Childhood anxiety disorders are often considered gateway disorders: having an anxiety disorder in youth is associated with a higher likelihood of developing a related psychological disorder in adulthood. Successfully treating youth with anxiety disorders may reduce the likelihood of subsequent anxiety, depressive, and substance use disorders later in life. This study evaluates follow-up outcomes associated with treatment for childhood anxiety by comparing successfully and unsuccessfully treated participants 16 years after the completion of treatment. A sample of 66 youth (ages 7 to 14 at time of initial study treatment, ages 18 to 32 at present follow-up) who had been diagnosed with an anxiety disorder and randomized to treatment in a randomized clinical trial on average 16.24 (SD = 3.56) years prior participated in the present follow-up evaluation that included self-report measures and a diagnostic interview conducted to assess anxiety, depression, and substance misuse. Results indicate that, relative to those who respond successfully to CBT intervention for an anxiety disorder in childhood, those who were less responsive to CBT for childhood anxiety had higher rates of panic disorder, alcohol dependence, and drug abuse in adulthood. The present study is the first to assess the 16-year follow-up effects of CBT treatment for an anxiety disorder in youth on anxiety, depression, and substance abuse through the period of young adulthood when these disorders are often seen. / Psychology

OBJECTIVES The aim of this analysis was to assess the 7-year long-term safety and effectiveness of a randomized comparison of percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) versus minimally invasive direct coronary artery bypass (MIDCAB) surgery for the treatment of isolated proximal left anterior descending lesions. BACKGROUND Long-term follow-up data comparing PCI by SES and MIDCAB surgery for isolated proximal left anterior descending lesions are sparse. METHODS Patients were randomized either to PCI with SES (n ¼ 65) or MIDCAB (n ¼ 65). Follow-up data were obtained after 7 years with respect to the primary composite endpoint of death, myocardial infarction, and target vessel revas- cularization. Angina was assessed by the Canadian Cardiovascular Society classification and quality of life with Short Form 36 and MacNew quality of life questionnaires. RESULTS Follow-up was conducted in 129 patients at a median time of 7.3 years (interquartile range: 5.7, 8.3). There were no significant differences in the incidence of the primary composite endpoint between groups (22% PCI vs. 12% MIDCAB; p ¼ 0.17) or the endpoints death (14% vs. 17%; p ¼ 0.81) and myocardial infarction (6% vs. 9%, p ¼ 0.74). However, the target vessel revascularization rate was higher in the PCI group (20% vs. 1.5%; p < 0.001). Clinical symptoms and quality of life improved significantly from baseline with both interventions and were similar in magnitude between groups. CONCLUSIONS At 7-year follow-up, PCI by SES and MIDCAB in isolated proximal left anterior descending lesions yielded similar long-term outcomes regarding the primary composite clinical endpoint and quality of life. Target vessel revascularization was more frequent in the PCI group. (Randomied Comparison of Minimally Invasive Direct Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention With Drug-Eluting Stents in Patients With Proximal Stenosis of the Left Anterior Descending Coronary Artery; NCT00299429) (J Am Coll Cardiol Intv 2014;-:-–-) © 2014 by the American College of Cardiology Foundation.

Anorexia Nervosa is a psychiatric illness with peak onset in ages 14-17. Most cases recover within a few years, but the illness can have a fatal outcome or long duration. Multifactor causes of anorexia nervosa include genetics, personality, family, and socio-cultural factors. This study measures mortality, recovery from anorexia nervosa, and psychosocial outcome of patients with adolescent onset anorexia nervosa that were treated in Child and Adolescent Psychiatry in northern Sweden from 1980 to 1985. In addition, this study assesses the predictive value of background variables and studies perfectionism in relation to recovery. Finally, this study looks at how patients understand the causes of their anorexia nervosa and how they view their recovery process. Follow ups were made 8 and 16 years after initial assessment at CAP. Quantitative and qualitative methods were used. These included a semistructured interview, DSM diagnostics of eating disorders (including GAF), and the self-assessment questionnaires EDI and SCL-90. The interview also contained questions about causes and recovery. Recovery increased from 68% to 85% from first to second follow-up and the mortality rate was 1%. Somatic problems and paediatric inpatient care during the first treatment period could predict long-term outcome of eating disorders. Most former patients had a satisfying family and work situation. At both follow-ups, individuals with long-term recovery had a lower level of perfectionism than those that recovered later. On individual levels, eating disorder symptoms and psychiatric symptoms decreased during recovery, whereas the levels of perfectionism stayed the same. Causes were attributed to self, family, and socio-cultural stressors outside of the family. The most common self-reported causes were high own demands and perfectionism. All recovered subjects could remember and describe a special turning point when the recovery started and 62% saw themselves as an active agent in the recovery process. Supportive friends, treatment, activities, family of origin, boyfriend, husband, and children were also helpful in the recovery process. Compared to other outcome studies, the results were good. In spite of the good outcome, some individuals had a long duration of illness and were not yet fully recovered after 16 years of follow-up. Predictors of non-recovery were related to initial somatic problems. Levels of perfectionism were associated to recovery and patients with initial high levels of perfectionism may need more complex treatment strategies. Results from the study also implied that one should stimulate the patients’ social contacts and their sense of self-efficacy in their recovery- process.

Einleitung Die aneurysmale Subarachnoidalblutung und ihre Komplikationen stellen eine akut lebensbedrohliche Erkrankung dar. Aufgrund einer hohen Letalität und Morbidität sowie zahlreichen, nicht modifizierbaren Risikofaktoren und fehlenden eindeutigen Präventionsmaßnahmen bleibt diese Krankheit eines der aktuellen Themen der Neurochirurgie. Ziel Ziel dieser Studie ist der Vergleich der Behandlungsergebnisse von Patienten mit aneurysmaler SAB im Klinikum Chemnitz mit aktuellen Literaturdaten. Material und Methode In dieser Arbeit wurden die Daten von insgesamt 200 Patienten mit aneurysmaler Subarachnoidalblutung retrospektiv zusammengefasst. Es wurde eine Populationsanalyse zusammen mit einer Analyse der Korrelationen zwischen verschiedenen Ausgangs- und Verlaufsparametern mit dem allgemeinen Outcome und der Mortalität durchgeführt. Zusätzlich erfolgte eine Follow-up-Analyse der Mortalität und Morbidität bei 108 Patienten. Im statistischen Modell wurden eine Uni- und Bivariatanalyse sowie binäre und multinomiale logistische Regression angewendet. Kaplan-Meier-Kurven in Verbindung mit Cox-Regressionsanalysen wurden zur Beurteilung der Mortalität eingesetzt. Die Ergebnisse wurden mit Literaturdaten verglichen. Das Votum der Ethikkommission der TU Dresden liegt vor (EK 181052014 vom 15.09.2014). Ergebnisse Von 200 Patienten mit einem Durchschnittsalter von 52 J (20-82 J, Medianalter 51 ± 13,6 J) waren 69 Patienten männlich (34,5 %), 131 – weiblich (65,2 %). Das männlich : weiblich Verhältnis betrug 1:1,9. Der klinische Schweregrad der Patienten bei Aufnahme wurde durch die WFNS- und die HH-Skalen evaluiert. Zusätzlich wurden die BNI- und Fisher-Skalen zwecks Evaluation des radiologischen Schweregrades der aSAB eingesetzt. Die Patientendistribution anhand der WFNS-Skala war: WFNS °I – 42,0 %, WFNS °II – 10,0 %, WFNS °II – 16,5 %, WFNS °IV – 22,5%, WFNS °V – 9,0 %. Die Verteilung der Patienten durch die HH-Skala war vergleichbar. 14,5 % der Patienten hatten eine BNI 1, 41,5 % - BNI 2, 32,0 % – BNI 3, 10,5 % - BNI 4, 1,5 % - BNI 5 Blutung. Bei 5,5 % der Patienten lag eine Fisher 1, 10,5 %– Fisher 2, 28,0% - Fisher 3 und 56,0 % - Fisher 4 SAB vor. 77,5 % der Aneurysmata waren klein (<11mm), 18,5 % - groß (11-25mm), 4 % - Giant (>25mm). Die Aneurysmen war meist im Bereich der Acom (41,5 %) und MCA (36,5 %) lokalisiert. Insgesamt 94,5 % der Aneurysmen gehörten zur vorderen Zirkulation. Die primäre Mortalitätsrate betrug 14,5 %. 21,5% der Patienten hatten einen mRS von 0-1 bei Entlassung, 26,0 % - einen mRS 2-3, 38,0 % - einen mRS 4-5. Die mittlere Follow-up-Dauer betrug 71,3 ± 43,2 Monate (Spannweite 2-168 Monate). Von den initial Überlebenden und im Follow-up eingeschlossenen Patienten sind 10,2 % im Verlauf verstorben. 48,1 % hatten einen mRS 0-1, 30,6% mRS 2-3, 11,1 % - mRS 4-5. Diskussion Das Outcome der Patienten mit einer aSAB trägt einen multifaktoriellen Charakter. Die wesentlichen Prädiktoren des Outcomes sind das Alter, der klinische und radiologische Schweregrad der Blutung, die Notwendigkeit der Versorgung eines posthämorrhagischen Hydrozephalus (temporäre und dauerhafte CSF-Ableitung), ein Vasospasmus, DIND und Entgleisun-gen im Serum-Natrium-Spiegel. Die Mortalitätsrate bei der primären Versorgung der Patienten mit einer aSAB in unserer Ko-horte ist um etwa 5 % niedriger als in der Literatur angegeben. Die Mortalitätsrate steigert sich allmählich während der ersten 3 Wochen. Sie wird im Wesentlichen vom Patientengeschlecht, dem klinischen und radiologischen Schweregrad der Blutung, der Notwendigkeit einer Akutversorgung eines aufgetretenen Hydrozephalus, einem Vasospasmus, Entgleisungen im Serum-Natrium-Spiegel sowie der Notwendigkeit einer CSF-Dauerableitung beeinflusst. Die Notwendigkeit einer CSF-Außenableitung bei Aufnahme korreliert mit einem schlechten Zustand der Patienten bei Entlassung und im Follow-up. Der Vasospasmus ist ein unabhängiger Prädiktor eines primär schlechten Outcomes und einer hohen Mortalität, zeigt sich aber als nicht signifikanter Faktor im Langzeit-Follow-up. Die Shuntpflicht ist bei Patienten mit Elektrolytentgleisungen, beidseitigen EVDs und DIND 3-4fach erhöht, beeinflusst jedoch nur die primäre Morbidität/Mortalität. Entgleisungen im Serum-Natrium-Spiegel zeigten sich als unabhängiger Prädiktor eines schlechten Outcomes und erhöhter Mortalität sowohl während des stationären Aufenthaltes, als auch im Langzeit-Follow-up. Die Notwendigkeit einer dekompressiven Kraniektomie wiederspiegelt sich in einem niedrigen BI der Patienten im primären Outcome und ist Prädiktor eines schlechten Outcomes und erhöhter Mortalität im Langzeit-Follow-up.

Sammanfattning Bakgrund: Förutsättningarna för god och säker vård är att basala hygienrutinerna följs inom vården. Genom tillämpning av god handhygien motverkas smittspridning och vårdrelaterade infektioner. Vårdskador kan medföra att vårdtiden ökar och orsaka lidande för patienten och är därför ett hot mot säker vård. Syfte: Syftet var att undersöka vårdpersonalens följsamhet till basala hygienrutiner, på en medicinsk akutvårdsavdelning med fokus på handhygien. Metod: En kvantitativ registerstudie med långtidsuppföljning har utförts. Datamaterialet var hämtat från registret för Mätning och Analys (MOA). Observationerna insamlades av hygienobservatörer på en medicinsk akutvårdsavdelning i södra Sverige år 2013 – 2018. Data importerades över till statistikprogrammet SPSS. Deskriptiv och analytisk statistik har använts för analys.  Resultat: Vid analys framkom (n=491) det att följsamheten till handhygienen har brister, undersköterskor visar på högst följsamhet. Handsprit efter patientkontakt var det momentet som visade högst följsamhet. Det finns brister i handhygienen över tid då följsamheten inte var hundraprocentig under samtliga år. Slutsats: Följsamheten till handhygienen påverkas av många faktorer. God och säker vård är beroende av att vårdpersonal har kunskap om handhygien och smittspridning. För att vårdpersonal ska förbättra det preventiva arbetet mot säkrare vård är det vårdgivaren som ska medverka till ny kunskap. Medarbetare har ansvaret för att upprätthålla och följa den kunskapen. / Summary Backgorund: The preconditions for good and safe care is that the basic hygiene routines are followed within the care. The application of good hand hygiene prevents the spread of infection and health-related infections. Care injuries can increase the length of care and cause suffering for the patient and are therefore a threat to safe care. Aim: To investigate the compliance of healthcare professionals to basic hygiene routines, in a medical emergency care department with a focus on hand hygiene. Method: A quantitative registry study with long-term follow-up has been performed. The data material was retrieved from the register for Measurement and Analysis (MOA). The observations were collected by hygiene observers at a medical emergency department in southern Sweden in 2013 - 2018. Data was imported into the statistical program SPSS. Descriptive and analytical statistics have been used for analysis. Results: In the analysis (n=491) it was found that the adherence to the hand hygiene has shortcomings, the assistant nurses show the highest adherence. Hand rub after patient contact was the element that showed the highest level of compliance. There are shortcomings in hand hygiene overtime as compliance was not hundred percent during all years. Conclusion: Adherence to hand hygiene is influenced by many factors. Good and safe care is dependent on the fact that healthcare professionals have knowledge of hand hygiene and the spread of infection. In order for healthcare professionals to improve preventive work towards safer care, the healthcare provider must contribute to new knowledge. Employees are responsible for maintaining and following that knowledge.

Introduction: Gestational diabetes mellitus (GDM) is a risk factor for developing type 2diabetes mellitus (T2DM). However, compliance to postpartum follow-up remains low.The new outcome-based International Association of Diabetes and Pregnancy StudyGroups (IADPSG)-criteria have led to a worldwide increase of GDM prevalence. Thepotential impact of the new IADPSG-critera on the frequency of T2DM/prediabetesdiagnosis, during follow-up of prior GDM-women in Örebro County, has not yet beenstudied. Aim: To investigate whether there is a difference in prevalence of prediabetes/T2DM inGDM-women two years postpartum, based on older GDM-criteria vs. the new lower IADPSG2010/WHO 2013-criteria, and to describe compliance to follow-up in primary health care(PHC). Methods: A retrospective cohort study of 108 GDM-women in Örebro County. Data obtainedfrom medical records: cardiometabolic risk factors, compliance data, outcomes withnormoglycemia used as comparison at follow-up. Results: T2DM and prediabetes were non-statistically significant higher in the old criteriagroup[11 (28.9%) vs. 6 (18.2%), p=0.289] and [12 (30.8%) vs. 5 (15.6%), p=0.137],respectively. Compliance to both 1st and 2nd follow-up was seen in 81 (75%) women. 96(88.9%) to first and 88 (81.5%) to second follow-up. An increase in mean BMI was seen frombaseline to PHC (31 vs. 31.7, p=0.014) as well as an increase in alcohol consumption [4(6.6%) vs. 23 (37.7%), p&lt;0.001]. Conclusions: GDM-diagnosis based on IADPSG-criteria did not show any statisticallysignificant difference in the prevalence of T2DM/prediabetes two years postpartum, whencompared to GDM-diagnosis based on old criteria. Moderate compliance to postpartumfollow-up was observed, with an increased number of dropouts. More research is needed inthis area, following implication of IADPSG-criteria.

Introduction Developmental dysplasia of the hip has since 1953 in Sweden most commonly been treated with the von Rosen splint. Over time, different types of splints have been developed, one of which is the Orebro splint. In some countries it is advised to have long-term follow-ups with radiological exams of patients treated with a splint. In Orebro, there is currently no mandatory follow-up after treatment with the Orebro splint. Aim The aims were to investigate how many children, despite treatment with the Orebro splint, developed dysplasia in the adolescence period, to study the hip function in children treated with the Orebro splint and investigate if there were any differences in treatment outcomes between males and females. Methods All children born between 2000 and 2012, treated with the Orebro splint, were eligible for inclusion. The outcome measures for quality of life and hip function were EQ-5D-Y-VAS and CHOHES score. The outcome measures for the pelvic radiological exams were Acetabular Index and Center Edge angle. Results Data from 46 patients were collected, 7 males and 39 females. 5,3% of the patients showed residual dysplasia. Both males and females showed overall good results in the radiological images, the surveys, and the clinical exams. The results did not show significant differences between the genders. Conclusion Even though our participants reported an overall good quality of life, our results showed some cases of residual dysplasia. However, the small sample size makes it difficult to assess whether the Orebro splint is equal to other splints regarding treatment outcomes.

Objective: To study the quality of life, jaw function and aesthetics in patients, at least 10 years after they have completed orthognathic treatment, in comparison with a control group. Material and Methods: The sample was retrieved from a previous study by Abrahamsson et al. The treatment group consisted of 94 consecutive patients (59 women and 35 men) with dentofacial deformities who were referred to Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden for orthognathic surgery. The average age of the treatment group was 22.4 ±7.6 years. The control group consisted of 53 individuals (30 women and 23 men, with mean age 23.4 ± 7.3) and was recruited from the Department of Oral Diagnostics in Dentistry University in Malmö and at the Public Dental Service in Oxie. A questionnaire including Oral health impact profile (OHIP-14), Jaw functional limitation scale (JFLS-8) and Orofacial aesthetic scale (OAS-8) supplemented with two questions directed to the treatment group was sent out to both the treatment and the control group. Result: The response rate was 57% (n=54) in the treatment group and 53% (n=28) in the control group. According to the result from OHIP-14 the quality of life was better in the treatment group in comparison with the control group. However, jaw function and orofacial aesthetics were comparable between the groups according to the results from JFLS-8 and OAS-8. The majority of the patients in this study were very satisfied with the result of orthognathic surgery at 10 years follow-up.Conclusion: Orthognathic treatment has been shown to be a successful treatment not only in term of jaw function and aesthetic but also in enhanced quality of life.

Die klinischen Langzeitergebnisse des vorderen Kreuzbandersatz mit dem Patellarsehnentransplantat nach durchschnittlich 13,8 Jahren waren nicht zufriedenstellend. Hauptursachen hierfür waren operativ-technische Mängel, wie Fehlpositionierung der Bohrkanäle und die Fixierung der Transplantate in einer zu hohen Kniebeugestellung. Diese Abweichungen führten zu signifikant schlechteren Bewegungsausmaßen sowohl in der Streckung als auch in der Beugung. Insbesondere bei zu weit ventral positionierter femoraler Bohrkanalanlage resultierte ein erhebliches Beugedefizit mit Stressbelastung auf das femorotibiale Kompartiment, ähnlich einem Nußknackerphänomen. Bei zu weit ventral positioniertem tibialen Bohrkanal wurde eine signifikante Verringerung der Extension beobachtet. Die Patienten mit gleichzeitiger Meniskusresektion hatten signifikant höhere arthrotische Veränderungen. Sowohl die zum damaligen Zeitpunkt allgemein anerkannte Operationstechnik als auch die postoperative Rehabilitation ist zeitlich überholt und entspricht nicht den gegenwärtigen internationalen Standards. In der experimentellen Untersuchung zum Einwachsverhalten einer autologen vorderen Kreuzbandplastik am Kaninchenmodell konnte der Einfluss und die Wirkung von manipulativ wirkenden Faktoren auf die Ausbildung eines stabilen Bindegewebsregenerates belegt werden. Sowohl der fibrinstabilisierende Faktor XIII als auch die eingesetzte Transplantat-Splitting-Technik zeigten eine positive Wirkung auf den Ein- und Umbau sowie den biomechanischen Ausrissfestigkeiten der Transplantate. Die alleinige Wirkung des Faktor XIII spielt vor allem in der Frühphase eine stimulierende Rolle auf die Initiierung der Umbauvorgänge und der ossären Intergration der Knochenblöcke. Mittel- und langfristig wird die Ausbildung von belastungsstabilen Kollagenfibrillen durch andere weitestgehend unbekannte Einflussfaktoren bestimmt. Die neuartig entwickelte Transplantat-Splitting-Technik erwies sich für den Transplantatumbau ebenfalls als vorteilhaft. Mit dieser Transplantatbearbeitung wurde die Grundlage für eine frühzeitige synoviale Ernährung der Bündel gewährleistet. Durch die artifizielle Gewebsläsion werden reparative Vorgänge beschleunigt. Auf der Grundlage der experimentell gewonnenen Daten kann die Transplantat-Splitting- Technik für die klinische Erprobung und Praxiseinführung empfohlen werden. / The clinical long term results mean 13,8 years after anterior cruciate ligament reconstructions with bone-patellar tendon-bone transplant were not satisfied. Main reasons were technical errors, malpositioning of the bone tunnels and fixation of the transplant in a too high degree of flexion. As a result the patients had significant reductions of motion in extension as well as in flexion. Especially in cases with an anterior femoral bone tunnel position the patients had a loss of flexion and high degree of shear forces in the femoro-tibial compartment similar a nutcracker phenomenon. In ACL reconstructions with an anterior tibial bone tunnel position could be observed a loss of extension. Patients with concomitant meniscal resection showed significant higher rate of osteoarthrotic changes. Both, the former operative technique and the postoperative rehabilitation programme had no clinical relevance today and are replaced by new standards. In an experimental study regarding to the remodeling process of an autologous anterior cruciate ligament plasty in a rabbit model could be examined factors which influencing the maturation process of the graft. The fibrin stabilizing factor XIII as well as the transplant splitting technique showed a positive effect in the remodelling process and the pull-out strength of the transplants. In the early phase the factor XIII activated the initial remodeling and the osseous ingrowth of the bone blocks. In middle and long term period of remodeling there plays unknown factors an important role for building of force restraint collagen fibrils. The new developed splitting technique had some additional advantages. Using these technique the basis of early synovial nutrition could be realized. The artificial tissue lesion leads to an acceleration of the reparative response. On the basis of the experimental data the transplant splitting technique can be recommended and introduce in the clinical trial.

Vaginismus is a sexual pain disorder, where spasm of musculature of the outer third of the vagina interferes with intercourse. Vaginismus exists in two forms: total vaginismus, where intercourse is impossible, and the more seldom described partial vaginismus, in which intercourse is possible but painful. The aim of the thesis was to develop a useful definition of partial vaginismus for both clinical and scientific purposes; to describe the prevalence of partial vaginismus among women with superficial coital pain; to report on symptoms and clinical findings in women with partial vaginismus; and to present treatment results for women with vaginismus. In a clinical sample of 224 women with superficial coital pain, we found a great overlap of the clinical diagnoses of partial vaginismus (PaV) and vulvar vestibulitis (VVS) (nowadays called provoked vestibulodynia); 102 women had both PaV and VVS. All women with VVS had vaginismus. Partial vaginismus was more common in all our samples than total vaginismus. sEMG of pelvic floor muscles was found to be of no value in distinguishing women with partial vaginismus with or without vulvar vestibulitis (PaV+/-VVS) (n=47) from each other or from an asymptomatic group (n=27). Women with PaV+/-VVS (n=53) reported not only burning pain but also itch during a standardized penetration situation (sEMG of pelvic floor muscles), while asymptomatic women (n=27) did not. In most cases, the appearance of burning pain preceded the appearance of itch. In a retrospective interview study, 24 women with PaV+/-VVS reported pain after intercourse more often than pain during penetration at the onset of the problem. When the women ceased having intercourse, both symptoms were equally common. Intensity of pain during penetration increased dramatically from very low at onset of the problem to very high when the women ceased having intercourse, while intensity of pain after intercourse was already high at onset of the problem and increased to very high when the women ceased having intercourse. Pain after intercourse in women with PaV+/-VVS was described as burning and/or smarting and lasted in mean for two hours, while pain during penetration was described with words like sharp/incisive/bursting and lasted for one minute. At long-term follow-up (more than three years) of a group of women treated with cognitive behaviour therapy for vaginismus (n=59, response rate 44/59 on a questionnaire), a majority were able to have and enjoy intercourse. The proportion of women with positive treatment outcome was, however, associated to the definition of treatment outcome. An ability to have intercourse at end of therapy was maintained at follow-up. Every tenth women with vaginismus healed spontaneously after thorough assessment. Conclusion: Partial vaginismus was more common in our studies than total vaginismus, and all women with vulvar vestibulitis had partial vaginismus. Women with PaV+/-VVS reported not only burning pain during standardized penetration but also itch. When the problem started in women with PaV+/-VVS, pain after intercourse was more common than pain during penetration. Pain after intercourse was described as longlasting and burning and/or smarting, while pain during penetration was described as short and sharp/incisive/bursting. Long-term follow-up results of a series of women treated with CBT for vaginismus show good treatment outcome.