain only, and any genital pain using a validated pain diagram. Mean adjusted scores and indices were compared using general linear modelling. RESULTS Of 1,973 eligible women, 250 (12.7%) reported genital pain, 609 (30.9%) reported nongenital pain only, and 1,114 (56.5%) reported no pain. Women with any genital pain had lower (worse) adjusted mean scores across all bladder health scales (BHS; BHS global adjusted mean 47.5; 95% CI 40.8-54.1), compared with those with nongenital pain only (53.7; 95% CI 47.6-59.8), and no pain (59.3; 95% CI 53.3-65.4). Similarly, adjusted mean total Bladder Functional Index scores were lower for those with genital pain (63.1; 95% CI 58.4-67.9) compared with nongenital pain (72.1; 95% CI 67.7-76.5) and no pain (77.4; 95% CI 73.0-81.8). CONCLUSIONS Heightened awareness of the relationship between genital pain and bladder health should prompt clinicians caring for women with genital pain to assess bladder health and function.
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Affiliation(s)
- Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
| | - Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Department of Obstetrics and Gynecology and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Colleen M Fitzgerald
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Jerry L Lowder
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melanie Meister
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, KS, USA
| | - Deepa R Camenga
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Ann Stapleton
- Division of Allergy & Infectious Disease, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Vanika Chary
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Emily S Lukacz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, CA, USA
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Penteado SRL, Bonduki CE, de Araújo TRE, Alves SV, de Luccas Batista NMT, Ambrogini CC, Sartori MGF. Individualized multidisciplinary therapy for vulvodynia. J Obstet Gynaecol Res 2024; 50:147-174. [PMID: 37968775 DOI: 10.1111/jog.15829] [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: 08/15/2023] [Accepted: 11/04/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE The main objective of this review was to develop strategies for individualizing multidisciplinary therapy for vulvodynia. METHODS We conducted two literature searches; the first one focused on clinical trials assessing vulvodynia treatments published after the recommendations of the expert committee of the Fourth International Consultation on Sexual Medicine. The second search targeted studies identifying predictive factors and mediators of vulvodynia treatments, published from the earliest date to October 2022. RESULTS Based on data from 55 relevant studies, we developed models of individualized multidisciplinary therapy targeting groups of women less responsive to multidisciplinary therapy (characterized by women with higher vulvar pain intensity, impaired sexual functioning, and vulvodynia secondary subtype) and to physical therapy, as an isolated treatment (characterized by women with increased pelvic floor muscle tone and vulvodynia primary subtype). Each individualized multidisciplinary therapy model comprises three components: psychotherapy, medical care, and physical therapy. These components provide distinct therapeutic modalities for distinct subgroups of women with vulvodynia; the women subgroups were identified according to the characteristics of women, the disease, partners, and relationships. Additionally, for women with provoked vestibulodynia who exhibit less benefits from vestibulectomy (such as those with higher levels of erotophobia, greater vulvar pain intensity, and the primary subtype) and encounter resistance to individualized multidisciplinary therapy, we suggest additional conservative treatments before performing vestibulectomy. CONCLUSION Our study is a pioneer in the development of models that allow the individualization of multidisciplinary therapy for vulvodynia and represents a significant advance in the clinical practice of gynecologists, physiotherapists, and psychologists.
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Affiliation(s)
| | - Claudio Emilio Bonduki
- Department of Gynecology, Federal University of São Paulo-UNIFESP, São Paulo, São Paulo, Brazil
| | | | - Suzana Valeska Alves
- Department of Gynecology, Federal University of São Paulo-UNIFESP, São Paulo, São Paulo, Brazil
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Diaz-Mohedo E, Hita-Contreras F, Castro-Martin E, Pilat A, Perez-Dominguez B, Valenza-Peña G. Using Myofascial Therapy to Improve Psychological Outcomes, Quality of Life, and Sexual Function in Women with Chronic Pelvic Pain-A Case Series. Healthcare (Basel) 2024; 12:304. [PMID: 38338190 PMCID: PMC10855135 DOI: 10.3390/healthcare12030304] [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: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Chronic pelvic pain represents a prevalent condition afflicting women. Research has highlighted the presence of psychological distress and sexual dysfunction in these individuals. Regrettably, myofascial pelvic pain often goes unnoticed and untreated despite its integral role in chronic pelvic pain. (2) Methods: By employing a longitudinal case series design, we studied eighteen women afflicted with chronic pelvic pain. Over a 12-week period, these participants underwent 15 sessions of myofascial therapy. Data encompassing sociodemographic particulars, the Hospital Anxiety and Depression Scale, the Medical Outcomes Study Short Form 12 questionnaire, and the Female Sexual Function Index were collected at baseline, 12 weeks post-intervention, and again at the 24-week mark. (3) Results: After a span of 12 weeks subsequent to the intervention, the participants demonstrated noteworthy enhancements (p < 0.001) in their depression and anxiety scores, their overall Mental Component scores in the Medical Outcomes Study Short Form 12, as well as sexual function. Importantly, these gains were sustained at the 24-week juncture post-therapy. (4) Conclusions: The findings stemming from our prospective case study underscore the potential utility of myofascial therapy for women grappling with chronic pelvic pain. This form of intervention yields significant advancements in alleviating anxiety, depression, health-related quality of life, and sexual function.
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Affiliation(s)
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaen, 23071 Jaen, Spain;
| | - Eduardo Castro-Martin
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (E.C.-M.); (G.V.-P.)
| | - Andrzej Pilat
- Myofascial Therapy School “Tupimek”, Physiotherapy School ONCE, Universidad Autonoma, 28049 Madrid, Spain;
| | | | - Geraldine Valenza-Peña
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain; (E.C.-M.); (G.V.-P.)
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6
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Rains A, Bajzak K, Miller ME, Swab M, Logan GS, Jackman VA, Gustafson DL. Multimodal and Interdisciplinary Interventions for the Treatment of Localized Provoked Vulvodynia: A Scoping Review of the Literature from 2010 to 2023. Int J Womens Health 2024; 16:55-94. [PMID: 38250180 PMCID: PMC10798054 DOI: 10.2147/ijwh.s436222] [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: 09/29/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Localized provoked vulvodynia (LPV) is a chronic condition characterized by pain in the vulvar vestibule, which can be provoked by pressure or touch and which is not tied to a clear underlying cause. Research into the etiology of and most appropriate treatment strategy for LPV is still limited. Methods Using Arksey and O'Malley's model for scoping reviews, we evaluated the research question: what is the current evidence regarding the efficacy/effectiveness of multimodal or interdisciplinary interventions for the treatment of LPV? We collated and analyzed articles from 2010 to 2023 to capture the current research landscape. Results Our review identified 27 studies, which either compared treatments between classes (eg pharmacologic versus psychologic modalities) or described interdisciplinary treatment programs. We identify several trends in the literature. First, outcome measures are inconsistent between studies, often unvalidated, and may not adequately mirror patient concerns. Second, the absence of appropriate comparator groups in many studies restricts providers' ability to appraise which treatments may be most efficacious. Third, selection bias and demographic homogeneity limit generalizability. Finally, we highlight the need for head-to-head trials of vestibulectomy with other treatments considered first line for vulvodynia management. Conclusion There is insufficient evidence to suggest the superiority of one treatment modality for LPV relative to others or to recommend a particular interdisciplinary management strategy. Future research should use a head-to-head design where sham control is impossible, incorporate patient-centered outcome measures, and investigate impacts of treatment among diverse samples of LPV patients.
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Affiliation(s)
- Alex Rains
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Krisztina Bajzak
- Discipline of Obstetrics and Gynecology, Memorial University, St. John’s, Newfoundland & Labrador, Canada
| | - Michelle E Miller
- Discipline of Obstetrics and Gynecology, Memorial University, St. John’s, Newfoundland & Labrador, Canada
| | - Michelle Swab
- Health Sciences Library, Faculty of Medicine, Memorial University, St. John’s, Newfoundland & Labrador, Canada
| | - Gabrielle S Logan
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Victoria A Jackman
- Faculty of Medicine, Memorial University, St. John’s, Newfoundland & Labrador, Canada
| | - Diana L Gustafson
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John’s, Newfoundland & Labrador, Canada
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Kaarbø MB, Danielsen KG, Helgesen ALO, Wojniusz S, Haugstad GK. A conceptual model for managing sexual pain with somatocognitive therapy in women with provoked vestibulodynia and implications for physiotherapy practice. Physiother Theory Pract 2023; 39:2539-2552. [PMID: 35815605 DOI: 10.1080/09593985.2022.2096516] [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: 01/12/2022] [Revised: 05/11/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
Somatocognitive therapy is a multimodal physiotherapy treatment developed in the early 2000s to alleviate the burden of chronic pelvic pain. In recent years, somatocognitive therapy has been further developed to treat women with provoked vestibulodynia. This prevalent gynecological pain condition is a subgroup of chronic pelvic pain and the most common form of vulvodynia. Provoked vestibulodynia is a neglected multifactorial pain condition of unknown cause, adversely affecting women's sexual life, relation to their partners and their psychological health. Pain is located at the vulvar vestibule and is provoked by touch or pressure such as sexual intercourse. In the management of sexual pain, somatocognitive therapy combines bodily exploration, pain education, cognitive coping strategies and structured homework to improve sexual function and reduce pain. To support these processes, developing a sound therapeutic alliance with the patient is essential. The aim of this article is to provide a conceptual model for managing provoked vestibulodynia with somatocognitive therapy, including a theoretical rational for this treatment. We base our conceptual model on the biopsychosocial model, i.e., considering the complex interplay of biomedical, emotional/cognitive, psychosexual and interpersonal factors in provoked vestibulodynia management. In addition, implications for practice and a detailed description of somatocognitive therapy for provoked vestibulodynia will be provided, to allow replication in clinical practice and in clinical trials.
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Affiliation(s)
| | | | - Anne Lise Ording Helgesen
- Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Slawomir Wojniusz
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Gro Killi Haugstad
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Unit for Psychosomatics/CL Outpatient Clinic for Adults, Acute Psychiatric Department, Oslo University Hospital, Norway
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8
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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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Bajzak K, Rains A, Bishop L, Swab M, Miller ME, Logan GS, Jackman V, Jackman L, Gustafson DL. Pharmacological Treatments for Localized Provoked Vulvodynia: A Scoping Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:427-443. [PMID: 38601726 PMCID: PMC10903690 DOI: 10.1080/19317611.2023.2222114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 04/12/2024]
Abstract
Introduction Localized provoked vulvodynia (LPV) is a chronic pain condition without an identifiable cause that is localized to a portion of the vulva and provoked by pressure or touch. LPV is a commonly occurring but poorly understood condition lacking consensus on management. Method This scoping review used Arksey and O'Malley's approach to identify and evaluate literature published between 2010 and 2023 that addressed the question: What is the current evidence on the efficacy or effectiveness of pharmacological treatments in the management of LPV? Results This review evaluated 18 papers reporting on the efficacy or effectiveness of oral, topical, and injectable medications. Seven of the studies were randomized controlled trials. Oral gabapentin and oral desipramine showed some improvement in sexual function compared to placebo. Small sample sizes and methodological issues limited confidence in interpreting findings. Pain was reduced in descriptive studies of tricyclic antidepressants, milnacipran, injectable anesthetics, and botulinum toxin. Where pain did not improve with treatment, some oral medications improved participants' mood and sexual function. Some topical agents may be effective in reducing peripherally mediated neuropathic pain. Botulinum toxin was the most well-studied injectable but yielded mixed outcomes related to pain, quality of life, and sexual function. Conclusion There is a lack of convincing evidence to draw conclusions about the efficacy or effectiveness of pharmacological therapies for LPV. The breadth of therapies for treating LPV warrants the development of evidence-based, consensus guidelines for measuring treatment outcomes and improving comparisons across studies. Recommendations for research include addressing methodological shortcomings and diversifying the participant pool to increase the generalizability of findings.
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Affiliation(s)
- Krisztina Bajzak
- Faculty of Medicine, Memorial University, St. John’s, NL, Canada
| | - Alex Rains
- Department of Medicine, University of Chicago, Chicago, IL
| | - Lisa Bishop
- School of Pharmacy, Memorial University, St. John’s, NL, Canada
| | - Michelle Swab
- Health Sciences Library, Memorial University, St. John’s, NL, Canada
| | - Michelle E. Miller
- Faculty of Medicine, Memorial University, St. John’s, NL, Canada
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gabrielle S. Logan
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Victoria Jackman
- Faculty of Medicine, Memorial University, St. John’s, NL, Canada
| | - Liam Jackman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Lynn M, Iftekhar N, Adams W, Mumby P. Multidisciplinary approach to the treatment of sexual dysfunction in couples using a biopsychosocial model. J Sex Med 2023; 20:991-997. [PMID: 37170949 DOI: 10.1093/jsxmed/qdad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/28/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Given the complexity of the psychological and biological pathologies associated with sexual dysfunction, which affects at least a third of adult women and men worldwide, a multidisciplinary approach has been advocated. AIM To assess sexual functioning, relationship satisfaction, and mood stability pre- and post- treatment at the Loyola University Sexual Wellness Program. METHODS Couples attending the 6-week multidisciplinary Sexual Wellness Program provided consent and completed pre- and post- intervention assessments. Linear mixed effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency. OUTCOMES All patients completed self-reported surveys: Dyadic Adjustment Scale, PROMIS Sexual Function and Satisfaction Measures Brief Profile (Patient-Reported Outcomes Measurement Information), and International Index of Erectile Function. RESULTS There were 85 respondents: 42 men and 43 women. The mean age was 49.82 years (range, 25-77). The largest improvement was on the total Dyadic Adjustment Scale score, which increased by approximately 5.18 points (95% CI, 2.55-7.81). PROMIS scores for global satisfaction with sex life, erectile function, and interest in sexual activity significantly increased from baseline, while the vaginal discomfort score significantly declined. Overall the score for global satisfaction with sex life increased from baseline by approximately 5.57 points (95% CI, 3.03-8.10). On average, men reported a 4.33-point increase (95% CI, 0.04-8.62) in their International Index of Erectile Function score from baseline. CLINICAL IMPLICATIONS A multidisciplinary treatment approach focused on the couple positively affects a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function. STRENGTHS AND LIMITATIONS This study is one of the few to document the effects of a multidisciplinary treatment approach for both members of a heterosexual couple-male and female. Limitations include the narrow demographics and lack of a control group in our population. Furthermore, this was completed at 1 academic center. CONCLUSION These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being.
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Affiliation(s)
- Mary Lynn
- Department of Obstetrics and Gynecology, Loyola University Medical System, Maywood, IL 60153, United States
| | - Noama Iftekhar
- Department of Surgery, University of Nevada, Las Vegas, Nevada, NV 89154, United States
| | - William Adams
- Loyola University Medical Center, Department of Medicine, Maywood, IL 60153, United States
| | - Patricia Mumby
- Loyola University Medical Center, Department of Psychiatry and Behavioral Neurosciences, Maywood, IL 60153, United States
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11
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Krieger JF, Kristensen E, Marquardsen M, Ofer S, Mortensen EL, Giraldi A. Mindfulness in sex therapy and intimate relationships: a feasibility and randomized controlled pilot study in a cross-diagnostic group. Sex Med 2023; 11:qfad033. [PMID: 37465532 PMCID: PMC10350486 DOI: 10.1093/sexmed/qfad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 07/20/2023] Open
Abstract
Background Mindfulness facets can be trained with structured mindfulness interventions, but little is known regarding application on a broader level within sex therapy (e.g. men, partners and different sexual dysfunctions). Aim To evaluate the feasibility and preliminary efficacy of an 8-week intervention-specifically, mindfulness for sex and intimacy in relationships (MSIR)-as a supplement to treatment as usual (TAU) as compared with only TAU in a clinical sample of men and women referred for sexual difficulties with or without a partner. Methods In this randomized controlled feasibility pilot study, 34 participants were randomized to MSIR + TAU (n = 15) or TAU (n = 19). Six healthy partners were also included in the study. MSIR was administered as 2 individual evaluations and six 2-hour group sessions of mixed gender and different types of sexual dysfunction. Outcomes The primary outcome measures were as follows: (1) feasibility, defined as the implementation of recruitment, acceptance, and attendance of intervention in daily clinical practice and the MSIR completion rate; (2) sexual functioning, as measured on a visual analog scale ("bothered by problem") and by validated questionnaires (Changes in Sexual Function Questionnaire for Females and Males, Female Sexual Function Index, Female Sexual Distress Scale, International Index of Erectile Function). Results MSIR was feasible and well received by patients, with high rates of acceptance and intervention completion. As compared with pretreatment, the MSIR + TAU group and TAU control group were significantly less bothered by their sexual problems at the end of treatment, but the change was significantly larger in the MSIR + TAU group (P = .04). Participants in the MSIR + TAU group did not receive fewer TAU sessions than the TAU group (MSIR + TAU mean, 6 sessions; TAU mean, 8 sessions). Clinical Implications MSIR could be effectively used in a clinical setting as an add-on to TAU in the treatment of female and male sexual dysfunction and healthy partners. Strengths and Limitations The major strength of the study is that it is a randomized controlled study. This study is novel in the sense that it included men and women with different types of sexual dysfunction in the same mindfulness group. Limitations include the pilot nature of the study (e.g. a small sample size), and statistical conclusions should be made with caution. More accurate results may be found in a larger sample. Conclusion Results from this study support already existing evidence that mindfulness-based interventions are feasible and effective for targeting sexual dysfunctions in men and women.
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Affiliation(s)
- Julie Fregerslev Krieger
- Corresponding author: Sexological Clinic, Mental Health Centre Copenhagen, Ole Maaløes Vej 14, 2200 Copenhagen N.
| | - Ellids Kristensen
- Sexological Clinic, Mental Health Centre Copenhagen, Mental Health Services - Capital Region of Denmark 2200, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Mikkel Marquardsen
- Sexological Clinic, Mental Health Centre Copenhagen, Mental Health Services - Capital Region of Denmark 2200, Denmark
| | - Shlomy Ofer
- Sexological Clinic, Mental Health Centre Copenhagen, Mental Health Services - Capital Region of Denmark 2200, Denmark
| | | | - Annamaria Giraldi
- Sexological Clinic, Mental Health Centre Copenhagen, Mental Health Services - Capital Region of Denmark 2200, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
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12
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Patla G, Mazur-Bialy AI, Humaj-Grysztar M, Bonior J. Chronic Vulvar Pain and Health-Related Quality of Life in Women with Vulvodynia. Life (Basel) 2023; 13:life13020328. [PMID: 36836685 PMCID: PMC9967635 DOI: 10.3390/life13020328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
The aim of this study was to investigate the severity of chronic vulvar pain in women with vulvodynia and its impact on their health-related quality of life (QL). The study group consisted of 76 women aged 19 to 58. The study was carried out using the diagnostic survey method, i.e., (1) the questionnaire technique, comprising (A) the author's questionnaire (76 questions) and (B) the WHOQOL-BREF questionnaire, and (2) the VAS. When analyzing the severity of vulvar pain on the VAS, the highest proportion of women rated it at level 6 (23.68%). This was significantly determined by certain personal characteristics (age < 25 years old) and sociodemographic characteristics (marital status: unmarried women, divorcees, widows; high school education), each at p < 0.05. Vulvodynia causes a significant deterioration (64.47%) in QL, which is mainly caused by a reduction in the ability to perform activities of daily living (27.63%) and a decrease in sexual satisfaction (27.63%). The level of stress significantly exacerbates pain (p < 0.05). The severity correlates significantly (p < 0.05) and negatively (r < 0) with QL perception, which was rated worst in the physical domain. The use of treatment resulted in a significant improvement in the physical and psychological domains (p < 0.05), and the latter was particularly influenced by physiotherapy (p < 0.05).
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Affiliation(s)
- Gabriela Patla
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 12 Michałowskiego Street, 31-126 Krakow, Poland
| | - Agnieszka I. Mazur-Bialy
- Department of Biomechanics and Kinesiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska Street, 31-066 Krakow, Poland
| | - Magdalena Humaj-Grysztar
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 58 Zamoyskiego Street, 31-501 Krakow, Poland
| | - Joanna Bonior
- Department of Medical Physiology, Chair of Biomedical Sciences, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, 12 Michałowskiego Street, 31-126 Krakow, Poland
- Correspondence: ; Tel.: +48 012-634-33-97
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13
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Moravek MB, Legocki LJ, Piper CK, Bernard K, Reed BD, Haefner HK. Impact of a single-session psychosocial counseling intervention for women with vulvodynia. Int J Gynaecol Obstet 2023; 160:202-208. [PMID: 35766991 PMCID: PMC10083978 DOI: 10.1002/ijgo.14321] [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: 11/17/2021] [Revised: 04/15/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the impact of a single session of psychosocial counseling on patients with vulvodynia. METHODS Patients diagnosed with vulvodynia at a vulvovaginal specialty clinic were randomly assigned to receive either a one-on-one 30- to 45-min psychosocial counseling session with a psychosexual counselor plus written educational materials (intervention group) or written materials alone (control group). They completed a survey before and 6 weeks after randomization that included demographic information and validated measures of sexual function and illness perception. RESULTS Thirty-one of 38 (81.6%) women approached chose to participate; 26 of the 31 (83.9%) completed the 6-week follow-up survey. Only the intervention group showed improvement in knowledge about vulvovaginal and sexual health, as well as in most measures of improvement in illness perception, as measured by the Brief Illness Perception Questionnaire (P < 0.05). When compared directly with those in the control group, patients in the intervention group reported increased understanding of their vulvar symptoms (P < 0.005) and lessened emotional impact of these symptoms (P = 0.035). CONCLUSION Patients receiving one session of the one-on-one psychosocial counseling intervention reported improved understanding and lessened emotional impact of their vulvar symptoms, compared with the control group. This study suggests that improvement may occur following minimal intervention and supports the need for further study.
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Affiliation(s)
- Molly B Moravek
- University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Laurie J Legocki
- University of Michigan Department of Family Medicine, Ann Arbor, MI, USA
| | | | - Katie Bernard
- University of Michigan Department of Social Work, Ann Arbor, MI, USA
| | - Barbara D Reed
- University of Michigan Department of Family Medicine, Ann Arbor, MI, USA
| | - Hope K Haefner
- University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
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14
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Schlaeger JM, Glayzer JE, Villegas‐Downs M, Li H, Glayzer EJ, He Y, Takayama M, Yajima H, Takakura N, Kobak WH, McFarlin BL. Evaluation and Treatment of Vulvodynia: State of the Science. J Midwifery Womens Health 2023; 68:9-34. [PMID: 36533637 PMCID: PMC10107324 DOI: 10.1111/jmwh.13456] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 12/23/2022]
Abstract
Vulvodynia affects 7% of American women, yet clinicians often lack awareness of its presentation. It is underdiagnosed and often misdiagnosed as vaginitis. The etiology of vulvodynia remains unknown, making it difficult to identify or develop effective treatment methods. The purpose of this article is to (1) review the presentation and evaluation of vulvodynia, (2) review the research on vulvodynia treatments, and (3) aid the clinician in the selection of vulvodynia treatment methods. The level of evidence to support vulvodynia treatment varies from case series to randomized controlled trials (RCTs). Oral desipramine with 5% lidocaine cream, intravaginal diazepam tablets with intravaginal transcutaneous electric nerve stimulation (TENS), botulinum toxin type A 50 units, enoxaparin sodium subcutaneous injections, intravaginal TENS (as a single therapy), multimodal physical therapy, overnight 5% lidocaine ointment, and acupuncture had the highest level of evidence with at least one RCT or comparative effectiveness trial. Pre to posttest reduction in vulvar pain and/or dyspareunia in non-RCT studies included studies of gabapentin cream, amitriptyline cream, amitriptyline with baclofen cream, up to 6 weeks' oral itraconazole therapy, multimodal physical therapy, vaginal dilators, electromyography biofeedback, hypnotherapy, cognitive behavioral therapy, cold knife vestibulectomy, and laser therapy. There is a lack of rigorous RCTs with large sample sizes for the treatment of vulvodynia, rendering it difficult to determine efficacy of most treatment methods. Clinicians will be guided in the selection of best treatments for vulvodynia that have the highest level of evidence and are least invasive.
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Affiliation(s)
- Judith M. Schlaeger
- Department of Human Development Nursing ScienceUniversity of Illinois Chicago College of NursingChicagoIllinoisUSA
| | - Jennifer E. Glayzer
- Department of Human Development Nursing ScienceUniversity of Illinois Chicago College of NursingChicagoIllinoisUSA
| | - Michelle Villegas‐Downs
- Department of Human Development Nursing ScienceUniversity of Illinois Chicago College of NursingChicagoIllinoisUSA
| | - Hongjin Li
- Department of Human Development Nursing ScienceUniversity of Illinois Chicago College of NursingChicagoIllinoisUSA
| | - Edward J. Glayzer
- Department of Sociology, Anthropology, and Social WorkUniversity of Dayton College of Arts and SciencesDaytonOhioUSA
| | - Ying He
- Department of Pharmaceutical SciencesOklahoma State UniversityStillwaterOklahomaUSA
| | - Miho Takayama
- Department of Acupuncture and MoxibustionTokyo Ariake University of Medical and Health SciencesTokyoJapan
| | - Hiroyoshi Yajima
- Department of Acupuncture and MoxibustionTokyo Ariake University of Medical and Health SciencesTokyoJapan
| | - Nobuari Takakura
- Department of Acupuncture and MoxibustionTokyo Ariake University of Medical and Health SciencesTokyoJapan
| | - William H. Kobak
- Department of Obstetrics and GynecologyUniversity of Illinois Chicago College of MedicineChicagoIllinoisUSA
| | - Barbara L. McFarlin
- Department of Human Development Nursing ScienceUniversity of Illinois Chicago College of NursingChicagoIllinoisUSA
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15
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Merlino L, Titi L, Pugliese F, D’Ovidio G, Senatori R, Rocca CD, Piccioni MG. Vulvodynia: Pain Management Strategies. Pharmaceuticals (Basel) 2022; 15:ph15121514. [PMID: 36558965 PMCID: PMC9781267 DOI: 10.3390/ph15121514] [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: 10/17/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Vulvodynia is defined in this international consensus as persistent vulvar pain that occurs for >3 months without an identifiable cause and with several potential associated factors. At present there is no univocal consensus in the therapeutic treatment of vulvodynia. The methods of intervention are based on various aspects including, above all, the management of painful symptoms. Methods: a research on scientific database such as “Pubmed”, “Medline Plus”, “Medscape” was conducted, using the words “women’s genital pain” and “vulvodynia” for the review of the scientific evidence on the assessment and treatment of women’s genital pain. Results: Among the drugs with pain-relieving action, the most effective in the treatment of vulvodynia would seem to be those with antidepressant and anticonvulsant action, even if their mechanisms of action are not known and there are still insufficient studies able to demonstrate their real validity. Among the least effective are non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. However, the ideal would seem to use a combined treatment with multiple types of drugs. Conclusions: Future studies are needed to draw up a unique therapeutic action plan that considers the stratification of patients with vulvodynia and the variability of the symptom.
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Affiliation(s)
- Lucia Merlino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
| | - Luca Titi
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Pugliese
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Giulia D’Ovidio
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Roberto Senatori
- Italian Society of Colposcopy and Cervicovaginal Pathology (SICPV), 00186 Rome, Italy
| | - Carlo Della Rocca
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Grazia Piccioni
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
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16
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Rivera S, Flood A, Dykstra C, Herbenick D, DeMaria AL. Genital Self-Image, Sexual Function, and Quality of Life Among Individuals with Vulvar and Non-Vulvar Inflammatory Dermatoses. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3965-3979. [PMID: 35900677 PMCID: PMC9332093 DOI: 10.1007/s10508-022-02353-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/30/2022] [Accepted: 05/08/2022] [Indexed: 05/10/2023]
Abstract
Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to impact on genital self-image. A 20-min web-based survey was distributed September-November 2020 through social media ads, support groups, and online research recruitment services. Individuals in the USA over age 18 who were assigned female at birth and self-reported having been diagnosed with an inflammatory dermatosis were eligible. The primary outcome was the Female Genital Self-Image Scale (FGSIS). Secondary outcomes included the Female Sexual Function Index (FSFI), the Skindex-16 (a skin-related quality of life measure), the PROMIS Global-10 (assessing global physical/mental health), and sexual behavior histories. Participants (n = 348) reported mean age of 43.1 ± 15.5 (range = 19-81). Nearly one-third (n = 101; 29.0%) reported VID, 173 (50%) had NVID, and 74 (21%) experienced both vulvar and non-vulvar symptoms; they were analyzed as part of the VID group. The mean FGSIS score among participants with VID was 16.9 ± 4.1 and was significantly (p < .01) lower than that of participants with NVID (M = 21.2 ± 4.3), indicating lower genital self-image. Mental health (as measured by PROMIS-Global 10) was also impaired in VID. Rates of sexual dysfunction were high in both groups (> 60%). Findings suggest that in VID, lower genital self-image is correlated with poorer sexual function, quality of life, and global physical and mental health. Additional recommendations for VID management are proposed.
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Affiliation(s)
- Sydney Rivera
- Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN, 46202, USA.
| | - Anna Flood
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| | - Chandler Dykstra
- Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA
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17
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Chauhan S, More A, Chauhan V, Kathane A. Endometriosis: A Review of Clinical Diagnosis, Treatment, and Pathogenesis. Cureus 2022; 14:e28864. [PMID: 36225394 PMCID: PMC9537113 DOI: 10.7759/cureus.28864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022] Open
Abstract
Endometriosis is a condition that affects women of reproductive age, and it is distinguished by the development of endometrial-like tissue outside the uterine cavity. It is frequently accompanied by persistent pelvic discomfort and infertility. This investigation looks into recent findings on clinical manifestation to help doctors and improve women's health. PubMed and Google Scholar were used to review on clinical diagnosis of endometriosis. The search strategy contained the terms “endometriosis” and “clinical diagnosis.” All research articles published between 1960 and 2021 were included in the search. The findings were then categorized to summarize the evidence. There was a total of 29 instances of endometriosis discovered. The patients' ages varied from 20 to 45 years old, with a median of 28.8 years and a mean of 29.4±7.7 years. Dysmenorrhea is a common disorder among adolescent girls experiencing various physical and emotional symptoms which have a detrimental influence on their quality of life. In this study, scar endometriosis was shown to be the more common variety of endometriosis, with 50% of cases predominantly developing at the lower segment cesarean section (LSCS) scar site. As a result, women with endometriosis are more likely to have miscarriages, and the quality of their embryos declines as a result.
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18
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Yessick LR, Gauvin S, Salomons TV, Pukall CF. Pain Characteristics, Sexual Script Flexibility, and Penetration Control Cognitions in Those Experiencing Anodyspareunia. PSYCHOLOGY & SEXUALITY 2022. [DOI: 10.1080/19419899.2022.2118069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
| | - Stéphanie Gauvin
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Tim V. Salomons
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
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19
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A longitudinal case-control analysis of pain symptoms, fear of childbirth, and psychological well-being during pregnancy and postpartum among individuals with vulvodynia. Midwifery 2022; 114:103467. [DOI: 10.1016/j.midw.2022.103467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
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20
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Ghizzani A, Toto G, Luisi S. Behavioral sex therapy and medications associated in the treatment of provoked vulvodynia: efficacy on pain and sexuality in three illustrative cases. Minerva Obstet Gynecol 2022; 74:302-307. [PMID: 35642714 DOI: 10.23736/s2724-606x.22.04894-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper tests the hypothesis that medications combined with behavioral sex therapy might lessen pain and restore sexuality in women with provoked vulvodynia. Three women affected by vulvodynia, otherwise healthy, in heterosexual relationship were treated at the Department of Obstetrics and Gynecology in a university hospital. In consecutive sessions of behavioral sex therapy, oral tricyclic antidepressants and vulvar applications of estrogen and hydrocortisone creams were prescribed in association with vaginal dilators and sensate focus exercises. The outcome supports the hypothesis that combined medications and sexual behavior interventions may be effective in lessening pain and restoring sexuality in women with provoked vulvodynia. The different dyadic balances observed in this small case series suggest how to best use this protocol. The positive results appear to be mostly due to behavioral sex therapy that was the new element added to the combination of pharmacological agents commonly used to treat provoked vulvodynia.
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Affiliation(s)
- Anna Ghizzani
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, Le Scotte Polyclinic, University of Siena, Siena, Italy
| | - Giulia Toto
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, Le Scotte Polyclinic, University of Siena, Siena, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, Le Scotte Polyclinic, University of Siena, Siena, Italy -
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21
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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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22
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Meana M, Binik YM. The Biopsychosocial Puzzle of Painful Sex. Annu Rev Clin Psychol 2022; 18:471-495. [PMID: 35216521 DOI: 10.1146/annurev-clinpsy-072720-014549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Genital pain associated with sex is a prevalent and distressing problem with a complex research and clinical profile. This article reviews the historical context of the "sexual pain disorders" and the circuitous trajectory that has led from the first mention of painful sex in ancient documents to the latest diagnostic category of genito-pelvic pain penetration disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as well as in other existing and proposed nomenclatures. Prominent etiologic research and emergent theoretical models are critically assessed, as is the latest treatment outcome research of note. Finally, the review points to a number of extant needs in the research and clinical effort, including an integrated biopsychosocial and multidisciplinary approach, randomized clinical trials, targeting of treatment barriers, and expansion of the entire enterprise to include populations that have not been considered. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Marta Meana
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA;
| | - Yitzchak M Binik
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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23
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Novak-Hlebar I, Crnković M, Djaković I, Magdić-Turković T, Petričević T, Lugović-Mihić L. A multidisciplinary approach to a patient with vulvodynia: a successful treatment and outcome. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2022. [DOI: 10.15570/actaapa.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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24
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Aboussouan AB, Mandell D, Johnson J, Thompson N, Huffman KL. An interdisciplinary chronic pain rehabilitation program effectively treats impairment in sexual function, depression, alexithymia, and pain in women with chronic pelvic pain. J Psychosom Obstet Gynaecol 2021; 42:261-271. [PMID: 32141387 DOI: 10.1080/0167482x.2020.1735341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Chronic pelvic pain (CPP) in women is often associated with marked emotional distress and disability, with particular impairments in sexual functioning. Research supports the efficacy of interdisciplinary chronic pain rehabilitation programs (ICPRPs) in treating chronic pain, however less is known about their utility in CPP. METHODS This retrospective study examined pain-related sexual impairment, emotional symptoms, and pain severity in CPP patients before and after completing a 3-4 week ICPRP. Predictors of post-treatment sexual impairment were also investigated. Participants included 58 female CPP patients and 58 age-matched females with non-pelvic chronic pain (NPCP). RESULTS All participants reported robust improvements across outcome measures. Women with CPP reported greater pre- and post-treatment impairment in sexual function than NPCP patients, despite significant treatment-related improvements. In contrast, CPP patients also reported higher levels of depression at baseline but showed greater treatment related-improvements. In participants with CPP, treatment-related improvements in depression, alexithymia, and pain severity significantly explained decreases in pain-related sexual impairment following treatment, whereas none of these variables explained sexual impairment outcomes in women with NPCP. CONCLUSION Results demonstrate that ICPRPs can effectively treat CPP, particularly through changes in depression and alexithymia. Future research should examine whether specific interventions can be added in ICPRPS to address CPP-related sexual impairment.
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Affiliation(s)
- Alix B Aboussouan
- Department of Clinical Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Darcy Mandell
- Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Johnson
- Center for Comprehensive Pain Recovery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
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Lotfi Y, Schweizer A. « Moi la femme excisée, c’est pas plaisir, c’est seulement douleur » : recherche exploratoire sur le vécu sexuel de femmes excisées vivant en Suisse. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Connor JJ, Brady SS, Chaisson N, Mohamed FS, Robinson BBE. Understanding Women's Responses to Sexual Pain After Female Genital Cutting: An Integrative Psychological Pain Response Model. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1859-1869. [PMID: 31011992 PMCID: PMC8240838 DOI: 10.1007/s10508-019-1422-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 05/05/2023]
Abstract
The World Health Organization estimates that over 200 million women and girls have experienced female genital cutting (FGC). Many women and girls who have undergone FGC have migrated to areas of the world where providers are unfamiliar with the health needs associated with FGC. Both providers in Western healthcare systems and female immigrant and refugee patients report communication difficulties leading to distrust of providers by women who have experienced FGC. Sexual pain is one common problem requiring discussion with healthcare providers and possible intervention. Yet, existing clinical and research literature provides little guidance for assessment and intervention when sexual pain is a result of FGC. Several conceptual frameworks have been developed to conceptualize and guide treatments for other types of pain, such as back pain and headaches. In this article, we integrate four prominent models-the fear avoidance model, eustress endurance model, distress endurance model, and pain resilience model-to conceptualize sexual pain in women who have experienced FGC. The resulting integrative psychological pain response model will aid in providing culturally responsive clinical management of sexual pain to women who have experienced FGC. This integrative model also provides a theoretical foundation for future research in this population.
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Affiliation(s)
- Jennifer Jo Connor
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA.
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicole Chaisson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Beatrice Bean E Robinson
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA
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Jackowich RA, Smith KB, Brotto LA. Pain Characteristics, Psychosocial Wellbeing, and Sexual Wellbeing of Women Diagnosed With Provoked Vestibulodynia and a History of Sexual Abuse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:447-454. [PMID: 33359553 DOI: 10.1016/j.jogc.2020.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Provoked vestibulodynia (PVD) is a common chronic pain condition characterized by pain at the vulvar vestibule elicited by touch. Both PVD and sexual abuse lead to negative psychosocial and sexual consequences. However, little is known about the wellbeing of women with PVD and a history of sexual abuse. The aim of this study was to characterize a sample of women seeking treatment for PVD who have experienced sexual abuse. METHODS A total of 404 women diagnosed with PVD completed self-report questionnaires of PVD symptoms and psychosocial and sexual wellbeing before and after participating in a multidisciplinary PVD treatment program. History of sexual abuse was assessed via self-report, and women were dichotomized into groups. RESULTS No significant differences were found on sociodemographic variables, baseline psychosocial or sexual functioning between women with and without a self-reported history of sexual abuse (n = 40 and n = 364, respectively). Significantly more women with a history of sexual abuse than without reported other comorbid chronic pain conditions and radiating PVD pain. History of sexual abuse did not affect improvements in sexual distress scores following multidisciplinary treatment for their PVD. CONCLUSION Ten percent of women in our sample self-reported a history of sexual abuse, but the two groups did not differ significantly with respect to their baseline psychosocial or sexual functioning concerns, and both groups reported reductions in sexual distress following treatment for PVD. These findings indicate that a history of sexual abuse does not significantly affect the efficacy of multidisciplinary treatment approaches for PVD.
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Affiliation(s)
| | - Kelly B Smith
- BC Centre for Vulvar Health, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.
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Otero Torres L, Da Cuña Carrera I, González González Y. Papel de las distintas modalidades de fisioterapia en mujeres con dispareunia: una revisión bibliográfica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2020. [DOI: 10.1016/j.gine.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Witzeman K, Antunez Flores O, Renzelli-Cain RI, Worly B, Moulder JK, Carrillo JF, Schneider B. Patient-Physician Interactions Regarding Dyspareunia with Endometriosis: Online Survey Results. J Pain Res 2020; 13:1579-1589. [PMID: 32636669 PMCID: PMC7334010 DOI: 10.2147/jpr.s248887] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Dyspareunia can be a debilitating symptom of endometriosis. We performed this study to examine women's experiences with painful sexual intercourse, the impact of dyspareunia on patients' lives, and perceptions of interactions with healthcare practitioners. METHODS An anonymous 24-question online survey was provided through the social media network MyEndometriosisTeam.com and was available internationally to women aged 19-55 years who were self-identified as having endometriosis and had painful sexual intercourse within the past 2 years. RESULTS From June 13 to August 20, 2018, 860 women responded and 638 women completed the survey (United States, n = 361; other countries, n = 277; 74% survey completion rate). Respondents reported high pain levels (mean score, 7.4 ± 1.86; severity scale of 0 [no pain] to 10 [worst imaginable pain]), with 50% reporting severe pain [score of 8 to 10]). Nearly half (47%) reported pain lasting ≥24 hours after intercourse with the pain often leading to avoiding (34%) or stopping (29%) intercourse. Pain impacted patients' lives, causing depression (61%), anxiety (61%), low self-esteem (55%), and relationship strain. Many women feared to seek help (10%). Of those women who approached practitioners, many (36%) did not receive effective treatments. DISCUSSION Women with dyspareunia related to endometriosis experience severe pain that can negatively impact patients' lives. Dyspareunia may be a challenging topic for discussion for both patient and practitioner, leading to a suboptimal treatment approach and management. Results suggest that practitioners need improved education and training regarding dyspareunia to evaluate and treat patients' sexual pain caused by endometriosis.
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Affiliation(s)
- Kathryn Witzeman
- Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, CO, USA
| | | | | | - Brett Worly
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Janelle K Moulder
- Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jorge F Carrillo
- Department of Obstetrics and Gynecology, University of Central Florida, Orlando, FL, USA
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Connor JJ, Haviland M, Brady SS, Robinson BBE, Harlow BL. Psychosocial Factors Influence Sexual Satisfaction among Women with Vulvodynia. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:589-598. [PMID: 32460678 PMCID: PMC7413302 DOI: 10.1080/0092623x.2020.1766611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Vulvodynia affects about 8% of women, many of whom report a negative impact on their ability to have sexually satisfying relationships. In this study, we examined predictors of sexual satisfaction in 207 women with clinically confirmed vulvodynia. We adapted a model examining resilience in chronic pain patients originally developed by Sturgeon and Zautra to include resilience factors (communication with partner about sexual health and coping strategies) and vulnerable factors (abuse history, pain intensity, rumination). These variables were regressed onto sexual satisfaction. In the full model, only emotion-based rumination was predictive of sexual satisfaction. Thus, focusing on emotion-based rumination in clinical intervention may improve sexual satisfaction.
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Affiliation(s)
- Jennifer Jo Connor
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Twin Cities, Minnesota, USA
| | - Miriam Haviland
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Beatrice Bean E Robinson
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Twin Cities, Minnesota, USA
| | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Pelvic Floor Dysfunction in Women. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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The Role of Biofeedback in the Treatment of Sexual Dysfunction. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van’t Hof S, Rydin A, Treur J, Enzlin P. An Adaptive Computational Fear-Avoidance Model Applied to Genito-Pelvic Pain/Penetration Disorder. Brain Inform 2020. [DOI: 10.1007/978-3-030-59277-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Vulvodynia is a common, recurrent, vulvar pain condition with debilitating consequences for affected women's health and quality of life. The heterogeneity of women suffering from vulvodynia as well as its uncertain and likely multifactorial etiology pose a significant challenge to identifying any kind of "gold standard" treatment. Thus, treatment providers must be well versed in the various options and the evidence for each. In this review, we begin with pharmacological treatments, followed by non-pharmacological treatments, surgery, and finally multimodal treatments. For each approach, we briefly discuss the method, mechanism of action, and empirical support for the treatment. In sum, pharmacological treatments that may be beneficial but require further research include antinociceptive agents (lidocaine, capsaicin), anti-inflammatory agents (corticosteroids, interferon), neuromodulating medications (anticonvulsants and antidepressants), hormonal agents, and muscle relaxants (e.g., botulinum toxin). There is strong evidence to support and recommend non-pharmacological interventions including psychological therapy, pelvic floor physical therapy, as well as surgery (i.e., vestibulectomy for provoked vestibulodynia) for the treatment of vulvodynia. We conclude this review with a discussion of issues that may have hindered progress of treatment efficacy and effectiveness, and recommendations for moving the field forward.
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Labuschagne E, van Niekerk M. Sensory processing of women diagnosed with genito-pelvic pain/penetration disorder: a research proposal. BMC Res Notes 2019; 12:577. [PMID: 31519220 PMCID: PMC6743158 DOI: 10.1186/s13104-019-4612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/06/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives The study objectives are to describe the sensory processing patterns of women diagnosed with genito-pelvic pain/penetration disorder (GPPPD), to explore the level of anxiety when both GPPPD and sensory processing disorder (SPD) are present and to investigate participants’ experience of participating in a sensory-based home programme. Methods A descriptive two-phased study design will be used. Phase one is a quantitative, cross sectional non-experimental descriptive study, using the Adolescent/Adult Sensory History (ASH) and Hospital Anxiety and Depression Scales (HADS) to obtain data from purposive sampling. Phase two is an exploratory qualitative study involving participants who were identified with SPD in phase one. They will participate in a sensory-based home programme and their experience thereof will be established during semi-structured interviews. Outcomes Descriptive studies are known to be useful in planning health services and to develop hypotheses for future testing. This study could improve practitioners’ understanding of GPPPD and SPD and make alternative, non-invasive, non-pharmacological treatment options available to better assist these patients. The study could further clarify the role of the occupational therapist in sexuality. Exploring participants’ anxiety has important implications for treatment protocols in occupational therapy and assisting in describing the signs and symptoms of GPPPD.
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Affiliation(s)
- Elsie Labuschagne
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa.
| | - Matty van Niekerk
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Johannesburg, 2193, South Africa
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Mindfulness-Based Group Cognitive Behavior Therapy for Provoked Localized Vulvodynia: A Randomized Controlled Trial. J Low Genit Tract Dis 2019; 23:170-175. [PMID: 30688760 DOI: 10.1097/lgt.0000000000000456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to compare the effectiveness of mindfulness-based group cognitive behavior therapy (M-gCBT) versus education support group therapy for the pain and distress associated with provoked localized vulvodynia. MATERIALS AND METHODS Participants were randomized to M-gCBT or education support group therapy. Mindfulness-based group cognitive behavior participants attended 8 weekly sessions. Education support group participants received 8 weeks of online education with 3 in-person group visits. Vaginal insertion pain (tampon test) was the primary outcome. Secondary outcomes (Generalized Anxiety Disorder 7, Beck's Depression Index, Female Sexual Distress Scale, Female Sexual Function Index, and Pain Catastrophizing) were administered before intervention and at the completion of the study period, 3 months, and 6 months. Sample size was based on the ideal number for group dynamics of 6 to 12 participants per group. RESULTS Participants were enrolled from August 1, 2016, to January 30, 2017. Thirty-two participants were enrolled and 31 were randomized: 14 to M-gCBT and 17 to education support. Baseline characteristics did not differ significantly. Vaginal insertion pain decreased in both groups but was not statistically different between groups (difference of 1.23; 95% CI = -0.52 to 2.98). At 6 months, participants in the M-gCBT group showed statistically significant improvement in the Female Sexual Function Index, Generalized Anxiety Disorder 7, and Beck's Depression Index compared with the education support group. CONCLUSIONS Mindfulness-based group cognitive behavior and education support group therapy are effective in reducing pain and distress. However, women in the M-gCBT program showed greater improvement in certain secondary outcomes, indicating that M-gCBT may offer some advantages in reducing distress associated with provoked localized vulvodynia.
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Bao C, Noga H, Allaire C, Williams C, Bedaiwy MA, Sadownik LA, Brotto LA, Smith KB, Yong PJ. Provoked Vestibulodynia in Women with Pelvic Pain. Sex Med 2019; 7:227-234. [PMID: 30954496 PMCID: PMC6523038 DOI: 10.1016/j.esxm.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Pelvic pain and vulvar pain are common conditions in women. In this study, we sought to characterize the clinical picture of patients with concurrent pelvic pain and provoked vestibulodynia (PVD). AIM To analyze the association between sexual/clinical characteristics and a diagnosis of PVD among women with pelvic pain. METHODS Cross-sectional analysis of a prospective registry at a tertiary referral center for pelvic pain and endometriosis, involving consecutive non-menopausal sexually active patients 18-49 years-old seen by a single gynecologist from January 2016-December 2017. The sample was divided into 2 groups: pelvic pain with PVD; and pelvic pain alone (without PVD). MAIN OUTCOME MEASURES Superficial dyspareunia and deep dyspareunia on a 11-point numeric rating scale, and the sexual quality-of-life subscale of the Endometriosis Health Profile-30 (0-100%). RESULTS There were 129 patients that met study criteria: one third with pelvic pain and PVD (n = 42) and two-thirds with pelvic pain alone (without PVD) (n = 87). Women with pelvic pain and PVD had significantly more severe superficial dyspareunia ≥7/10 (OR = 12.00 (4.48-32.16), P < .001), more severe deep dyspareunia ≥7/10 (OR = 4.08 (1.83-9.10), P = .001), and poorer sexual quality of life (Endometriosis Health Profile-30 ≥50%) (OR = 4.39 (1.67-11.57), P = .002), compared with the group with pelvic pain alone. Women with pelvic pain and PVD also had more anxiety, depression, and catastrophizing, more frequent tenderness of the bladder and pelvic floor, and more common diagnosis of painful bladder syndrome. On the other hand, there were no significant differences between the 2 groups in terms of dysmenorrhea, chronic pelvic pain, abdominal wall allodynia, positive Carnett test for abdominal wall pain, functional quality of life, endometriosis, and irritable bowel syndrome. CONCLUSIONS In the pelvic pain population, PVD may be associated with more negative impact on dyspareunia, sexual quality of life, and bladder/pelvic floor function, but it may not significantly impact abdominopelvic pain or day-to-day function in general. Bao C, Noga H, Allaire C, et al. Provoked Vestibulodynia in Women with Pelvic Pain. Sex Med 2019;7:227-234.
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Affiliation(s)
- Carol Bao
- BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada
| | - Heather Noga
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Catherine Allaire
- BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada; Women's Health Research Institute, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Williams
- BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada; Women's Health Research Institute, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohamed A Bedaiwy
- BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada; Women's Health Research Institute, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie A Sadownik
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada; BC Centre for Vulvar Health, Vancouver, British Columbia, Canada
| | - Lori A Brotto
- Women's Health Research Institute, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada; BC Centre for Vulvar Health, Vancouver, British Columbia, Canada
| | - Kelly B Smith
- BC Centre for Vulvar Health, Vancouver, British Columbia, Canada
| | - Paul J Yong
- BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, British Columbia, Canada; Women's Health Research Institute, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada; BC Centre for Vulvar Health, Vancouver, British Columbia, Canada.
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Schvartzman R, Schvartzman L, Ferreira CF, Vettorazzi J, Bertotto A, Wender MCO. Physical Therapy Intervention for Women With Dyspareunia: A Randomized Clinical Trial. JOURNAL OF SEX & MARITAL THERAPY 2019; 45:378-394. [PMID: 30640585 DOI: 10.1080/0092623x.2018.1549631] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dyspareunia negatively affects women´s quality of life, and is a frequent complaint during the peri- and postmenopausal period. A randomized trial evaluated sexual function, quality of life, pain, and pelvic floor muscle function of climacteric women aged between 40 and 60 years old who were sexually active and had complaints of dyspareunia for at least six months. They were assessed before and after their randomization in one of the following interventions: the first group (n = 21) received five one-hour sessions of thermotherapy for relaxation of pelvic floor muscles, myofascial release, and pelvic training (pelvic floor muscle training-PFMT group). The second group (n = 21) received five one-hour sessions during which heat was applied to the lower back with myofascial release of abdominal diaphragm, piriformis, and iliopsoas muscles, with no involvement of pelvic training (lower back-LB group). Forty-two climacteric women with dyspareunia (mean ± SD, PFMT group: 51.9 ± 5.3 years, LB group: 50.6 ± 4.7 years, Student's t-test, p = 0.397) were studied. Pain scores (mean ± SEM) in the PFMT group decreased from 7.77 ± 0.38 to 2.25 ± 0.30; and in the LB group from 7.62 ± 0.29 to 5.58 ± 0.49 (generalized estimating equation-GEE model, p ≤ 0.001 for group, time, and interaction pairwise comparisons). Conclusion: The proposed pelvic floor muscle training protocol was effective to improve pain, quality of life, sexual function, and pelvic floor muscle function in climacteric women with dyspareunia.
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Affiliation(s)
- Renata Schvartzman
- a Pos-Graduation Program in Medical Sciences (PPGCM) , Hospital de Clínicas de Porto Alegre (HCPA). Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil
| | - Luiza Schvartzman
- a Pos-Graduation Program in Medical Sciences (PPGCM) , Hospital de Clínicas de Porto Alegre (HCPA). Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil
| | - Charles Francisco Ferreira
- b Pos-Graduation Program in Health Sciences: Gynecology and Obstetrics (PPGGO) , Hospital de Clínicas de (HCPA), Universidade Federal do (UFRGS) , Porto Alegre , RS , Brazil
| | - Janete Vettorazzi
- b Pos-Graduation Program in Health Sciences: Gynecology and Obstetrics (PPGGO) , Hospital de Clínicas de (HCPA), Universidade Federal do (UFRGS) , Porto Alegre , RS , Brazil
| | - Adriane Bertotto
- a Pos-Graduation Program in Medical Sciences (PPGCM) , Hospital de Clínicas de Porto Alegre (HCPA). Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil
| | - Maria Celeste Osório Wender
- a Pos-Graduation Program in Medical Sciences (PPGCM) , Hospital de Clínicas de Porto Alegre (HCPA). Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre , RS , Brazil
- b Pos-Graduation Program in Health Sciences: Gynecology and Obstetrics (PPGGO) , Hospital de Clínicas de (HCPA), Universidade Federal do (UFRGS) , Porto Alegre , RS , Brazil
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Aalto AP, Huhtala H, Mäenpää J, Staff S. Combination of Treatments With or Without Surgery in Localized Provoked Vulvodynia: Outcomes After Three Years of Follow-Up. Biores Open Access 2019; 8:25-31. [PMID: 30867980 PMCID: PMC6415354 DOI: 10.1089/biores.2018.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Most vulvodynia patients receive combinations of several treatment modalities for their chronic painful condition. If conservative treatments fail, vestibulectomy is considered to be the ultimate treatment option for localized provoked vulvodynia (LPV). The aim of this descriptive study was to analyze relief of pain, quality of life (QoL), and complications associated with combining surgery with conservative treatments among LPV patients, both in short term and after 3 years of follow-up. The study population consisted of a retrospective patient cohort of surgically (n = 16) and only conservatively (n = 50) treated LPV patients. QoL data were assessed by a validated questionnaire (RAND-36). Data were collected by reviewing patient records and by aid of postal questionnaires. Efficacy of treatments in relief of pain was measured by numerical rating scale (NRS). Two months after surgery, the NRS scores assessed by a physician were lower in the surgery group than in patients treated only conservatively (p = 0.008). However, after a median of 36 months of follow-up, self-reported NRS scores and QoL showed no difference between the two patient cohorts. Complication rate after vestibulectomy was 18.8%. The findings suggest that combining surgery with conservative treatments may result in a more effective short-term reduction of pain. However, the effect seemed to be only temporary, as no long-term benefit was achieved.
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Affiliation(s)
- Anu Pauliina Aalto
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Johanna Mäenpää
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Synnöve Staff
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
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Sensory pain characteristics of vulvodynia and their association with nociceptive and neuropathic pain: an online survey pilot study. Pain Rep 2019; 4:e713. [PMID: 31041417 PMCID: PMC6455692 DOI: 10.1097/pr9.0000000000000713] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 12/03/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Objectives: To evaluate self-reported sensory pain scores of women with generalized vulvodynia (GV) and provoked vestibulodynia (PVD), characterize pain phenotypes, and assess feasibility of using the Internet for recruitment and data collection among women with vulvodynia. Methods: Descriptive online survey. Data collected using an online survey accessed via a link on the National Vulvodynia Association web site. Convenience sample, 60 women aged 18 to 45 years (mean = 32.7 ± 5.5); 50 white, 2 black/African American, 4 Hispanic/Latino, and 4 Native American/Alaskan Native, diagnosed with vulvodynia, not in menopause. Pain assessment and medication modules from PAINReportlt. Results: Women with GV (n = 35) compared to PVD (n = 25). Estimated mean pain sites (2.5 ± 1.4 vs 2.2 ± 1.0, P = 0.31), mean current pain (8.7 ± 1.4 vs 5.5 ± 4.0, P = 0.0008), worst pain (8.1 ± 1.8 vs 6.1 ± 3.6, P = 0.02), and least pain in the past 24 hours (4.4 ± 1.8 vs 2.0 ± 2.0, P < 0.0001). Average pain intensity (7.1 ± 1.2 vs 4.6 ± 2.9, P = 0.0003) on a scale of 0 to 10, mean number of neuropathic words (8.3 ± 3.6 vs 7.7 ± 5.0), and mean number of nociceptive words (6.9 ± 4 vs 7.5 ± 4.4). Nineteen (54%) women with GV compared to 9 (38%) with PVD were not satisfied with pain levels. Conclusion: Women with GV reported severe pain, whereas those with PVD reported moderate to severe pain. Pain quality descriptors may aid a clinician's decisions about whether to prescribe adjuvant drugs vs opioids to women with vulvodynia.
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Zarski AC, Berking M, Hannig W, Ebert DD. Wenn Geschlechtsverkehr nicht möglich ist: Vorstellung eines internetbasierten Behandlungsprogramms für Genito-Pelvine Schmerz-Penetrationsstörung mit Falldarstellung. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000485041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis. Sex Med 2018; 6:224-233. [PMID: 29801714 PMCID: PMC6085224 DOI: 10.1016/j.esxm.2018.04.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/09/2018] [Accepted: 04/13/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Deep dyspareunia occurs in half of women with endometriosis, a condition present in 10% of reproductive-age women and associated with negative effects on sexual quality of life (SQoL). However, women with endometriosis can have other clinical factors (eg, superficial dyspareunia, other pelvic pains, and psychological or pain conditions) possibly affecting SQoL. Aims To determine whether deep dyspareunia is associated with SQoL in women with endometriosis, independent of potential confounders. Methods This study involved a prospective patient registry of women at a tertiary-level referral center for endometriosis and pelvic pain. Inclusion criteria were (i) referrals to the center recruited into the registry from January 2014 through December 2016 and (ii) subsequent surgery at the center with histologic confirmation of endometriosis. Exclusion criteria included menopausal status, age at least 50 years, never sexually active, or did not answer dyspareunia or SQoL questions. Bi-variable tests and multiple linear regression analysis were performed. Main Outcome Measures SQoL measured by the 5-item sexual intercourse subscale of the Endometriosis Health Profile-30 (EHP-30) modular questionnaire (0–100%, with higher scores indicating worse SQoL). Results Consent rate for the prospective registry was 87%; 277 women met the study criteria (mean age = 34.2 ± 7.1 years). Most women had stage I to II endometriosis at time of surgery (64%), with the remaining having stage III to IV endometriosis. Through regression analysis, worse SQoL (higher EHP-30 sexual intercourse subscale score) was independently associated with: more severe deep dyspareunia (P < .0001), more severe superficial dyspareunia (P < .0001), increased depression (P < .001), higher pain catastrophizing (P = .04), bladder pain syndrome (P = .02), heterosexual orientation (P < .001), and new referral status (P = .02). Conclusion In women with endometriosis at a tertiary referral center, more severe deep dyspareunia was associated with worse SQoL, independent of superficial dyspareunia, psychological comorbidities, and other potential confounders. Shum LK, Bedaiwy MA, Allaire C, et al. Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis. Sex Med 2018;6:224–233.
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Danielsen KG, Dahl-Michelsen T, Håkonsen E, Haugstad GK. Recovering from provoked vestibulodynia: Experiences from encounters with somatocognitive therapy. Physiother Theory Pract 2018; 35:1-10. [PMID: 29474104 DOI: 10.1080/09593985.2018.1442540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 06/04/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022]
Abstract
Although provoked vestibulodynia (PVD) represents a significant challenge for many young women in the Western world, little is known about how these women experience therapeutic efforts. The aim of this paper is to enhance our knowledge of the way that the therapeutic process is experienced by women with PVD undergoing somatocognitive therapy (SCT). The study enhances insight into this recently developed therapy through a detailed description of the physiotherapy approach. The empirical data are based on interviews with six women who participated in SCT. The empirical data analysis is guided by thematic analysis. Our findings demonstrate how the women experience SCT as a bodily process of wholeness. The process of wholeness relates to new experiences in the women's own bodies, awareness of muscular and mental tension and relaxation, breathing patterns, and perceptions focusing on pain. The findings are presented as three interrelated themes: 1) sensitizing the body as an interconnected unit; 2) incorporating the painful pubic region into the body; and 3) developing a new understanding of oneself. The women who participated in this study found that SCT contributed significantly to the process of their recovery from PVD.
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Affiliation(s)
| | - Tone Dahl-Michelsen
- a Faculty of Health Sciences , OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Elin Håkonsen
- a Faculty of Health Sciences , OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Gro Killi Haugstad
- a Faculty of Health Sciences , OsloMet - Oslo Metropolitan University, Oslo, Norway
- b Department of Psychosomatic and Behavioural Medicine , University of Oslo , Oslo, Norway
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Diagnosis and management of vulvodynia in postmenopausal women. Maturitas 2018; 108:84-94. [DOI: 10.1016/j.maturitas.2017.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 10/25/2017] [Accepted: 11/01/2017] [Indexed: 11/23/2022]
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Zarski AC, Berking M, Ebert DD. Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial. Front Psychiatry 2018; 8:260. [PMID: 29403395 PMCID: PMC5786827 DOI: 10.3389/fpsyt.2017.00260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Genito-pelvic pain/penetration disorder (GPPPD) not only adversely affects women's sexuality and sexual satisfaction but is also associated with a wide range of psychosocial consequences such as reduced quality of life and well-being, mental health comorbidities, and relationship distress. Evidence for effective treatment options is scarce. AIM This article describes the rationale, treatment protocol, and study design for a randomized controlled trial examining the efficacy of an Internet-based guided intervention for GPPPD. METHOD Two hundred women who meet the criteria for GPPPD and have not been able to experience sexual intercourse for at least the last 6 months will be recruited and randomly assigned either to the intervention group (IG) or a 6-month waitlist control group. Assessments take place at baseline (T1), peritreatment after completion of Session 5 in IG (T2), after completion of Session 8 or 12 weeks after randomization (T3), and after 6 months (T4). Data will be analyzed on an intention-to-treat and a completer basis. MAIN OUTCOME MEASURES The primary outcome will be sexual intercourse involving the insertion of the partner's penis at posttreatment. Secondary outcomes include, e.g., improved non-intercourse penetration, sexual functioning, dyadic stress coping, reduced fear of sexuality and negative penetration-related cognitions. Fear of sexuality, penetration-related cognitions, and exercise intensity will be assessed as mediators of intercourse in the IG. Sexual dysfunctions of partners will be measured at baseline (T1) and investigated as a potential moderator of the primary treatment outcome. DISCUSSION Given the burden associated with GPPPD and the need for specialized treatment, there is a surprising lack of evidence-based treatment options. This study aims to assess whether Internet-based interventions could contribute to closing this treatment gap. CLINICAL TRIAL REGISTRATION German Register of Clinical Studies (DRKS): DRKS00010228.
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Affiliation(s)
- Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Institute of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Berghmans B. Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. Int Urogynecol J 2018; 29:631-638. [PMID: 29318334 PMCID: PMC5913379 DOI: 10.1007/s00192-017-3536-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/29/2017] [Indexed: 01/06/2023]
Abstract
Introduction and hypothesis Chronic pelvic pain (CPP) in women is a complex syndrome. Pain sensation and intensity often do not correspond with the identified lesion location but are felt elsewhere, leading to muskuloskeletal and myofascial disorders and sexual dysfunction (SD). Although physical aspects are prevalent, they are often underdiagnosed and undertreated due to lack of understanding regarding its origin and distribution. Frequently, patients experience pelvic pain as psychological distress resulting in physical complaints, leading clinicians to prescribe medication or surgical intervention to correct or alleviate these symptoms, often with insufficient results. Because pelvic floor muscle disorders contribute significantly to CPP and SD, there is rationale for physiotherapy. However, physiotherapy is a widely underused and untapped resource, which has its place in the multidisciplinary approach to these health problems. Methods Computer-aided and manual searches and methodological quality assessment were carried out for meta-analyses, systematic reviews, and randomized controlled trials (RCTs) published between 1990 and 2017 investigating classification, assessment, and (physiotherapeutic) treatment of pelvic pain and/or female SD defined by the keywords below. Expert opinions were sought via interviews. Results Due to a lack of sufficient relevant medical information, referral data, and test results, focused physiotherapy is difficult to administer adequately. However, recent quality studies indicate significant clinical effects of physiotherapy for CPP and female SD, and experts advocate a multidisciplinary approach that includes physiotherapy. Conclusions Because of its holistic approach, physiotherapy can contribute significantly to the multidisciplinary assessment and treatment of CPP and female SD.
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Affiliation(s)
- Bary Berghmans
- Pelvic Care Center Maastricht, Maastricht University Medical Centre, P.O.Box 5800, 6202 az, Maastricht, The Netherlands.
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Corsini-Munt S, Rancourt KM, Dubé JP, Rossi MA, Rosen NO. Vulvodynia: a consideration of clinical and methodological research challenges and recommended solutions. J Pain Res 2017; 10:2425-2436. [PMID: 29070953 PMCID: PMC5640408 DOI: 10.2147/jpr.s126259] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vulvodynia, an idiopathic chronic vulvar pain, is a prevalent genital pain condition that results in significant impairment to sexual, relational, and psychological functioning of affected women and their romantic partners. Despite its high prevalence, there remain gaps in knowledge and health care access for women coping with vulvodynia, given its varied clinical presentation and no widely accepted treatment protocol. The past several decades have seen important advancements in understanding vulvodynia and developing effective treatments; however, progress has been impeded due to clinical and methodological challenges in conducting research with this vulnerable population. This review presents a brief overview of vulvodynia correlates, consequences, etiology, and treatment, and then turns its attention to considering the clinical and methodological challenges that hinder vulvodynia research. Identifying these barriers alongside potential mitigating solutions is essential to developing empirically supported treatments for all women affected by vulvodynia, across all age and minority groups. Potential solutions will require researchers to broaden eligibility criteria, examine subgroups of women, and expand definitions of treatment outcomes, and may be best facilitated by more active collaboration among research groups and across relevant disciplines. Engagement in these solutions may contribute to more representative findings and the development and dissemination of empirically based treatment options for this complex pain condition.
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Affiliation(s)
| | | | | | | | - Natalie O Rosen
- Department of Psychology and Neuroscience.,Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
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Vannier SA, Rosen NO, Mackinnon SP, Bergeron S. Maintaining Affection Despite Pain: Daily Associations Between Physical Affection and Sexual and Relationship Well-Being in Women with Genito-Pelvic Pain. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2021-2031. [PMID: 27620322 DOI: 10.1007/s10508-016-0820-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/11/2016] [Accepted: 07/19/2016] [Indexed: 06/06/2023]
Abstract
Provoked vestibulodynia (PVD) is a recurrent, genito-pelvic pain condition that affects 8-12 % of women and has negative implications for sexual and relationship functioning. Many women with PVD report avoiding physical affection because they are concerned that affectionate behavior will lead to painful sexual activity. In community samples, physical affection is associated with improved sexual and relational well-being; however, no research has assessed the influence of physical affection on well-being in women with PVD. The current study examined day-to-day, within-person associations between affectionate behavior (hugging/kissing, cuddling) and sexual satisfaction, relationship satisfaction, sexual functioning, and pain intensity in women with PVD. Seventy women diagnosed with PVD completed an 8-week daily survey. Data were analyzed using multilevel modeling. All outcomes were assessed on days involving sexual activity (n = 401 days). Physical affection was assessed on days with and without sexual activity. Hugging/kissing was positively associated with sexual satisfaction, relationship satisfaction, and sexual functioning within any given day and when predicting the next day. Hugging/kissing was unrelated to pain intensity. Cuddling was not associated with any outcomes. Results persisted for affection that occurred on days with and without sexual activity. Findings suggest physical affection is beneficial for the sexual and relationship well-being of women with PVD. These results may inform interventions that encourage women coping with PVD to engage in more daily physical affection with their partners.
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Affiliation(s)
- Sarah A Vannier
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, 1355 Oxford Street, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Natalie O Rosen
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, 1355 Oxford Street, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
- Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, NS, Canada
| | - Sean P Mackinnon
- Department of Psychology and Neuroscience, Life Sciences Centre, Dalhousie University, 1355 Oxford Street, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Sophie Bergeron
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
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