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Dyspareunia and vaginismus: Review of the literature and treatment

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Abstract

Dyspareunia and vaginismus are sexual pain disorders that partially overlap and are neglected in clinical practice. The etiology of sexual pain disorders is multifactorial. Pain may be perceived at vaginal entry (introital dyspareunia) or deep in the pelvis (deep dyspareunia). It may be lifelong, acquired, generalized, or situational and cause personal and interpersonal distress. Dyspareunia has a solid biological etiology. Comorbidity is frequent with lower urinary tract symptoms, sex-associated and recurrent cystitis, vulvodynia, recurrent Candida infections, vaginal dryness, obstructive constipation, myalgia of the levator ani, endometriosis, and disorders of desire and arousal disorders. Vaginismus has a psychosexual etiology with a variable myogenic component. Dyspareunia and vaginismus affect the patient on many levels: sexual, medical, emotional, and relational. The aim of the paper is to share with physicians the key steps of a focused clinical history and physical examination for a comprehensive diagnosis and effective multimodal treatment of sexual pain disorders.

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References and Recommended Reading

  1. Graziottin A: Sexual pain disorders: dyspareunia and vaginismus. In Standard Practice in Sexual Medicine. Edited by Porst H, Buvat J. Oxford: Blackwell; 2006:342–350.

    Chapter  Google Scholar 

  2. Graziottin A: Treatment of sexual dysfunction. In Evidence Based Physiotherapy For The Pelvic Floor—Bridging Research and Clinical Practice. Edited by Bo K, Berghmans B, van Kampen M, Morkved S. Oxford: Elsevier; 2007:277–287.

    Google Scholar 

  3. Engman M, Wijma K, Wijma B: Itch and burning pain in women with partial vaginismus with or without vulvar vestibulitis. J Sex Marital Ther 2007, 33:171–186.

    Article  PubMed  Google Scholar 

  4. Whitmore K, Siegel JF, Kellogg-Spadt S: Interstitial cystitis/painful bladder syndrome as a cause of sexual pain in women: a diagnosis to consider. J Sex Med 2007, 4:720–727.

    Article  PubMed  Google Scholar 

  5. Pukall C, Lahaie M, Binik Y: Sexual pain disorders: etiologic factors. In Women’s Sexual Function and Dysfunction: Study, Diagnosis, and Treatment. Edited by Goldstein I, Meston CM, Davis S, Traish A. London: Taylor and Francis; 2005:236–244.

    Google Scholar 

  6. Ter Kuile MM, Van Lankveld JJ, Vlieland CV, et al.: Vulvar vestibulitis syndrome: an important factor in the evaluation of lifelong vaginismus? J Psychosom Obstet Gynaecol 2005, 26:245–249.

    Article  PubMed  Google Scholar 

  7. Graziottin A, Rovei V: Sexual pain disorders. In Sexual Health. Edited by Owens AF, Tepper MS. Westport, CT: Praeger; 2007:287–313.

    Google Scholar 

  8. Rosenbaum TY: Physiotherapy treatment in sexual pain disorders J Sex Marital Ther 2005, 31:329–340.

    Article  PubMed  Google Scholar 

  9. Payne KA, Binik YM, Amsel R, Khalife S: When sex hurts, anxiety and fear orient attention towards pain. Eur J Pain 2005, 9:427–436.

    Article  PubMed  Google Scholar 

  10. Abramov L, Wolman I, David M: Vaginismus: an important factor in the evaluation and management of vulvar vestibulitis syndrome. Gynecol Obstet Invest 1994, 38:194–197.

    Article  PubMed  CAS  Google Scholar 

  11. Basson R, Leiblum S, Brotto L, et al.: Revised definitions of women’s sexual dysfunction. J Sex Med 2004, 1:40–48.

    Article  PubMed  Google Scholar 

  12. Wijma B, Engman M, Wijma K: A model for critical review of the literature—with vaginismus as an example. J Psychosom Obstet Gynaecol 2007, 28:21–36.

    Article  PubMed  Google Scholar 

  13. Meana M, Binik YM, Khalife S, Cohen D: Dyspareunia: sexual dysfunction or pain syndrome? J Nerv Ment Dis 1997, 185:561–569.

    Article  PubMed  CAS  Google Scholar 

  14. Reissing E, Binik Y, Khalifé S: Does vaginismus exist? A critical review of the literature. J Nerv Ment Dis 1999, 187:261–274.

    Article  PubMed  CAS  Google Scholar 

  15. Binik Y: Should dyspareunia be classified as a sexual dysfunction in DSM-V? A painful classification decision. Arch Sex Behav 2005, 34:11–21.

    Article  PubMed  Google Scholar 

  16. Leiblum S: Vaginismus: a most perplexing problem. In Principles and Practice of Sex Therapy, edn 3. Edited by Leiblum SR, Rosen RC. New York: Guilford Press; 2000:181–204.

    Google Scholar 

  17. Lamont J: Vaginismus. Am J Obstet Gynecol 1978, 131:632–636.

    Google Scholar 

  18. van der Velde J, Laan E, Everaerd W: Vaginismus, a component of a general defensive reaction: an investigation of pelvic floor muscle activity during exposure to emotion inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct 2001, 12:328–331.

    Article  PubMed  Google Scholar 

  19. Reissing E, Binik Y, Khalifé S: Etiological correlates of vaginismus: sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. J Sex Marital Ther 2003, 29:47–59.

    Article  PubMed  Google Scholar 

  20. Vincenti E, Graziottin A: Sexual pain disorders: management by anesthetic blocks. In Women’s Sexual Function and Dysfunction: Study, Diagnosis, and Treatment. Edited by Goldstein I, Meston CM, Davis S, Traish A. London: Taylor and Francis; 2005:524–525.

    Google Scholar 

  21. Foster D: Chronic vulval pain. In Pain in Obstetrics and Gynecology. Edited by MacLean AB, Stones RW, Thornton S. London: RCOG Press; 2001:198–208.

    Google Scholar 

  22. Graziottin A, Brotto LA: Vulvar vestibulitis syndrome: a clinical approach. J Sex Marital Ther 2004, 30:125–139.

    Article  PubMed  Google Scholar 

  23. Peters KM, Killinger KA, Carrico DJ, et al.: Sexual function and sexual distress in women with interstitial cystitis: a case control study. Urology 2007, 70:543–547.

    Article  PubMed  Google Scholar 

  24. Graziottin A: Sexual pain disorders in adolescents. In Proceedings of the 12th World Congress of Human Reproduction, International Academy of Human Reproduction. Rome: CIC Edizioni Internazionali; 2005:434–449.

    Google Scholar 

  25. Graziottin A: Dyspareunia: clinical approach in the perimenopause. In The Management of Menopause, edn 3. Edited by Studd J. London: The Parthenon Publishing Group; 2003:229–241.

    Google Scholar 

  26. Graziottin A: Sexuality in postmenopause and senium. In Current Management of Menopause. Edited by Lauritzen C and Studd J. London: Martin Duniz; 2004:185–203.

    Google Scholar 

  27. Graziottin A, Bottanelli M, Bertolasi L: Vaginismus: a clinical and neurophysiological study. Urodynamica 2003, 14:117–121.

    Google Scholar 

  28. Harlow B, Wise L, Stewart E: Prevalence and predictors of chronic lower genital tract discomfort. Am J Obstet Gynecol 2001, 185:545–550.

    Article  PubMed  CAS  Google Scholar 

  29. Harlow B, Stewart B: A population-based assessment of chronic unexplained vulvar pain: have we underestimated the prevalence of vulvodynia? J Am Med Womens Assoc 2003, 58:82–88.

    PubMed  Google Scholar 

  30. Alvarez D, Rockwell P: Trigger points: diagnosis and management. Am Fam Physician 2002, 65:653–660.

    PubMed  Google Scholar 

  31. Wesselmann U, Burnett AL, Heinberg LJ: The urogenital and rectal pain syndromes. Pain 1997, 73:269–294.

    Article  PubMed  CAS  Google Scholar 

  32. Oskai U, Baj N, Yalcin O: A study on urogenital complaints of postmenopausal women aged 50 and over. Acta Obstet Gynecol Scand 2005, 84:72–78.

    Article  Google Scholar 

  33. Friedrich E: Vulvar vestibulitis syndrome. J Reprod Med 1987, 32:110–114.

    PubMed  Google Scholar 

  34. Bohm-Starke N, Hilliges M, Falconer C: Neurochemical characterization of the vestibular nerves in women with vulvar vestibulitis syndrome. Gynecol Obstet Invest 1999, 48:270–275.

    Article  PubMed  CAS  Google Scholar 

  35. Bohm-Starke N, Hilliges M, Blomgren B: Increased blood flow and erythema in posterior vestibular mucosa in vulvar vestibulitis. Am J Obstet Gynecol 2001, 98:1067–1074.

    Article  CAS  Google Scholar 

  36. Bornstein J, Goldschmid N, Sabo E: Hyperinnervation and mast cell activation may be used as histopathologic diagnostic criteria for vulvar vestibulitis. Gynecol Obstet Invest 2004, 58:171–178.

    Article  PubMed  Google Scholar 

  37. Laumann EO, Paik A, Rosen RC: Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999, 281:537–544.

    Article  PubMed  CAS  Google Scholar 

  38. Bonica J: Definitions and taxonomy of pain. In The Management of Pain. Philadelphia: Lea & Febiger; 1990:35–87.

    Google Scholar 

  39. Woolf C: The pathophysiology of peripheral neuropathic pain: abnormal peripheral input and abnormal central processing. Acta Neurochir 1993, 58(Suppl):125–130.

    CAS  Google Scholar 

  40. Latthe P, Mignini L, Gray R, et al.: Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006, 332:749–755.

    Article  PubMed  Google Scholar 

  41. Bachmann G, Rosen R, Pinn V, et al.: Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management J Reprod Med 2006, 51:447–456.

    PubMed  Google Scholar 

  42. Bergeron S, Binik YM, Khalife S, et al.: A randomized comparison of group cognitive-behavioural therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain 2001, 91:297–306.

    Article  PubMed  CAS  Google Scholar 

  43. McKay E, Kaufman R, Doctor U, et al.: Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature. J Reprod Med 2001, 46:337–342.

    PubMed  CAS  Google Scholar 

  44. Glazener C: Sexual function after childbirth: women’s experiences, persistent morbidity and lack of professional recognition. Br J Obstet Gynaecol 1997, 104:330–335.

    PubMed  CAS  Google Scholar 

  45. Ferrero S, Esposito F, Abbamonte L: Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril 2005, 83:573–579.

    Article  PubMed  Google Scholar 

  46. Plaut M, Graziottin A, Heaton J: Sexual Dysfunction. Oxford: Health Press; 2004.

    Google Scholar 

  47. Mariani L: Vulvar vestibulitis syndrome: an overview of non-surgical treatment. Eur J Obstet Gynecol Reprod Biol 2002, 101:109–112.

    Article  PubMed  CAS  Google Scholar 

  48. Pukall CF, Binik YM, Khalife S, et al.: Vestibular tactile and pain thresholds in women with vulvar vestibulitis syndrome. Pain 2002, 96:163–175.

    Article  PubMed  Google Scholar 

  49. Nappi RE, Ferdeghini F, Abbiati I, et al.: Electrical stimulation (ES) in the management of sexual pain disorders. J Sex Marital Ther 2003, 29(Suppl 1):103–110.

    Article  PubMed  Google Scholar 

  50. North American Menopause Society: The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of the North American Menopause Society. Menopause 2007, 14:355–369.

    Article  Google Scholar 

  51. Crowley T, Richardson D, Goldmeier D; BASHH Special Interest Group for Sexual Dysfunction: Recommendations for the management of vaginismus: BASHH Special Interest Group for Sexual Dysfunction. Int J STD AIDS 2006, 17:14–18.

    Article  PubMed  Google Scholar 

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  1. Center of Gynecology and Medical Sexology, H. San Raffaele Resnati, Via Santa Croce 10/a, 20122, Milano, Italy

    Alessandra Graziottin

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  1. Alessandra Graziottin
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Correspondence to Alessandra Graziottin.

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Graziottin, A. Dyspareunia and vaginismus: Review of the literature and treatment. Curr sex health rep 5, 43–50 (2008). https://doi.org/10.1007/s11930-008-0008-7

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