Vulvodynia: Assessment and Treatment Goldstein, Andrew T; Pukall, Caroline F; Brown, Candace ...
Journal of sexual medicine,
04/2016, Letnik:
13, Številka:
4
Journal Article
Recenzirano
Vulvodynia constitutes a highly prevalent form of sexual pain in women, and current information regarding its assessment and treatment is needed.
To update the scientific evidence published in 2010, ...from the Third International Consultation on Sexual Medicine, pertaining to the assessment and treatment of women's sexual pain.
An expert committee, as part of the Fourth International Consultation on Sexual Medicine, was comprised of researchers and clinicians from biological and social science disciplines for the review of the scientific evidence on the assessment and treatment of women's genital pain.
A review of assessment and treatment strategies involved in vulvodynia.
We recommend the following treatments for the management of vulvodynia: psychological interventions, pelvic floor physical therapy, and vestibulectomy (for provoked vestibulodynia). We also support the use of multidisciplinary treatment approaches for the management of vulvodynia; however, more studies are needed to determine which components are most important. We recommend waiting for more empirical evidence before recommending alternative treatment options, anti-inflammatory agents, hormonal agents, and anticonvulsant medications. Although we do not recommend lidocaine, topical corticosteroids, or antidepressant medication for the management of vulvodynia, we suggest that capsaicin, botulinum toxin, and interferon be considered second-line avenues and that their recommendation be revisited once further research is conducted.
A comprehensive assessment is needed to understand the pain experience of women presenting with vulvodynia. In addition, treatment typically progresses from less invasive to more invasive, and several treatment options are worth pursuing.
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Non-medical and non-surgical treatments for provoked vestibulodynia target psychological, sexual, and pelvic floor muscle factors that maintain the condition.
The goal of the study was to compare the ...effects of cognitive-behavioral therapy (CBT) and physical therapy (PT) on pain and psychosexual outcomes in women with provoked vestibulodynia.
In a clinical trial, 20 women with provoked vestibulodynia were randomly assigned to receive CBT or comprehensive PT. Participants were assessed before treatment, after treatment, and at 6-month follow-up by gynecologic examination, structured interviews, and standardized questionnaires measuring pain, psychological, and sexual variables.
Outcome measurements were based on an adaptation of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials recommendations. The primary outcome was change in intercourse pain intensity. Secondary outcomes included pain during the cotton swab test, pain with various sexual and non-sexual activities, and sexual functioning and negative pain cognitions.
The two treatment groups demonstrated significant decreases in vulvar pain during sexual intercourse, with 70% and 80% of participants in the CBT and PT groups demonstrating a moderate clinically important decrease in pain (≥30%) after treatment. Participants in the two groups also had significant improvements in pain during the gynecologic examination, the percentage of painful intercourse attempts, the percentage of activities resulting in pain, and the ability to continue intercourse without stopping because of pain. Psychological outcomes, including pain catastrophizing and perceived control over pain, also showed improvement in the two groups. Significant improvements in sexual functioning were observed only in participants who completed CBT. Few between-group differences were identified other than the PT group showing earlier improvements in some outcomes. Nearly all improvements were maintained at the 6-month follow-up.
The results of the study suggest that CBT and PT can lead to clinically meaningful improvements in pain and areas of psychosexual functioning.
Persistent genital arousal disorder (PGAD) is a highly distressing, understudied condition characterized by persistent genital arousal (eg, genital sensations, sensitivity) in the absence of sexual ...desire. Currently, there is limited information about the prevalence of PGAD based on its proposed diagnostic criteria (“PGAD criteria”).
This study sought to assess the prevalence of PGAD criteria in 2 North American samples: a large, non-clinical sample of Canadian undergraduate students (Study 1), and a nationally representative sample from the U.S. (Study 2).
The incoming class of undergraduate students (N = 1,634) enrolled in the Introduction to Psychology course at a Canadian university and a nationally representative sample of U.S. participants (N = 1,026) responded to questions about each PGAD criterion, and distress associated with these experiences.
5 self-report questions were developed based on each of the Leiblum and Nathan 2001 PGAD criteria, and a measure of associated distress was included. The U.S. sample (Study 2) also responded to questions about medical comorbidities and their knowledge of the term “PGAD.”
1.1% (n = 4; Study 1) to 4.3% (n = 22; Study 2) of men and 0.6% (n = 7; Study 1) to 2.7% (n = 14; Study 2) of women reported experiencing all 5 PGAD criteria at a moderate to high frequency. Even greater proportions of participants reported experiencing all 5 criteria at any frequency (6.8–18.8%). Although ratings of associated distress varied, participants who were distressed by these symptoms most frequently endorsed the first PGAD criterion: physiological genital arousal in the absence of sexual excitement or desire. These results are similar to previously reported rates of PGAD.
A non-trivial number of individuals may experience PGAD, and it should be screened for by healthcare practitioners.
This study is the first to use 2 large, non-clinical samples to assess the prevalence of PGAD symptoms. However, barriers to reporting symptoms, such as shame or embarrassment, may have resulted in underestimates of prevalence in the present sample.
The prevalence of the 5 PGAD criteria in 2 large non-clinical samples ranged from similar to higher than rates reported in previous research. However, distress ratings associated with each of the 5 criteria varied, with most respondents describing them primarily as neutral or non-distressing.
Jackowich RA, Pukall CF. Prevalence of Persistent Genital Arousal Disorder in 2 North American Samples. J Sex Med 2020;17:2408–2416.
Which sexual activities result in the most frequent and most satisfying orgasms for men and women in same- and mixed-sex relationships? The current study utilized a convenience sample of 806 ...participants who completed an online survey concerning the types of sexual activities through which they experience orgasms. Participants indicated how frequently they reached orgasm, how satisfied they were from orgasms resulting from 14 sexual activities, and whether they desired a frequency change for each sexual activity. We present the overall levels of satisfaction, frequency, and desired frequency change for the whole sample and also compare responses across four groups of participants: men and women in same-sex relationships and men and women in mixed-sex relationships. While all participants reported engaging in a wide variety of activities that either could, or often did, lead to the experience of orgasm, there were differences in the levels of satisfaction derived from different types of orgasms for different types of participants, who also engaged in such activities with varying degrees of frequency. We discuss group differences within the context of sexual scripts for same- and mixed-sex couples and question the potential explanations for gender differences in the ability to experience orgasm during partnered sexual activity.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Previous studies have demonstrated the deleterious effects of pain anxiety (ie, the degree to which one fears pain), stress, and solicitous partner responses (ie, expressions of sympathy and ...attention to one's partner's pain) on pain and pain-related disability, but little is known about whether these variables moderate the robust pain–pain-related disability relationship in individuals with provoked vestibulodynia (PVD).
We investigated whether pain anxiety, stress, and solicitous partner responses moderated the relationship between penetrative pain and pain-related sexual disability in women with PVD symptoms.
Participants with PVD symptoms (N = 65, age range = 18–73 years) completed an online survey assessing pain anxiety (Pain Anxiety Symptoms Scale-20), perceived stress (Perceived Stress Scale), solicitous partner responses (WHYMPI Solicitous Responses Scale), penetrative pain (Female Sexual Function Index), and pain-related sexual disability (Pain Disability Index). Moderated regression analyses were performed using pain anxiety, stress, and solicitous partner responses as moderators of the relationship between penetrative pain, and pain-related sexual disability.
Outcomes in the current study included the moderating effect of pain anxiety, perceived stress, and solicitous partner responses on the relationship between penetrative genital pain and pain-related disability in sexual behavior.
Higher genital pain from penetrative intercourse and higher pain anxiety significantly predicted higher pain-related sexual disability, but perceived stress was not significantly related to sexual disability. Solicitous partner responses were significantly positively correlated with pain-related sexual disability. None of the moderators significantly moderated the pain–pain-related sexual disability relationship.
For women with PVD, pain anxiety and solicitous partner responses to their pain may exacerbate their pain-related sexual disability, signifying that pain anxiety and solicitous partner responses represent important targets of therapeutic intervention for women with PVD.
The present study extended past research on the relationships between psychological and behavioral factors and pain in women with PVD symptoms by demonstrating the deleterious relationship between pain anxiety, solicitous responses, and pain-related sexual disability. However, the study was correlational in nature, which precludes conclusions about the effect of pain anxiety, and solicitous partner responses on pain-related sexual disability.
High pain anxiety and frequent solicitous partner responses to an individual's pain predicted higher pain-related sexual disability, suggesting that it may be possible to improve the quality of life of PVD sufferers through interventions that aim to decrease pain anxiety, and solicitous partner responses, in addition to interventions that aim to decrease pain per se.
Maunder L, Dargie E, Pukall C. Moderators of the Relationship Between Pain and Pain-Related Sexual Disability in Women with Provoked Vestibulodynia Symptoms. J Sex Med 2022;19:809–822.
Millions suffer from chronic vulvar pain (ie, vulvodynia). Vulvodynia represents the intersection of 2 difficult subjects for health care professionals to tackle: sexuality and chronic pain. Those ...with chronic vulvar pain are often uncomfortable seeking help, and many who do so fail to receive proper diagnoses. The current research developed a multidimensional assessment questionnaire, the Vulvar Pain Assessment Questionnaire (VPAQ) inventory, to assist in the assessment and diagnosis of those with vulvar pain. A large pool of items was created to capture pain characteristics, emotional/cognitive functioning, physical functioning, coping skills, and partner factors. The item pool was subsequently administered online to 288 participants with chronic vulvar pain. Of those, 248 participants also completed previously established questionnaires that were used to evaluate the convergent and discriminant validity of the VPAQ. Exploratory factor analyses of the item pool established 6 primary scales: Pain Severity, Emotional Response, Cognitive Response, and Interference with Life, Sexual Function, and Self-Stimulation/Penetration. A brief screening version accompanies a more detailed version. In addition, 3 supplementary scales address pain quality characteristics, coping skills, and the impact on one's romantic relationship. When relationships among VPAQ scales and previously researched scales were examined, evidence of convergent and discriminant validity was observed. These patterns of findings are consistent with the literature on the multidimensional nature of vulvodynia. The VPAQ can be used for assessment, diagnosis, treatment formulation, and treatment monitoring. In addition, the VPAQ could potentially be used to promote communication between patients and providers, and point toward helpful treatment options and/or referrals.
Laser Doppler imaging is a valid method of assessing genital response, detecting increases in genital blood flow to sexual, but not nonsexual stimuli. Although laser Doppler imaging provides a direct ...measure of genital blood flow, its discrete perfusion images provide a discontinuous assessment of genital response, limiting some study designs. The aims of this study were to investigate the measurement properties of laser Doppler flowmetry, a direct and continuous measure of blood flow, as well as examine the time course of genital response using flowmetry. A sample of 45 cisgender women attended two experimental sessions wherein they viewed sexual and nonsexual stimuli (e.g., neutral, anxiety, humor) while their genital responses were assessed using laser Doppler flowmetry. As expected, laser Doppler flowmetry was a valid measure of genital response—detecting increases in genital blood flow elicited by the sexual stimuli only—and was sensitive to varying degrees of genital response elicited by low, moderate, and high‐intensity sexual stimuli. The measure also exhibited convergent validity with genital response assessed via laser Doppler imaging, test–retest reliability across testing sessions, and internal consistency as well as high sexual concordance with self‐reported sexual arousal. Descriptive analyses showed that genital blood flow assessed using laser Doppler flowmetry was highly responsive, with initial, peak, and return to baseline responses occurring within timeframes appropriate for repeated measurement within a single session. Laser Doppler flowmetry is a valid, reliable, and sensitive measure of women's genital response that can be usefully applied in sexual psychophysiology research.
This study is the first to demonstrate that laser Doppler flowmetry is a valid, reliable, and sensitive measure of women's genital response; this method is unique because it offers a direct and continuous measure of genital blood flow that is highly responsive to dynamic changes in genital response over time.
Vulvodynia constitutes a highly prevalent form of chronic genital pain in women, and current information regarding its definition, prevalence, impact, and pathophysiologic factors involved is needed.
...To update the scientific evidence published in 2010 from the Third International Consultation of Sexual Medicine pertaining to the definition, prevalence, impact, and pathophysiologic factors of women's sexual pain.
An expert committee, as part of the Fourth International Consultation of Sexual Medicine, comprised of researchers and clinicians from biological and social science disciplines, reviewed the scientific evidence on the definition, prevalence, impact, and pathophysiologic factors related to chronic genital pain.
A review of the definition, prevalence, impact, and pathophysiological factors involved in vulvodynia.
Vulvodynia is a prevalent and highly impactful genital pain condition. Numerous factors have been implicated in its development and maintenance.
What is becoming increasingly apparent is that it likely represents the end point of different factors that can differ from patient to patient. Longitudinal research is needed to shed light on risk factors involved in the expression of vulvodynia, as well as in potential subgroups of affected patients, in order to develop an empirically supported treatment algorithm.
Numerous studies have described declines in sexual well-being during the COVID-19 pandemic, although experiences of sexual distress during this time appear to be mixed. Previous research has relied ...on cross-sectional methodology and focused on individuals in relationships. Furthermore, little is known about the frequency of “COVID-safe” sexual behaviors, such as online sexual activities. These gaps in the literature were addressed using a prospective, longitudinal online study examining sexual distress, predictors of sexual distress (i.e., perceived stress), and online sexual activities over time in single and partnered individuals. Participants were single (
N
= 64) and partnered (
N
= 60) individuals who completed surveys at three timepoints over a 6-month period during the COVID-19 pandemic. Mean age across the two groups was 29 years, and approximately half were women (51.6% and 50%, respectively). Results indicated that single individuals reported significantly higher sexual distress than partnered individuals at Times 1 and 2, but not at Time 3. Sexual distress significantly decreased over time for individuals in the single group but remained stable for partnered individuals. At each timepoint, there was a conditional effect of perceived stress on sexual distress depending on one’s relationship status, and the nature of these conditional effects changed throughout the course of the study. Results suggested that single individuals demonstrated improvements in sexual distress over time. Perceived stress is an important predictor of sexual distress but may operate differently depending on relationship status. Results highlight the resiliency of both single and partnered individuals during the COVID-19 pandemic.
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