Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial

Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study

BACKGROUND

Sexual pain is a common but neglected disorder that affects approximately 3% to 18% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients.

OBJECTIVE

The purpose of this study was to understand patients' perspectives on how sexual pain-related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions.

METHODS

Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis.

RESULTS

The findings revealed 4 overarching themes that represented participants' perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain.

CONCLUSIONS

This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions.

Improving sexual dysfunction through guided imagery music (GIM): A clinical trial study

BACKGROUND

Women with perfect health are strong foundations of a healthy and prosperous family life and suppressing the natural needs of women will have adverse effects on the intimacy and vitality of family members, especially in the field of sexual function. This study aimed to determine the effect of GIM on the level of sexual function in women with sexual dysfunction.

MATERIALS AND METHODS

In this cluster randomized trial, which was conducted from 2018 to 2019 in the randomly selected comprehensive health centers of Isfahan, Iran, 72 women of reproductive age (two groups of 36 people) with sexual dysfunction were selected by convenience sampling method, and then, music-guided imagination was performed on the intervention group. No special intervention was performed in the control group. Data collection tools were demographic characteristics questionnaire and a standard questionnaire of the female sexual function index.

RESULTS

There was no statistically significant difference in sexual function and demographic characteristics before the intervention between the two groups (P = 0/301). The results demonstrated that the overall score of sexual function in the intervention subjects was better than the control group (P = 0/003). Improvement of sexual function dimensions (desire, arousal, orgasm) was also significant in the intervention group compared to the control group (P < 0.05).

CONCLUSION

GIM can be effective in improving women's sexual function. Providing this technique as a low-cost and affordable method is recommended to health experts in private and government clinics. This method can improve the mental health of the family and society.

Effectiveness of an Unguided Online Intervention for Sexual Pleasure in Women: A Randomized Controlled Pilot Study

The importance of sexual pleasure as a factor promoting sexual and public health is increasingly recognized. Nevertheless, hardly any theory-based and empirically tested interventions exist for fostering sexual pleasure. Consequently, we developed an unguided online intervention called PleaSure to promote sexual pleasure in women. In a randomized controlled pilot trial with a mixed-method design, we evaluated the effectiveness of PleaSure by comparing the intervention group to a waitlist control group in pre–post measurements over 4 weeks. With 657 participants (Mage = 31.46, SDage = 8.78), we evaluated an index of sexual pleasure and five facets: sensual pleasure, pleasure-related mastery, pleasure-related validation, interaction pleasure, and bonding pleasure. The results show that the online intervention primarily strengthened the intrapersonal domain of sexual pleasure by increasing pleasure-related mastery. Neither the other facets nor the index was significantly influenced by the intervention. Although the effects of the quantitative data are small, the qualitative data support overall positive effects on participants’ sexual experience. We discuss the content of the intervention and the methods used. Our pilot study suggests that sexual pleasure can be promoted but that major improvements are needed to the intervention’s content and design to do so effectively. Therefore, future studies are encouraged to further develop and implement such resource-efficient interventions in clinical and non-clinical samples to better understand the importance of sexual pleasure to sexual health.

Quality analysis of YouTube videos on vulvodynia

Background

Social media, with its low cost and easy accessibility, represents an ideal medium for sharing medical interests, but the quality of its content is questionable.

Aim

The primary aim of this study was to evaluate the quality of video content related to vaginismus on YouTube as a source of information by using scores of established classification systems. The secondary aim was to examine the relationship between objective and subjective measures of their quality.

Methods

The term vaginismus was typed into the YouTube search bar (http://www.youtube.com). The first 50 videos with the highest number of views were included in the study. All videos were assessed on August 18, 2022, by a gynecologist and/or a urologist experienced in vulvodynia. Data of all the videos were recorded, such as source, content, duration, day since upload date, number of views, number of likes, number of comments, and views per day. The Global Quality Scale (GQS) and modified DISCERN score were employed to assess the quality of the videos.

Outcomes

The primary outcomes of this study were the scores of established classification systems and the measures relating to the preference and evaluation of viewers of YouTube videos on vulvodynia.

Results

A total of 50 videos were evaluated. The sources of 32 (64%) of these videos were “universities/professional organizations/nonprofit physicians/physicians” and “stand-alone health information websites.” The GQS and modified DISCERN scores of the videos whose source was “universities/professional organizations/nonprofit physicians/physicians” were higher than those whose source was “talk show programs/television programs” (P = .014 for GQS score, P = .046 for modified DISCERN score). When classified according to GQS score, the quality level of 58% of the videos was low. Of the videos whose source was “universities/professional organizations/nonprofit physicians/physicians,” 56.3% were of good quality.

Clinical Implications

The quality of information was very low and suggested that health care professionals should take on a more active role in configuring the qualitative characteristics of the material available online about the given health issues.

Strengths and Limitations

To the best of our knowledge, this is the first study to investigate the quality of YouTube videos on vaginismus (vulvodynia). However, the limitation of this study is the relatively subjective evaluation of videos, including the risk of observer bias, although we attempted to overcome this problem with the inclusion of 2 independent reviewers and the use of validated tools.

Conclusion

YouTube videos may offer a huge amount of information about this condition, but the quality of the available sources is heterogeneous.

The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review

BACKGROUND

There is low social awareness of vaginismus despite it being a relatively common female sexual dysfunction that makes vaginal penetration painful, difficult, and/or impossible. While existing literature on vaginismus has had a clinical focus on the affected genitalia, there is a lack of research on women's help-seeking experiences of vaginismus from their perspective.

OBJECTIVES

This integrative review's objective was to explore: women's help-seeking experiences of vaginismus, and how such help-seeking experiences impact their sense of self.

DESIGN

Cooper's five-step integrative review approach was followed to develop a research question, a search strategy, selection criteria, and data evaluation, analysis, and presentation.

DATA SOURCES AND METHODS

A systematic search of the literature was completed in the following seven databases in January 2023: PsycINFO, ProQuest Central, PubMed, Scopus, CINAHL, Cochrane, and Embase. Out of the 373 articles found through database searches and additional citation searching, 22 studies were included in this review for meeting the eligibility criteria of having an empirical design, being written in English, and examining women's help-seeking experiences for vaginismus and its impact on their sense of self.

RESULTS

Thematic analysis was used to summarize the findings from the included studies which were informed by 1671 participants. Help-Seeking Process, Medical Management, Help-Seeking and Sense of Self, and Holistic Care Recommendations from the Findings emerged as four major themes with corresponding subthemes.

CONCLUSION

This review indicates that women continue to face difficulties in seeking and receiving help for vaginismus even through the healthcare system. However, the studies did not explicitly discuss how women's help-seeking for vaginismus impacted their sense of self. This highlights an epistemological gap on how women's help-seeking for their vaginismus impacts their sense of self, which can affect their treatment responses. Recommendations are provided for future healthcare and research to improve health outcomes for women with vaginismus.

Digital health applications and the fast-track pathway to public health coverage in Germany: challenges and opportunities based on first results

Objectives

Evidence-based decision-making is the sine qua non for safe and effective patient care and the long-term functioning of health systems. Since 2020 Digital Health Applications (DiHA) in Germany have been undergoing a systematic pathway to be reimbursed by statutory health insurance (SHI) which is attracting attention in other European countries. We therefore investigate coverage decisions on DiHA and the underlying evidence on health care effects, which legally include both medical outcomes and patient-centred structural and procedural outcomes.

Methods

Based on publicly available data of the Institute for Medicines and Medical Devices searched between 08/2021 and 02/2022, all DiHA listed in the corresponding registry and thus reimbursable by the SHI were systematically investigated and presented descriptively on the basis of predefined criteria, such as clinical condition, and costs. The clinical trials on DiHA permanently included in the registry were reviewed with regard to their study design, endpoints investigated, the survey instruments used, and whether an intention-to-treat analysis was performed. Risk of bias was assessed using the ROB II tool.

Results

By February 2022, 30 DiHA had been included in the DiHA registry, one third of them permanently and two thirds conditionally. Most DiHA were therapeutic applications for mental illness based on cognitive behavioural therapy. For all permanently included DiHA, randomised controlled trials were conducted to demonstrate the impact on health care effects. While medical outcomes were investigated for all of these DiHA, patient-centred structural and procedural outcomes were rarely investigated. The majority of clinical trials showed a high risk of bias, mainly due to insufficient reporting quality. Overall, the prices for DiHA covered by SHI are on average around € 150 per month (min. € 40; max. € 248).

Conclusions

Evidence-based decision-making on coverage of DiHA leaves room for improvements both in terms of reporting-quality and the use of patient-centred structural and procedural outcomes in addition to medical outcomes. With appropriate evidence, DiHA can offer an opportunity as an adjunct to existing therapy while currently the high risk of bias of the trials raises doubts about the justification of its high costs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08500-6.

A risk algorithm that predicts alcohol use disorders among college students

The first year of college may carry especially high risk for onset of alcohol use disorders. We assessed the one-year incidence of alcohol use disorders (AUD) among incoming first-year students, predictors of AUD-incidence, prediction accuracy and population impact. A prospective cohort study of first-year college students (baseline: N = 5843; response rate = 51.8%; 1-year follow-up: n = 1959; conditional response rate = 41.6%) at a large university in Belgium was conducted. AUD were evaluated with the AUDIT and baseline predictors with the Composite International Diagnostic Interview Screening Scales (CIDI-SC). The one-year incidence of AUD was 3.9% (SE = 0.4). The most important individual-level baseline predictors of AUD incidence were being male (OR = 1.53; 95% CI = 1.12-2.10), a break-up with a romantic partner (OR = 1.67; 95% CI = 1.08-2.59), hazardous drinking (OR = 3.36; 95% CI = 1.31-8.63), and alcohol use characteristics at baseline (ORs between 1.29 and 1.38). Multivariate cross-validated prediction (cross-validated AUC = 0.887) shows that 55.5% of incident AUD cases occurred among the 10% of students at highest predicted risk (20.1% predicted incidence in this highest-risk subgroup). Four out of five students with incident AUD would hypothetically be preventable if baseline hazardous drinking was to be eliminated along with a reduction of one standard deviation in alcohol use characteristics scores, and another 15.0% would potentially be preventable if all 12-month stressful events were eliminated. Screening at college entrance is a promising strategy to identify students at risk of transitioning to more problematic drinking and AUD, thus improving the development and deployment of targeted preventive interventions.

Common Pitfalls in the Management of Vaginismus in Couples With Subfertility in India

Vaginismus is described as an involuntary pelvic muscular spasm that occurs due to “fear of pain” associated with vaginal penetration which prevents a woman from experiencing penovaginal sexual intercourse despite her wish to do so. In the context of heterosexual couples with subfertility, untreated vaginismus may result in unconsummated marriage and/or reduced quality of sex life and/or can affect a woman’s perception about her potential of femininity and motherhood. Though vaginismus is an easily diagnosable and treatable condition in many instances, it often gets ignored or inadequately/inappropriately managed. There is paucity of practice-informed clinical data on management of vaginismus in couples with subfertility that is contextualized to the Indian setting. The present viewpoint is based on real-world clinical scenarios who presented as couples to a tertiary fertility center with unconsummated marriage as their chief complaint. The intent of this viewpoint is not only to highlight the common pitfalls in the management of vaginismus but also showcase a clinically proven interdisciplinary management approach for assessment and management of vaginismus and any associated sexual problems.

Genitopelvic pain: retrospective evaluation of a multimodal treatment efficacy

BACKGROUND

Genitopelvic and sexual pain penetration disorder (GPPD) recognizes a multifaceted etiology. As with syndromes of chronic pain, it responds poorly to medications and its management is difficult. Clinicians consequently favor a multimodal comprehensive approach to tackle the different aspects of the disorder. To treat GPPD women, we chose a multimodal regimen including topical and systemic medications associated with physical interventions and behavioral couple therapy. Our aim was to evaluate the regimen efficacy and the influence that demographic, clinical, and pain characteristics may have on the outcome.

METHODS

Sixty self -referred women requesting medical care for GPPD, who were free of debilitating illness, in stable heterosexual relationships and with healthy and sexually functional partners, were treated according with the multimodal regimen we tailored on the specific needs of these women. As said, it associated topical and systemic medications combined with physical exercises used in behavioral sex therapy, and behavioral couple therapy. Past sexual history, characteristics of pain, vestibular hyperreactivity, pelvic floor hypertonicity, general health, and couple harmony were evaluated and statistically analyzed to determine which characteristics were associated with therapy outcome.

RESULTS

The statistical analysis of an association between demographic, reproductive, pain and medical conditions on one hand and therapy outcome on the other did not find any significance.

CONCLUSIONS

The lack of association between the investigated characteristics and treatment outcome is disappointing; on the other hand, the statistically significant impact of couple harmony (evaluated as partner presence and participation) on the treatment results may be the answer to our search for factors predicting outcome.

Psychological Treatment of Low Sexual Desire in Women: Protocol for a Randomized, Waitlist-Controlled Trial of Internet-Based Cognitive Behavioral and Mindfulness-Based Treatments

BACKGROUND

Psychological therapies are effective treatments for hypoactive sexual desire dysfunction (HSDD; formerly hypoactive sexual desire disorder), a common sexual dysfunction among women. Access to evidence-based treatments, however, remains difficult. Internet-based interventions are effective for a variety of psychological disorders and may be a promising means to close the treatment gap for HSDD.

OBJECTIVE

This article describes the treatment protocol and study design of a randomized controlled trial, aiming to study the efficacy of cognitive behavioral and mindfulness-based interventions delivered via the internet for women with HSDD to a waitlist control group. Outcomes are sexual desire (primary) and sexual distress (secondary). Additional variables (eg, depression, mindfulness, rumination) will be assessed as potential moderators or mediators of treatment success.

METHODS

A cognitive behavioral and a mindfulness-based self-help intervention for HSDD will be provided online. Overall, 266 women with HSDD will be recruited and assigned either to one of the intervention groups, or to a waitlist control group (2:2:1). Outcome data will be assessed at baseline, at 12 weeks, and at 6 and 12 months after randomization. Intention-to-treat and completer analyses will be conducted.

RESULTS

We expect improvements in sexual desire and sexuality-related distress in both intervention groups compared to the waitlist control. Recruitment has begun in January 2019 and is expected to be completed in August 2021. Results will be published in 2022.

CONCLUSIONS

This study aims to contribute to the improvement and dissemination of psychological treatments for women with HSDD and to clarify whether cognitive behavioral and/or mindfulness-based treatments for HSDD are feasible and effective when delivered via the internet.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03780751; https://clinicaltrials.gov/ct2/show/NCT03780751.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20326.