Provoked Vestibulodynia (PVD) is the most common form of chronic vulvar pain, affecting 12% of women in the general population. Research has demonstrated that women with PVD display both allodynia and hyperalgesia to pain at vulvar and non-vulvar sites, as well as reduced psychosocial functioning. The goal of this study was to use a multi-method approach (interview, questionnaires, sensory testing, and fMRI) to examine group differences between women with PVD (N=15) and healthy control women (N=15). Results will allow for improved understanding of the interaction between psychosocial and neurobiological underpinnings of this disorder, which can contribute to the creation of better treatment strategies. Variables included psychophysical and psychosocial measures, as well as neural activations associated with painful pressure, painful words, and psychosocial functioning. Differences between subgroups of PVD, based on temporal onset, were also examined. There were no robust group differences in neural activation during the application of pain or pain words. This finding is consistent with many studies that match groups on pain intensity ratings, as opposed to amount of pressure applied. Painful pressures and painful words resulted in greater neural activation than neutral words or touch; however, there were no group differences for the word conditions. Women with PVD reported increased psychosocial dysfunction, including higher levels of anxiety and catastrophizing. Significant correlations were found between these psychosocial variables and areas of the brain associated with pain modulation and attention (e.g., PFC). Examination of PVD subgroups revealed differences in neural correlates of anxiety and catastrophizing during painful stimulation. This finding adds to the literature suggesting that women with primary PVD experience greater dysfunction than women with secondary PVD. Overall, these studies support findings of pain processing in the general pain literature, as well as supporting PVD as a chronic pain condition. They also add to the development of a greater understanding of the interaction between psychophysical and psychosocial components of chronic pain by examining their relationship with neural activations. Future research should examine brain functioning in PVD women pre- and post-treatment as well as examining neural correlates of other psychosocial variables that contribute to the pain experience (e.g., somatization). / Thesis (Ph.D, Psychology) -- Queen's University, 2013-01-30 09:14:09.652

A dor é uma experiência desagradável associada a uma lesão tecidual, mas que se diferencia para cada indivíduo, pois sofre diversas influências. Dentre estas queixas relacionadas ao ato sexual, a dispareunia e o sofrimento decorrente dela me chamaram a atenção, fato que aliado a uma lacuna acerca de intervenções para resolver ou minimizar este problema motivou a realização deste estudo. Frente a essas considerações o objetivo deste estudo foi compreender, entre mulheres usuárias do serviço de Saúde da Mulher do Centro de Saúde II de Cardoso, município do estado de São Paulo, a concepção que elas têm sobre a dispareunia e as conseqüências dessa ocorrência na sua saúde sexual. Além disso, objetivou-se identificar como a mulher descreve a dor relacionada ao ato sexual; verificar, entre as mulheres, a presença de eventos psicológicos que podem desencadear a dispareunia; compreender como a dispareunia interfere na sua prática sexual; e verificar se a presença da dor interferiu no relacionamento com o parceiro e na satisfação sexual. Para o alcance dos objetivos foi utilizado a metodologia qualitativa, com a análise de conteúdo das entrevistas de dezesseis mulheres pesquisadas, que por meio da técnica de análise temática emergiram as seguintes categorias: dispareunia - um problema para a mulher; a dispareunia e o desenvolvimento da sexualidade; a dispareunia e a sexualidade: compreendendo os fatores psico-sócio-culturais e busca por ajuda, que foram descritas em subcategorias. Observou-se que muitas ainda se submetem à prática sexual sem vontade, na presença da dor, para satisfazer o parceiro e cumprir o seu dever de esposa. As mulheres demonstraram desconhecer a etiologia da dor, algumas buscavam relacioná-la com algum problema físico que apresentavam no momento, e ao descrever a dor o fizeram de forma amena, como uma dorzinha fraca que incomoda. Ao responder ao Questionário de Dor McGill os termos escolhidos apontaram para uma dor de grande intensidade geradora de sofrimento intenso, o que reforça a possibilidade de desqualificação da dor, como se sua presença fosse normal e esperado à mulher. Os discursos também demonstraram que os fatores não orgânicos, como a educação recebida e o relacionamento com o parceiro, apresentaram uma forte influência no desenvolvimento e manutenção da dispareunia. Apesar de conviverem com a dispareunia por muitos anos, as mulheres entrevistadas não encontraram formas de resolver o problema, pois quando conseguiram exteriorizá-lo à profissionais de saúde receberam orientações desconexas e não foram encaminhadas à profissionais habilitados à temática da sexualidade, o que demonstra o despreparo dos profissionais de saúde e dos serviços para receber e auxiliar esta clientela. / Pain is an unpleasant experience associated to tecidual lesion, particular to each individual because it is affected by several factors. Among the complains related to the sexual intercourse, dyspareunia and the suffering it causes, caught my attention because of the lack of interventions to solve or alleviate the problem, which motivated me to accomplish this study. In view of these considerations, this study aimed to understand conceptions held by women, users of the Women Service of the Health Center II in Cardoso, SP, Brazil, regarding dyspareunia and its consequences for sexual health. It also aimed to identify how they describe the pain related to the sexual intercourse; verify, among them, the presence of psychological events that can potentially trigger dyspareunia; understand how it interferes in their sexual practice; and verify whether the presence of pain interfered in the relationship with the partner and sexual pleasure. For achieving such objectives, qualitative methodology was used, with content analysis of interviews carried out with 16 women. From the thematic content technique, the following categories emerged: dyspareunia - a problem for the woman, dyspareunia and the development of sexuality; dyspareunia and sexuality: understanding psycho-socio-cultural factors and search for help, which were described in subcategories. It was observed that many of them submit to the sexual practice without desire and with pain, to satisfy the partner and to comply with their obligations as wives. Women showed lack of knowledge on pain etiology and some sought to relate it to some physical problem they were presenting at the moment. When they described the pain, they reported it mildly, as a bothering weak pain. When answering the McGill Pain Questionnaire, the terms chosen appointed to a pain of great intensity that generates intense suffering, which reinforces the possibility of disqualification of pain, as if its presence was normal and expected. The reports also demonstrated that non-organic factors, such as the education received and relationship with the partner, exerted strong influence in the development and maintenance of dyspareunia. Despite the experience of many years with dispaurenia, the women interviewed did not find ways of solving the problem, because when they managed to talk about with health professionals, they received misleading guidance and were not refereed to professionals specialized in the sexual thematic, which shows the lack of preparedness of health professionals and services to receive and assist this clientele.

A dor é uma experiência desagradável associada a uma lesão tecidual, mas que se diferencia para cada indivíduo, pois sofre diversas influências. Dentre estas queixas relacionadas ao ato sexual, a dispareunia e o sofrimento decorrente dela me chamaram a atenção, fato que aliado a uma lacuna acerca de intervenções para resolver ou minimizar este problema motivou a realização deste estudo. Frente a essas considerações o objetivo deste estudo foi compreender, entre mulheres usuárias do serviço de Saúde da Mulher do Centro de Saúde II de Cardoso, município do estado de São Paulo, a concepção que elas têm sobre a dispareunia e as conseqüências dessa ocorrência na sua saúde sexual. Além disso, objetivou-se identificar como a mulher descreve a dor relacionada ao ato sexual; verificar, entre as mulheres, a presença de eventos psicológicos que podem desencadear a dispareunia; compreender como a dispareunia interfere na sua prática sexual; e verificar se a presença da dor interferiu no relacionamento com o parceiro e na satisfação sexual. Para o alcance dos objetivos foi utilizado a metodologia qualitativa, com a análise de conteúdo das entrevistas de dezesseis mulheres pesquisadas, que por meio da técnica de análise temática emergiram as seguintes categorias: dispareunia - um problema para a mulher; a dispareunia e o desenvolvimento da sexualidade; a dispareunia e a sexualidade: compreendendo os fatores psico-sócio-culturais e busca por ajuda, que foram descritas em subcategorias. Observou-se que muitas ainda se submetem à prática sexual sem vontade, na presença da dor, para satisfazer o parceiro e cumprir o seu dever de esposa. As mulheres demonstraram desconhecer a etiologia da dor, algumas buscavam relacioná-la com algum problema físico que apresentavam no momento, e ao descrever a dor o fizeram de forma amena, como uma dorzinha fraca que incomoda. Ao responder ao Questionário de Dor McGill os termos escolhidos apontaram para uma dor de grande intensidade geradora de sofrimento intenso, o que reforça a possibilidade de desqualificação da dor, como se sua presença fosse normal e esperado à mulher. Os discursos também demonstraram que os fatores não orgânicos, como a educação recebida e o relacionamento com o parceiro, apresentaram uma forte influência no desenvolvimento e manutenção da dispareunia. Apesar de conviverem com a dispareunia por muitos anos, as mulheres entrevistadas não encontraram formas de resolver o problema, pois quando conseguiram exteriorizá-lo à profissionais de saúde receberam orientações desconexas e não foram encaminhadas à profissionais habilitados à temática da sexualidade, o que demonstra o despreparo dos profissionais de saúde e dos serviços para receber e auxiliar esta clientela. / Pain is an unpleasant experience associated to tecidual lesion, particular to each individual because it is affected by several factors. Among the complains related to the sexual intercourse, dyspareunia and the suffering it causes, caught my attention because of the lack of interventions to solve or alleviate the problem, which motivated me to accomplish this study. In view of these considerations, this study aimed to understand conceptions held by women, users of the Women Service of the Health Center II in Cardoso, SP, Brazil, regarding dyspareunia and its consequences for sexual health. It also aimed to identify how they describe the pain related to the sexual intercourse; verify, among them, the presence of psychological events that can potentially trigger dyspareunia; understand how it interferes in their sexual practice; and verify whether the presence of pain interfered in the relationship with the partner and sexual pleasure. For achieving such objectives, qualitative methodology was used, with content analysis of interviews carried out with 16 women. From the thematic content technique, the following categories emerged: dyspareunia - a problem for the woman, dyspareunia and the development of sexuality; dyspareunia and sexuality: understanding psycho-socio-cultural factors and search for help, which were described in subcategories. It was observed that many of them submit to the sexual practice without desire and with pain, to satisfy the partner and to comply with their obligations as wives. Women showed lack of knowledge on pain etiology and some sought to relate it to some physical problem they were presenting at the moment. When they described the pain, they reported it mildly, as a bothering weak pain. When answering the McGill Pain Questionnaire, the terms chosen appointed to a pain of great intensity that generates intense suffering, which reinforces the possibility of disqualification of pain, as if its presence was normal and expected. The reports also demonstrated that non-organic factors, such as the education received and relationship with the partner, exerted strong influence in the development and maintenance of dyspareunia. Despite the experience of many years with dispaurenia, the women interviewed did not find ways of solving the problem, because when they managed to talk about with health professionals, they received misleading guidance and were not refereed to professionals specialized in the sexual thematic, which shows the lack of preparedness of health professionals and services to receive and assist this clientele.

Orientadores: Cristina Laguna Benetti Pinto, Paulo César Giraldo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T02:18:45Z (GMT). No. of bitstreams: 1 Pacello_PolianaCordeiroCesar_M.pdf: 630399 bytes, checksum: 3a17ca972fbf7042258cf286d9d756d3 (MD5) Previous issue date: 2013 / Resumo: Introdução: Em mulheres com falência ovariana prematura (FOP) em uso de terapia hormonal (TH) os aspectos microbiológicos e funcionais da mucosa vaginal e sua relação com a função sexual (FS) não está clara. Não está claro também se a FS em mulheres com FOP está mais relacionada a questões emocionais ou a problemas orgânicos. Objetivo: Avaliar a função sexual em mulheres com FOP em uso de TH e correlacioná-la com algumas características da mucosa vaginal de mulheres. Identificar o escore de lubrificação e dor no ato sexual e relacioná-los com as características da mucosa vaginal. Desenho do estudo: Corte transversal com 36 mulheres com FOP em uso de TH, acompanhadas no Ambulatório de Ginecologia Endócrina do Departamento de Tocoginecologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, pareadas por idade (± 2 anos) com 36 mulheres com função gonadal normal; todas sexualmente ativas e referindo pelo menos uma relação sexual no último mês. Avaliou-se função sexual através do questionário Female Sexual Function Index (FSFI), o trofismo vaginal através da citologia hormonal vaginal, pH e escore vaginal e a flora vaginal através do teste de amina, bacterioscopia e cultura de fungo. Resultados: As mulheres pareadas por idade apresentaram no grupo FOP 33,8 ± 6,1 anos e controles 34,9 ±6,1 anos e tinham relacionamento conjugal estável (91,7% e 97,2% para FOP e controle, respectivamente). O FSFI mostrou escore total para o grupo FOP e controles, respectivamente, de 21,3 ± 6,3 vs. 27,9 ± 3,4 (p<0,0001), com pior desempenho sexual na presença da falência gonadal. Também se observou diferença significativa, com mais dor e pior lubrificação, no grupo com FOP do que nos controles. O escore vaginal mostrou pior trofismo da mucosa vaginal no grupo FOP (20,8 ± 3,5) em relação ao controle (23,4 ± 1,8), p<0,0001. O estudo de citologia hormonal e do pH vaginal não evidenciou diferenças. Da mesma forma, a flora vaginal, o teste de amina, a bacterioscopia e a cultura de fungo foram semelhantes nos dois grupos. . O escore vaginal não apresentou correlação direta ou indireta com os domínios dor e lubrificação ou escore total no questionário FSFI. Conclusão: Mulheres com FOP em uso de TH apresentaram aspectos microbiológicos e funcionais normais, com exceção do escore vaginal, além de pior FS do que mulheres de mesma idade na menacme. Estes achados sugerem que o uso de estrógeno sistêmico em mulheres com FOP não foi suficiente para melhorar a lubrificação e a dispareunia, apesar de conferir trofismo e flora vaginais normais indicando a necessidade de terapêutica sexual específica / Abstract: Introduction: In women with Premature Ovarian Failure (POF) using hormonal therapy (HT) the microbiologycal and functional aspects of the vaginal mucosa and its relationship with sexual function (SF) is not clear. It is also unclear if SF in women with POF is more related to issues in emotional or physical problems. Objective: To evaluate SF in women with POF using HT and to correlate to some characteristics of the vaginal mucosa. To identify the lubrication and pain score during the intercourse and to correlate with the vaginal mucosa characteristics. Study design: Matched cross-sectional study between 36 women with POF and 36 women of the same age (± 2 years) with normal ovarian function, accompanied by the Endocrine Gynecology Clinic, Department of Obstetrics and Gynecology, School of Medical Sciences at the State University of Campinas. Women were sexually active and had at least one sexual intercourse in the last month. Sexual function was assessed using the Female Sexual Function Index questionnaire (FSFI). The trophism was determined by vaginal hormonal cytology, pH and vaginal health index. The vaginal flora was identified by amine test, bacterioscopy and culture for fungi. Results: Women showed a similar age - in the POF group were 33.8 ± 6.1 years and in the control group were 34.9 ± 6.1 (p=0.296) - and had stable marital status (91.7% and 97.2% respectively for POF and control, p = ns). The sexual function of women with POF resulted in the total score of 21.3 ± 6.3 vs. 27.9 ± 3.4 for control group (p<0.0001). The vaginal health index showed better trophism in the control group than in the POF group (23.4 ± 1.8 vs 20.8 ± 3.5, p < 0.0001), both with trophic scores. There was more pain and poorer lubrication in the group with POF than in controls. The study of the vaginal hormonal cytology and vaginal pH showed no differences. Likewise the vaginal flora, the amine test, the bacterioscopy and culture for fungi were similar in both groups. The vaginal health index did not correlated directly or indirectly to the domains of pain and lubricating or FSFI total score on the questionnaire. Conclusion: There were no changes in the vaginal mucosa of women with POF in use of hormonal therapy to justify the worse lubrication or higher prevalence of pain during intercourse. These findings sugest that the use of systemic estrogen in women with POF is not enough to improve lubrication and to decrease pain despite conferring similar trophism and vaginal flora, which suggests the need of specific sexual therapeutic approach / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Vaginismus is defined as a persistent difficulty with vaginal entry, despite a woman’s expressed wish, due to muscle tension, avoidance, and/or pain (Basson et al., 2003). The disorder is classified as a sexual dysfunction; however, there is a paucity of literature on the sexual response, sexual function, and sexual behaviour of women with vaginismus. This thesis research was designed to investigate the differential aspects of sexual health in women with lifelong vaginismus, compared to women with lifelong dyspareunia (pain with intercourse) and women with pain-free intercourse. In the first study, 45 women viewed erotic films, of which one set depicted penetration and the other did not. Physiological sexual arousal was assessed via thermography. Subjective responses to films were assessed with questionnaires. Despite significantly greater negative emotions and lower mental sexual arousal in response to erotic stimuli, women with vaginismus showed genital arousal comparable to the comparison groups. In the second study, 174 women completed an online survey. Women with vaginismus reported more sexual difficulties than the no-pain group and a restricted range of lifetime sexual behaviours and lower frequency of intercourse attempts/experiences than the comparison groups. Women with vaginismus and dyspareunia reported more anxiety during sexual activity and a restricted sexual behaviour repertoire in the previous year and month compared to the no-pain group. Women with vaginismus endorsed more negative cognitions related to penetration, specifically concerns about losing control of their body and the situation. The findings suggest that sexual function difficulties and restricted behavioural repertoire may be associated with negative emotions and maladaptive cognitions. Women with vaginismus may avoid encounters that could lead to intercourse. Alternatively, the negative response to sexual stimuli may be indicative of a more global negative response to sexuality beyond intercourse. The negative penetration-related cognitions, negative responses to sexual stimuli, anxiety during sexual activity, and reduced range and frequency of sexual behaviours of women with vaginismus provide support for the Fear-Avoidance Model of Vaginismus. The impairment in sexual functioning supports the need to move beyond the singular treatment focus of making intercourse possible to an approach that addresses overall sexual rehabilitation.

Female sexual pain is a common problem affecting women worldwide yet remains a poorly researched area of women’s sexual health. Dyspareunia and vaginismus are two types of sexual pain disorder each having psychological and physical health consequences for women and their partners. Part 1: A literature review of the qualitative research literature exploring women’s experiences of sexual pain disorders and their treatment was conducted adopting a narrative synthesis approach. Searches of psychological and medical electronic databases highlighted the paucity of research exploring women’s experiences of sexual pain disorders. Ten studies met the inclusion criteria for the review. The type of qualitative method and quality varied. Findings highlighted the complexity of women’s experiences of sexual pain. Positive experiences of treatment identified alternative benefits of treatment in addition to the traditional outcome of vaginal penetration and penetration without pain. Existing literature has focussed on dyspareunia, and further research is needed on vaginismus. Part 2: The research study used an Interpretative Phenomenological Analysis (IPA) of women’s experiences of vaginismus. Three women were interviewed about their experiences of vaginismus and the treatment they received. Interview transcripts were analysed using IPA. The findings identified the complexity of experiencing vaginismus, the struggle the women faced when trying to make sense of their vaginismus and the wider impact of these experiences on their identity. The findings highlight the value of psychological therapy with this client group and of the need to raise awareness amongst primary care professionals whom women with vaginismus are likely to consult in the first instance. Part 3: A critical appraisal of the research process is presented with focus on the experience of conducting qualitative research as a trainee clinical psychologist. A discussion of the findings is presented in the context of critical reflections on both the strengths and limitations of the study.

INTRODUÇÃO: A dor coital é definida pelo Manual Diagnóstico e Estatístico dos Transtornos Mentais (DSM-IV), como transtorno de dor sexual, fazendo referência ao vaginismo e a dispareunia. OBJETIVOS: Avaliar o efeito da intervenção fisioterapêutica na dor coital, avaliar a função sexual das mulheres portadoras de dor coital, verificar presença risco para depressão e ansiedade, avaliar o impacto do tratamento fisioterapêutico na função sexual destas mulheres e identificar o número de sessões necessárias para redução da dor coital. MÉTODOS: Trata-se de um ensaio clinico controlado não randomizado que incluiu onze mulheres com diagnóstico de dispareunia e cinco com vaginismo, referenciadas para atendimento no Ambulatório de Estudos em Sexualidade Humana (AESH) do Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. A avaliação prévia da dor foi realizada através da escala visual analógica (EVA) e Índice de dor de Mc Gill, para avaliação da função sexual foi utilizado o Índice de Função Sexual Feminina (IFSF). A Escala Hospitalar de Ansiedade e Depressão (HAD) foi utilizada para rastrear sinais de ansiedade e depressão, em seguida foi realizada a avaliação funcional e do tônus dos músculos do assoalho pélvico, pelo Sistema de Graduação Modificada de Oxford. Os recursos utilizados para o tratamento das mulheres foram orientações gerais (visualização dos músculos do assoalho pélvico e percepção corporal e importância das preliminares), auto- relaxamento, alongamento passivo dos músculos adutores do quadril, propriocepção e a massagem intravaginal. RESULTADOS: 81,25% das mulheres apresentavam risco para disfunção sexual e 43,75% para ansiedade, verificou se uma diferença significativa (p<0,05) de todas as medidas de desfecho entre: avaliação inicial e avaliação pós tratamento imediato e entre avaliação inicial e avaliação após seis meses de tratamento. Houve forte correlação positiva entre IFSF e Oxford; forte correlação negativa entre IFSF e Mc Gill, e entre as medidas HAD depressão e Oxford. CONCLUSÃO: O tratamento fisioterapêutico foi eficaz para o tratamento da dor coital. Contribuindo para melhora da função sexual, redução do risco para disfunção sexual ansiedade e depressão de mulheres com dispareunia e vaginismo. / INTRODUCTION: Coital pain is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), as a disorder of sexual pain, referring to vaginismus and dyspareunia. OBJECTIVES: To evaluate the effect of physiotherapeutic intervention on coital pain, to evaluate the sexual function of women with coital pain, to verify the presence of risk for depression and anxiety, to evaluate the impact of physiotherapeutic treatment on the sexual function of these women and to identify the number of sessions required to reduce Coital pain. METHODS: This was a randomized non- controlled clinical trial that included eleven women diagnosed with dyspareunia and Five with vaginismus, referenced for care at the Ambulatory of Studies on Human Sexuality (AESH) of the Department of Gynecology and Obstetrics of the Medical School of Ribeirão Preto, University of São Paulo. Pre-assessment of pain was performed using the Visual Analogue Scale (EVA) and Mc Gill Pain Index. The Female Sexual Function Index (IFSF) was used to assess sexual function. The Hospital Anxiety and Depression Scale (HAD) was used to track signs of anxiety and depression, and functional and pelvic floor muscle tone assessment was performed by the Oxford Modified Graduation System. The resources used to treat women were general guidelines (visualization of the pelvic floor muscles and body perception and importance of the preliminaries), selfrelaxation, passive stretching of the adductor muscles, proprioception of the hip and intravaginal massage. RESULTS: 81.25% of the women had a risk for sexual dysfunction and 43.75% for anxiety, and a significant difference (p <0.05) was found between all the outcome measures between: initial assessment and immediate post-treatment evaluation and between Assessment and evaluation after six months of treatment. There was a strong positive correlation between IFSF and Oxford; Strong negative correlation between IFSF and Mc Gill, and between HAD depression and Oxford measures. CONCLUSION: Physiotherapy treatment was effective for the treatment of coital pain. Contributing to improved sexual function, reduced risk for sexual dysfunction anxiety and depression of women with dyspareunia and vaginismus.

Vaginismus is defined as a persistent difficulty with vaginal entry, despite a woman’s expressed wish, due to muscle tension, avoidance, and/or pain (Basson et al., 2003). The disorder is classified as a sexual dysfunction; however, there is a paucity of literature on the sexual response, sexual function, and sexual behaviour of women with vaginismus. This thesis research was designed to investigate the differential aspects of sexual health in women with lifelong vaginismus, compared to women with lifelong dyspareunia (pain with intercourse) and women with pain-free intercourse. In the first study, 45 women viewed erotic films, of which one set depicted penetration and the other did not. Physiological sexual arousal was assessed via thermography. Subjective responses to films were assessed with questionnaires. Despite significantly greater negative emotions and lower mental sexual arousal in response to erotic stimuli, women with vaginismus showed genital arousal comparable to the comparison groups. In the second study, 174 women completed an online survey. Women with vaginismus reported more sexual difficulties than the no-pain group and a restricted range of lifetime sexual behaviours and lower frequency of intercourse attempts/experiences than the comparison groups. Women with vaginismus and dyspareunia reported more anxiety during sexual activity and a restricted sexual behaviour repertoire in the previous year and month compared to the no-pain group. Women with vaginismus endorsed more negative cognitions related to penetration, specifically concerns about losing control of their body and the situation. The findings suggest that sexual function difficulties and restricted behavioural repertoire may be associated with negative emotions and maladaptive cognitions. Women with vaginismus may avoid encounters that could lead to intercourse. Alternatively, the negative response to sexual stimuli may be indicative of a more global negative response to sexuality beyond intercourse. The negative penetration-related cognitions, negative responses to sexual stimuli, anxiety during sexual activity, and reduced range and frequency of sexual behaviours of women with vaginismus provide support for the Fear-Avoidance Model of Vaginismus. The impairment in sexual functioning supports the need to move beyond the singular treatment focus of making intercourse possible to an approach that addresses overall sexual rehabilitation.

Provoked vestibulodynia (PVD), or recurrent vulvar pain, is a prevalent condition among women. Although research has documented that PVD is associated with sexual problems, little research has systematically examined the intimate relationships of affected women. The general purpose of the current studies was to comprehensively examine sexual and relationship functioning among women with provoked vulvar pain. In order to do so, three related studies were conducted. The first study was a systematic review of the literature examining sexual and relationship satisfaction among PVD-affected women. Secondly, an online study was conducted using both standardized and qualitative measures to examine sexual, relationship, and psychological functioning among women with self-reported provoked vulvar pain and their male partners in comparison to controls. The online study also examined associations between affected women’s pain and women and partner’s functioning. The final study was a laboratory-based study that included women with PVD and matched control women and examined psychosexual functioning, including sexual and relationship satisfaction, and vestibular pain sensitivity; additionally, this study examined potential associations between women’s pain and self-reported functioning. Overall, these studies suggest that women with provoked vulvar pain experience decreased sexual functioning, sexual satisfaction, and psychological functioning in comparison to control women, and that pain-affected partners experience decreased sexual functioning and sexual satisfaction. The findings also indicate that some aspects of women’s pain experiences are related to their self-reported functioning and to that of their partners. This research has implications for understanding the potential sexual and relationship consequences associated with provoked vulvar pain, and is among the first to comprehensively examine affected partners’ functioning. It is hoped that these studies will contribute novel information to the vulvar pain literature, and that they will encourage future research examining sexual and relationship functioning among women with provoked vulvar pain and their partners. / Thesis (Ph.D, Psychology) -- Queen's University, 2010-08-25 12:02:29.446

Bakgrund: Många patienter som är födda med en livmoder upplever livmodern som ett sexuellt organ och är vid hysterektomi rädda att förlora sin sexuella identitet. Hysterektomi, avlägsnande av livmodern, är ett av det vanligaste gynekologiska ingreppen och i Sverige genomgår cirka en av tio patienter födda med livmoder behandlingen. Teoretiskt sett kan hysterektomi påverka sexualiteten och den sexuella förmågan. Syfte: Beskriva patientens sexuella förmåga efter hysterektomi. Metod: En litteraturöversikt av tio kvantitativa artiklar som undersöker den sexuella förmågan efter hysterektomi. Datainsamlingen gjordes i databaserna PubMed och CINAHL. Resultat: Första halvåret efter hysterektomi är den sexuella förmågan försämrad för många patienter. Sex månader till två år efter operationen förbättras den sexuella förmågan eller upplevdes oförändrad. Trots försämrad sexuell förmåga efter hysterektomi upplever många patienter sexuell tillfredställelse. Dyspareuni och depressionssymtom minskas efter hysterektomi. Information innan hysterektomin om möjliga sexuella förändringar efter operationen är en bidragande faktor för sexuell tillfredställelse. Ingen skillnad mellan typ och metod av hysterektomi påvisas. Slutsats: Resultatet av studien visar att den sexuella förmågan förändras efter hysterektomi, oberoende typ av hysterektomi eller operationsmetod. Information är en bidragande faktor till att patienter upplever sexuell tillfredställelse. Klinisk Betydelse: Det är viktigt att sjuksköterskan diskuterar sexualitet med patienten innan, under och efter hysterektomi, för att kunna säkerställa en god omvårdnad. / Background: Many patients, who are born with a uterus sees the uterus as a sexual organ. In conjunction with the hysterectomy a lot of patients are anxious of losing their sexual identity. Hysterectomy, removal of the uterus, is one of the most common gynecological surgeries and in Sweden approximately one of ten patients undergo the operation. Theoretically the hysterectomy could affect sexuality and sexual function. Objective: Describe the patient's sexual function after hysterectomy. Method: A literature review of ten quantitative articles that examines sexual functioning after hysterectomy. The data was collected in PubMed and CINAHL. Results: The first six months after the hysterectomy sexual function decreased for many patients. Six months to two years after the surgery the sexual function improves or perceived unchanged. Despite if the sexual function got worsened after hysterectomy many patients experience sexual satisfaction. Dyspareunia and depression symptoms decreased after hysterectomy. Information before the hysterectomy about possible sexual changes after surgery is a contributing factor for sexual satisfaction. There was no difference between the type and method of hysterectomy. Conclusion: The results of the study show that sexual function changes after hysterectomy, regardless type of hysterectomy or surgical procedure. Information is a contributing factor to patients experiencing sexual satisfaction. Clinical Significance: It is important that the nurses are discussing sexuality with the patient before, during and after hysterectomy in order to ensure good care.