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<p><em>Vaginism är ett sexuellt problem som förekommer hos kvinnor och som i tidigare utvärderade behandlingar betraktats som kvinnans problem. Forskning inom området vaginism är begränsad och kunskap om parrelationens roll för vidmakthållandet av problematiken och upplevd relationstillfredsställelse saknas. Studiens syfte var att utforma en parbehandling där kommunikationsinterventionen validering lärs ut som färdighet, utforska om det fanns ett intresse för deltagande, samt utvärdera om behandlingen kan påverka relationskvalitet och individuellt välbefinnande. Studien använde en single subject design där ett par fullföljde behandlingen. Resultatet visar ett begränsat intresse för deltagande och ingen större effekt av interventionen. Validering är en outforskad intervention som behöver utvärderas vidare inom området parbehandling. Att erbjuda parbehandling för par där kvinnan har vaginism är utmanande.</em></p> / <p><em>Vaginismus is a sexual problem that occurs in women. In previous evaluated studies it has been regarded as a problem belonging to the woman. The field of science is limited and the knowledge about the role of couple interaction for the maintaining factors of the problem and couple satisfaction is unknown. The aim of the study was to design a couple treatment where the communication skill validation, is learned, investigate if there where an interest for participating, and evaluate if treatment affect relationship satisfaction and individual well-being. The study has a single-subject design where one couple completed the treatment. The result shows that there was a limited interest for participating and no visible effect of the intervention. Validation is an unexplored intervention that needs to be evaluated further in the area of couple treatments. To offer couple treatment for couples where the woman has vaginismus is challenging. </em></p>

Vaginism är ett sexuellt problem som förekommer hos kvinnor och som i tidigare utvärderade behandlingar betraktats som kvinnans problem. Forskning inom området vaginism är begränsad och kunskap om parrelationens roll för vidmakthållandet av problematiken och upplevd relationstillfredsställelse saknas. Studiens syfte var att utforma en parbehandling där kommunikationsinterventionen validering lärs ut som färdighet, utforska om det fanns ett intresse för deltagande, samt utvärdera om behandlingen kan påverka relationskvalitet och individuellt välbefinnande. Studien använde en single subject design där ett par fullföljde behandlingen. Resultatet visar ett begränsat intresse för deltagande och ingen större effekt av interventionen. Validering är en outforskad intervention som behöver utvärderas vidare inom området parbehandling. Att erbjuda parbehandling för par där kvinnan har vaginism är utmanande. / Vaginismus is a sexual problem that occurs in women. In previous evaluated studies it has been regarded as a problem belonging to the woman. The field of science is limited and the knowledge about the role of couple interaction for the maintaining factors of the problem and couple satisfaction is unknown. The aim of the study was to design a couple treatment where the communication skill validation, is learned, investigate if there where an interest for participating, and evaluate if treatment affect relationship satisfaction and individual well-being. The study has a single-subject design where one couple completed the treatment. The result shows that there was a limited interest for participating and no visible effect of the intervention. Validation is an unexplored intervention that needs to be evaluated further in the area of couple treatments. To offer couple treatment for couples where the woman has vaginismus is challenging.

Made available in DSpace on 2016-04-28T20:40:04Z (GMT). No. of bitstreams: 1 Melina Serra.pdf: 2242068 bytes, checksum: 30be35b07de632805e2a2638dce6d946 (MD5) Previous issue date: 2009-04-27 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The vaginismus is characterized by ICD-10 (1993) as a spasm of muscles surrounding the vagina, causing occlusion of the vaginal opening, making possible the penetration of the penis or painful. Since 1990, the World Health Organization says the sex as one of the pillars for ensuring the quality of life. This study sought to understand how women, with vaginismus diagnoses and living in the city of São Paulo experience quality of life, from Psychology phenomenological approach. Four women participated in this research, aging between 34 and 43 years. The instruments used were: WHOQOL-bref, Instrument of Self-Perceived Quality of Life (Serra and Bassani) and open interview. Data were analyzed from the features of human existence - being in the world, temporalizing, and choose spatialization (Forghieri, 2004). The data indicated that sexual disorders affect any of the participants. The vaginismus seems to underline the world of these women, in their relationships with the environment, with others or with themselves. Most of the participants can live with keeping their experiences, expanding their temporalizing. They reported having lived alternatives ways of existence, with a prevalence of concerned and focused; information about sexual disorders and treatment options can provide a better understanding of the vaginismus, in order to facilitate the achievement of choices. This study indicates that: 1) the vaginismus affects all areas of life of these participants, with more intensity: health, sexual and emotional ones. 2) Health, sexual, family and social affairs, are the areas most directly affected on the overall assessment of quality of life. 3) getting information, understanding of the disorder and being able to attend to properly treatment, can promote the welfare of participants. 4) The resolution of the complaint of vaginismus influences the improvement and new meanings for quality of life / O vaginismo é caracterizado pela CID-10 (1993) como um espasmo dos músculos que circundam a vagina, causando oclusão da abertura vaginal, tornando a penetração do pênis impossível ou dolorosa. Desde 1990, a Organização Mundial de Saúde ressalta o sexo como um dos pilares para garantia de qualidade de vida. O presente estudo buscou compreender, a partir de um olhar fenomenológico, como mulheres moradoras no Estado de São Paulo e diagnosticadas com vaginismo, vivenciam a qualidade de vida em seu dia-a-dia. Participaram quatro mulheres, entre 34 e 43 anos. Os instrumentos utilizados foram: Questionário de Qualidade de Vida (WHOQOL-bref), Instrumento de Auto-Percepção de Qualidade de Vida (Serra e Bassani) e entrevista aberta. Os dados foram analisados a partir das características do existir humano ser-no-mundo, temporalizar, espacializar e escolher (Forghieri, 2004). Os dados obtidos ressaltam que a disfunção sexual afeta o existir das participantes. O vaginismo parece permear o ser-no-mundo dessas mulheres, seja nas relações com o ambiente, com outras pessoas ou consigo mesmas. A maioria das participantes consegue vivenciar com sintonia suas experiências, expandindo o temporalizar. Alternam as maneiras de existir, com prevalência das preocupada e sintonizada; Informações sobre a disfunção sexual e opções de tratamento proporcionam uma melhor compreensão do vaginismo, facilitando a realização de escolhas. Este estudo indica que: 1) O vaginismo afetou todos os âmbitos da vida das participantes, com mais intensidade os de saúde, sexual e emocional. 2) Os âmbitos que influenciaram diretamente a avaliação geral de qualidade de vida variaram para cada participante, destacam-se os âmbitos: saúde, sexual, familiar e social. 3) Obter informações, compreender a disfunção e ter a possibilidade de fazer tratamento, favorecem o bem-estar das participantes. 4) A resolução da queixa de vaginismo influencia na melhoria e na avaliação da qualidade de vida

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.

Enligt forskning har kvinnor en högre rädsla för brott än män. En förklaring är att kvinnors rädsla för sexuella brott ökar rädslan för alla typer av brott. Andra faktorer som har visat sig påverka rädsla för brott är fysisk och psykisk ohälsa. Dessa faktorer och teorin om att kvinnors rädsla för brott påverkas av rädsla för sexuella brott kan innebära att smärtsjukdomar som vulvodyni och vaginism som innebär svår smärta vid penetration och / eller beröring av slidan gör att kvinnor som lider av det kan uppleva en högre rädsla av brottslighet än andra kvinnor. Studiens syfte var att undersöka om vulvodyni har en inverkan på kvinnors rädsla för brott. Deltagarna bestod av 243 kvinnor (medelålder= 24,58, SD= 5,15) med (n=129) och utan (n=114) vulvodyni. Resultaten av studien indikerar att vulvodyni påverkar rädsla för brott och gör kvinnor som lider av den mer rädda för brott än de utan vulvodyni. Kvinnor med vulvodyni har också en högre rädsla för sexualbrott som våldtäkt och sexuella trakasserier. Vulvodyni visar på en unik association till rädsla för brott vid kontroll över andra variabler som tidigare forskning visat samband med rädsla för brott. Rädsla för sexualbrott visar också associationer med rädsla för andra brott hos kvinnor med och utan vulvodyni. Mer forskning om ämnet behövs för att se hur kvinnor med vulvodyni resonerar om sin rädsla för brott. / According to research, women have a higher fear of crime than men. one explanation is that women's fear of sexual offenses increases the fear of all types of crime. Other factors that have been shown to affect fear of crime are physical and mental health. The factors and the theory that women's fear of crime is affected by fear of sexual offenses could mean that pain diseases such as vulvodynia and vaginism that involve severe pain when penetrating and/or touching the vagina make women who suffer from it to have a higher fear of crime than other women. The purpose of the study was to investigate if vulvodynia has an impact on women's fear of crime. The study sample consisted of 243 women (mean age=24,58, SD= 5,15) with (n= 129) and without (n=114) vulvodynia. The results of the study indicate that vulvodynia affects fear of crime and makes women who suffer from it more afraid of crime than those without. Women with vulvodynia also have a higher fear of sexual offenses such as rape and sexual harassment. Vulvodynia also demonstrates having a unique compound to fear of crime proud control for other variables. Fear of sexual crime also shows associates of fear to other types of crimes for women with and without vulvodynia. More research on the subject is needed to see how women with vulvodynia reason about their fear of crime.

Syfte: Det saknas kunskap om samband mellan vaginism och bruxism. Syftet med studien var att studera förekomst av orala parafunktioner och bruxism hos kvinnor med vaginism i jämförelse med kvinnor utan vaginism. Studien syftar även till att undersöka eventuella skillnader kring smärta, stress och somatiska besvär mellan grupperna. Metod: En enkätstudie där en modifierad version av DC/TMD axel II, delades ut till patienter som sökt barnmorska. Resultat: Bland de 26 svarande fanns en tendens till ökade dagliga parafunktioner som att pressa tänder under vaken tid, vilket kunde ses i deltagargruppen med vaginism i jämförelse med kontrollgruppen. Smärta som skulle kunna relateras till TMD och parafunktioner var mer frekventa samt mer uttalade i deltagargruppen med vaginism. Deltagargruppen med vaginism hade även en antydan till mer stress, oro samt somatiska besvär.Konklusion: Den viktigaste slutsatsen utifrån utförd studie är att det inte tydligt skiljer sig mellan en grupp individer med vaginism och en kontrollgrupp avseende bruxism. Deltagargruppen med vaginism har en tendens till mer förekommande orala parafunktioner. TMD smärta är mer förekommande i deltagargruppen med vaginism vilket eventuellt kan vara en orsak av ökade parafunktioner. Båda grupperna hade förekomst av psykosociala riskfaktorer för bruxism, dock var de något mer frekventa i experimentgruppen. Det finns ingen tidigare forskning kring sambandet mellan vaginism och bruxism varvid denna studie med endast ett fåtal deltagare skulle kunna ses som en pilotstudie, vilken kan bidra till att öppna upp för interdisciplinär forskning i ämnet. / Aim: There is a lack of knowledge regarding the relationship between vaginismus and bruxism. The purpose of the study was to investigate the occurrence of bruxism and oral parafunctions in women with vaginismus in comparison to women without vaginismus. The study also aimed to investigate possible differences in pain, stress and somatic disorders between the groups.Method: The survey was executed with a modified version of DC/TMD Axis II, and was distributed to patients seeking care from a midwife.Results: Among the 26 respondents, there was a tendency for increased parafunctions, such as clenching teeth during awake time in the vaginismus group of participants. Pain that could be related to TMD and parafunctions were more frequent and more apparent in the group with vaginismus. The group with vaginismus also had a hint of more stress, anxiety and somatic problems.Conclusion: The most important conclusion from the study is that there is no clear difference between a group of individuals with vaginismus and a control group regarding TMD. The group with vaginismus had a tendency of more oral parafunctions. TMD pain is more common in the group with vaginismus, which might be caused by increased parafunctions. Both groups had psychosocial risk factors for bruxism, however, they were somewhat more frequent in the experimental group. There is no previous research on the relationship between vaginismus and bruxism, this study with only a few participants could be seen as a pilot study, which could help open up interdisciplinary research on the subject.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.