Female Sexual Pain Disorders: Evaluation and Management

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Goldstein Eds. Oxford: Blackwell Publishing. Psychosocial assessment of vulvodynia. Psychosocial treatments for vulvodynia. Harlow, B. Vulvodynia and psychiatric comorbidities. In Mario Incayawar, Michael R. MacIntosh, H. Sex and couple therapy with survivors of childhood trauma.

Hall Eds. Treating the patient with genito-pelvic pain. Gatchel Eds. Psychological management of provoked vestibulodynia. In Irwin Goldstein Editor , A. Clayton, A. Goldstein, N. Kingsberg Eds. New York, NY: Wiley. Lussier, C. Sabourin Eds. Dyspareunie, vaginisme et vulvodynie. Bonnierbale Eds. Painful sex. Levine, C. Althof Eds. Membres du Laboratoire. Publications Articles - Bosisio, M. Are depressive symptoms and attachment styles associated with observed and perceived partner responsiveness in couples coping with genito-pelvic pain? Journal of Sex Research , A comparison of mindfulness-based cognitive therapy vs.

Journal of Sexual Medicine, 16 6 , Journal of Marital and Family Therapy, 45 3 , Sexual distress mediates the associations between sexual contingent self-worth and well-being in women with genito-pelvic pain: A dyadic daily experience study. The Journal of Sex Research, 56 3 , Sexual behavior mediates the relationship between sexual motives and sexual outcomes: A daily diary study.

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Benoit-Piau, J. Fear-avoidance and pelvic floor muscle function are associated with pain intensity in women with vulvodynia. Clinical Journal of Pain, 34 9 , Couple sex therapy versus group therapy for women with genito-pelvic pain. Arousal disorders may be secondary to inadequate stimulation, especially in older women who require more stimulation to reach a level of arousal that was more easily attained at a younger age. Encouraging adequate foreplay or the use of vibrators to increase stimulation may be helpful.

Taking a warm bath before intercourse may also increase arousal. Anxiety may inhibit arousal, and strategies to alleviate anxiety by employing distraction techniques are helpful. Urogenital atrophy is the most common cause of arousal disorders in postmenopausal women, and estrogen replacement, when appropriate, is usually effective therapy. However, women taking systemic estrogens occasionally require supplementation with local therapy. Long-term use of estrogen-containing vaginal creams is considered an unopposed-estrogen treatment in women with an intact uterus, requiring progesterone opposition.

An oral progesterone such as medroxyprogesterone 5 mg daily for 10 days every one to three months or equivalent may be used initially, with frequency or dosage increased if withdrawal bleeding occurs. Estring an estradiol-containing vaginal ring has little systemic absorption and does not require the addition of progesterone. Patients who are uncomfortable wearing the ring during the day often achieve relief with night use only. Premenopausal women with arousal disorders, women who do not respond to estrogen therapy and women who are unable or unwilling to take estrogen represent difficult patient groups because few treatment options are available.

Investigators recognize that small-vessel atherosclerotic disease of the vagina and clitoris may contribute to arousal disorders and are exploring vasoactive medications as treatment. Currently, treatment of arousal disorder in women who are taking these medications, including sildenafil Viagra , is not recommended, although anecdotal success has been reported. Anorgasmia is quite responsive to therapy. This condition is caused by sexual inexperience or the lack of sufficient stimulation and is common in women who have never experienced orgasm.

Treatment relies on maximizing stimulation and minimizing inhibition. The latter is similar to Kegel exercises Table 8. Women who do not respond to therapy should be referred to an appropriate therapist. Advise repetitions during routine activities standing in line, at stop lights, etc. Dyspareunia can be divided into three types of pain: superficial, vaginal and deep Table 6. Superficial dyspareunia occurs with attempted penetration, usually secondary to anatomic or irritative conditions, or vaginismus.

Vaginal dyspareunia is pain related to friction i. Deep dyspareunia is pain related to thrusting, often associated with pelvic disease or relaxation. Diagnosis of an underlying etiology should be aggressively sought, even if surgical investigation laparoscopy is required. The physical examination must include meticulous detail, with the physician's focus on recreating the pain. Treatment of the underlying etiology is fundamental, but as in long-term pain disorders, counseling and pain control strategies are essential.

General recommendations for improved sexual function are discussed in Table 6 and are similar despite sexual orientation. Vaginismus, the involuntary contraction of the muscles of the outer one third of the vagina, is often related to sexual phobias or past abuse or trauma. Therapy for and counseling of women with vaginismus can be initiated and often successfully completed by primary care physicians. Treatment of women with vaginismus consists of progressive muscle relaxation and vaginal dilatation actually a misnomer because the vagina is not physically stretched.

Progressive muscle relaxation can be taught during an instructional examination by having the patient alternate contracting and relaxing the pelvic muscles around the examiner's finger. Women with vaginismus can achieve vaginal dilatation with the use of commercial dilators or tampons of increasing diameter, placed into the vagina for 15 minutes twice daily.

What is Dyspareunia? (Painful Intercourse)

Once the patient can easily accept an equivalent-sized dilator into the vagina, penile penetration by the partner can occur. Success rates approach 90 percent. Already a member or subscriber? Log in. Address correspondence to Nancy Phillips, M. Reprints are not available from the author. Sexual dysfunction. Chronic pelvic pain: an integrated approach. Philadelphia: Saunders, — ACOG technical bulletin. Washington, D. Brief sexual inquiry in gynecologic practice. Obstet Gynecol. Angst J. Sexual problems in healthy and depressed persons.

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Menopause and sexuality: basic and clinical aspects. Philadelphia: Lippincott Williams and Wilkins, — Cawood EH, Bancroft J. Steroid hormones, the menopause, sexuality and well-being of women. Psychol Med. Laan E, van Lunsen RH. Hormones and sexuality in postmenopausal women: a psychophysiological study. J Psychosom Obstet Gynecol.

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Sexual pain disorder | definition of sexual pain disorder by Medical dictionary

Is sexual life influenced by trans-dermal estrogen therapy? A double blind placebo controlled study in postmenopausal women. Acta Obstet Gynecol Scand. Sherwin BB. The impact of different doses of estrogen and progestin on mood and sexual behavior in postmenopausal women. Effects of estrogen, androgen and progestin on sexual psychophysiology and behavior in postmenopausal women. Gelfand MM, Wiita B. Androgen and estrogen—androgen hormone replacement therapy: a review of the safety literature, to Clin Ther.

Slayden SM. Risks of menopausal androgen supplementation. Semin Reprod Endocrinol. Azadzoi KM. Vasculogenic female sexual dysfunction: the hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile dysfunction. Oral phentolamine and female sexual arousal disorders: a pilot study. An open trial of oral sildenafil in antidepressant-induced sexual dysfunction. Psychther Psychosom.

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Kaplan HS. The illustrated manual of sex therapy. Treatment of sexual disorders in the s: an integrated approach. J Consult Clin Psychol. Dawson, Shah, Rinko, and Veselis report no potential conflict of interest relevant to this article, which originally appeared in The Journal of Family Practice ;66[12] C are of women with sexual disorders has made great strides since Masters and Johnson began their study in Female sexual dysfunction FSD has complex physiologic and psychologic components that require a detailed screening, history, and physical examination.

Most women consider sexual health an important part of their overall health. FSD is common in women throughout their lives and refers to various sexual dysfunctions including diminished arousal, problems achieving orgasm, dyspareunia, and low desire. Its classification of sexual disorders was simplified and published in May The diagnosis of sexual dysfunction due to a general medical condition and sexual aversion disorder are absent from the DSM True or False.

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