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.

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.

Orientador: Marilza Vieira da Cunha Rudge / Resumo: Introdução: A nova ênfase no diagnóstico e tratamento da Diabetes Mellitus Gestacional (DMG) não é apenas para prevenir a morbidade e mortalidade perinatal, mas também representa a lacuna única de oportunidades para prover cuidados a longo prazo da mãe e do feto. Os efeitos de toda essa informação dada às mães sobre DMG no meio da gravidez e sua responsabilidade de gerenciar os fatores metabólicos intrauterinos por controle hiperglicêmico rigoroso enfrentam um estado de ansiedade e incerteza sobre problemas futuros atuais ou potenciais. Todos esses ajustes podem afetar a emoção, a mentalidade e a sexualidade aprovada pela declaração da Organização Mundial de Saúde como o direito fundamental para todas as pessoas. As dificuldades sexuais mais frequentes durante a gestação estão associadas a fatores psicológicos, físicos, relacionais, socioculturais e religiosos, bem como medos e mitos sobre a sexualidade feminina durante a gravidez. Objetivos: Este estudo foi projetado para investigar a função sexual usando índices de composição e pontuação específica do Inventário de Resposta Sexual de Gravidez (PSRI) em uma população bem categorizada de pacientes recentemente diagnosticados e sob tratamento de mulheres com Diabetes Mellitus Gestacional (GDM). Método: O presente estudo de coorte transversal foi composto por dois grupos, sendo um com 168 participantes no grupo de normoglicêmicas e outro com 108 participantes no grupo de hiperglicêmicas. Foi aplicado o questionário Pregnancy Se... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The new emphasis on the diagnosis and treatment of Gestational Diabetes Mellitus (GDM) is not only to prevent perinatal morbidity and mortality but also represents the unique gap in opportunities to provide long-term care for the mother and fetus. The effects of all this information given to mothers about GDM in the midst of pregnancy and their responsibility for managing the intrauterine metabolic factors for rigorous hyperglycemic control face a state of anxiety and uncertainty about current or potential future problems. All of these adjustments can affect the emotion, mentality and sexuality endorsed by the World Health Organization statement as the fundamental right for all people. The most frequent sexual difficulties during gestation are associated with psychological, physical, relational, sociocultural and religious factors, as well as fears and myths about female sexuality during pregnancy. Objectives: This study was designed to investigate sexual function using composite indexes and specific Pregnancy Sexual Response Inventory (PSRI) scores in a well-categorized population of newly diagnosed and under-treated women with GDM (Gestational Diabetes Mellitus). Method: The present cross-sectional cohort study consisted of two groups, one with 168 participants in the normoglycemic group and another with 108 participants in the hyperglycemic group. The Pregnancy Sexual Response Inventory (PSRI) questionnaire was applied to evaluate the sexual quality of pregnant women in th... (Complete abstract click electronic access below) / Mestre

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Agradecemos a compreensão. on 2018-03-26T11:52:57Z (GMT) / Submitted by Sthefanie Kenickel Nunes null (sthe.kenickel@hotmail.com) on 2018-03-26T14:03:21Z No. of bitstreams: 1 Mestrado_Sthefanie 21_03_2018.pdf: 1924452 bytes, checksum: 7a1d57df33375c0f0da9d5ccd226523c (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-26T15:18:11Z (GMT) No. of bitstreams: 1 nunes_sk_me_bot.pdf: 1924452 bytes, checksum: 7a1d57df33375c0f0da9d5ccd226523c (MD5) / Made available in DSpace on 2018-03-26T15:18:11Z (GMT). No. of bitstreams: 1 nunes_sk_me_bot.pdf: 1924452 bytes, checksum: 7a1d57df33375c0f0da9d5ccd226523c (MD5) Previous issue date: 2018-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: A nova ênfase no diagnóstico e tratamento da Diabetes Mellitus Gestacional (DMG) não é apenas para prevenir a morbidade e mortalidade perinatal, mas também representa a lacuna única de oportunidades para prover cuidados a longo prazo da mãe e do feto. Os efeitos de toda essa informação dada às mães sobre DMG no meio da gravidez e sua responsabilidade de gerenciar os fatores metabólicos intrauterinos por controle hiperglicêmico rigoroso enfrentam um estado de ansiedade e incerteza sobre problemas futuros atuais ou potenciais. Todos esses ajustes podem afetar a emoção, a mentalidade e a sexualidade aprovada pela declaração da Organização Mundial de Saúde como o direito fundamental para todas as pessoas. As dificuldades sexuais mais frequentes durante a gestação estão associadas a fatores psicológicos, físicos, relacionais, socioculturais e religiosos, bem como medos e mitos sobre a sexualidade feminina durante a gravidez. Objetivos: Este estudo foi projetado para investigar a função sexual usando índices de composição e pontuação específica do Inventário de Resposta Sexual de Gravidez (PSRI) em uma população bem categorizada de pacientes recentemente diagnosticados e sob tratamento de mulheres com Diabetes Mellitus Gestacional (GDM). Método: O presente estudo de coorte transversal foi composto por dois grupos, sendo um com 168 participantes no grupo de normoglicêmicas e outro com 108 participantes no grupo de hiperglicêmicas. Foi aplicado o questionário Pregnancy Sexual Response Inventory.(PSRI) com a finalidade de avaliar a qualidade sexual das gestantes no terceiro trimestre gestacional. Foi analisado "por domínio" e a pontuação "geral" que variam de 0 (pior) até 100 (o melhor) e a pontuação final será proposta em categorização dividida em quartis como 0 <25 em "muito ruim", 25 <50 em "ruim", 50 <75 em "bom" e 75 a 100 em "excelente". Análise de dados: Ao término da coleta de dados, os resultados obtidos nos diferentes momentos foram compilados. A consistência interna e confiabilidade dos itens do PSRI de cada domínio foi avaliada por meio do coeficiente alfa de Cronbach. A comparação entre os valores de domínios classificados por trimestre foi avaliada pelo teste Wilcoxon e a comparação entre as medias foi avaliada pelo Teste-t. Para as variáveis quantitativas foi realizado o Teste t para dados com distribuição normal e com distribuição gama para variáveis com distribuição assimétrica. As associações entre as variáveis qualitativas serão feitas por meio de tabelas de contingência, com aplicação de teste qui-quadrado ou exato de Fisher. Todos os dados foram analisados usando o software estatístico SAS versão 9.2. Foi aplicado o cálculo para verificar o escore específico de cada um dos domínios. Resultados: A versão completa do PSRI em português brasileiro foi respondida por 276 mulheres grávidas, sendo 108 no grupo DMG e 168 no grupo não-DMG e os escores compostos de PSRI foram significativamente menores no grupo DMG em comparação com o grupo não-DMG (41,2 ± 17,3 versus 54,5 ± 15,0, P = <0001). De acordo com esses resultados, o grupo DMG no terceiro trimestre da gravidez apresenta menores escores de função sexual do que o grupo não-DMG. Conclusão: Os resultados deste estudo fornecem evidências adicionais de que as gestantes do grupo DMG foram mais propensas a reportar disfunção sexual causada pelo impacto adicional de todos os aspectos que transformam a gravidez normal em importante e súbito prejuízo com grande sofrimento para a mãe e sua família. / The new emphasis on the diagnosis and treatment of Gestational Diabetes Mellitus (GDM) is not only to prevent perinatal morbidity and mortality but also represents the unique gap in opportunities to provide long-term care for the mother and fetus. The effects of all this information given to mothers about GDM in the midst of pregnancy and their responsibility for managing the intrauterine metabolic factors for rigorous hyperglycemic control face a state of anxiety and uncertainty about current or potential future problems. All of these adjustments can affect the emotion, mentality and sexuality endorsed by the World Health Organization statement as the fundamental right for all people. The most frequent sexual difficulties during gestation are associated with psychological, physical, relational, sociocultural and religious factors, as well as fears and myths about female sexuality during pregnancy. Objectives: This study was designed to investigate sexual function using composite indexes and specific Pregnancy Sexual Response Inventory (PSRI) scores in a well-categorized population of newly diagnosed and under-treated women with GDM (Gestational Diabetes Mellitus). Method: The present cross-sectional cohort study consisted of two groups, one with 168 participants in the normoglycemic group and another with 108 participants in the hyperglycemic group. The Pregnancy Sexual Response Inventory (PSRI) questionnaire was applied to evaluate the sexual quality of pregnant women in the third trimester of pregnancy. It was analyzed by "domain" and the "general" score ranging from 0 (worst) to 100 (best) and the final score will be proposed in categorization divided into quartiles as 0 <25 in "rubbish", 25 <50 in "bad", 50 <75 in “good" and 75 to 100 in "excellent". Data analysis: At the end of the data collection, the results obtained in the different moments were compiled. The internal consistency and reliability of PSRI items in each domain was assessed using the Cronbach alpha coefficient. The comparison between the values of domains classified by quarter was evaluated by the Wilcoxon test and the comparison between the means was evaluated by the t-Test. For the quantitative variables, the t test was performed for data with normal distribution and with gamma distribution for variables with asymmetric distribution. The associations between the qualitative variables will be made by means of contingency tables, with application of chi-square test or Fisher's exact test. All data were analyzed using statistical software SAS version 9.2. The calculation was applied to verify the specific score of each of the domains. Results: The complete version of PSRI in Brazilian Portuguese was answered by 276 pregnant women, 108 in the DMG group and 168 in the non-DMG group, and the PSRI scores were significantly lower in the DMG group compared to the non-DMG group ( 41.2 ± 17.3 versus 54.5 ± 15.0, P = <10001). According to these results, the DMG group in the third trimester of pregnancy has lower sexual function scores than the non-DMG group. Conclusions: The results of this study provide additional evidence that pregnant women in the DMG group were more likely to report sexual dysfunction caused by the additional impact of all aspects that make normal pregnancy an important and sudden injury with great suffering for the mother and her family.

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.

There have been various approaches to the treatment of nonorgasmic women, including psychoanalysis, desensitization, relaxation, masturbation, and group therapy. The present study was conducted to examine the efficacy of group therapy combined with home-based training in the treatment of primary nonorgasmic women. A no-treatment control group was also employed. Treatment consisted of two weekly 1- hour group sessions for 5 weeks. Educative processes were employed, such as detailed information on physiology of female sexual response. Structured homework exercises were also utilized, such as mastubatory techniques, role-playing orgasm, strengthening vaginal muscles, and assertiveness training in sexual and nonsexual situations. Results indicated an 88% success rate in the treatment group and no change in the control group.

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