EHWA GUTING   Guting, E. Unga kvinnors upplevelser av behandling av  vulvasmärta. Masteruppsats i sexologi, 30 högskolepoäng. Malmö universitet:  Fakulteten för hälsa och samhälle, 2019   Många unga kvinnor upplever smärta i samband med penetrerande sex med partner och det är en frågeställning som dyker upp allt oftare på ungdomsmottagningar. Tidigare forskning har främst fokuserat på olika behandlingsmetoder och det har saknats studier som visar på unga kvinnors egna upplevelser av behandling av vulvasmärta. Syftet med denna studie var att öka förståelsen för hur unga kvinnor med vulvasmärta upplever och förhåller sig till behandling på ungdomsmottagning samt vad som bidragit till förändring av egna sexuella skript. Semi-strukturerade intervjuer genomfördes med nio kvinnor mellan 19 och 24 år som hade fått behandling för vulvasmärta vid olika ungdomsmottagningar. Teorin om sexuella skript användes för analys och förståelse om unga kvinnors sätt att agera sexuellt med sig själva och i relation till partners. Analysen av hela materialet utmynnade i ett gemensamt tema: Agent att kunna välja. Detta tema visade på en vilja och önskan hos unga kvinnor att ha möjlighet att göra egna val i behandling, sexuellt och med sig själv. Resultatet visade teman som behandlarens tillgänglighet och bemötande, stöd och kommunikation med partner, kunskap och medvetenhet om kroppen samt ökat fokus på egna behov. Studien visade också på att även om kvinnorna hittat alternativa sätt att vara sexuella med partner kvarstår ambivalens till att bryta penetrationsnormen. Tidiga interventioner och erbjudande att träffa behandlingspersonal ur flera professioner för fler perspektiv kan bidra till kunskap och understödja eget sexuellt agentskap. Kontinuerlig uppföljning i behandling kan behövas för att unga kvinnor ska få möjlighet att utforska sina egna sexuella skript och även tillsammans med partners.    Nyckelord: behandling, rådgivning, sexualitet, sexuellt skript, ungdomar, vulvasmärta / YOUNG WOMEN'S EXPERIENCE OF TREATMENT OF VULVODYNIA    EHWA GUTING Guting, E. Young women's experiences of treatment of vulvodynia. Master degree project, 30 Credits. Malmö University: Faculty of Health and Society. 2019. Many young women experiencing pain during vaginal sex with partners seem to be more occurring at youth clinics today. Young women need more knowledge of their own sexuality and how to be sexual active with partners. The aim of this study was to increase the knowledge of how young women with vulvodynia experience and relate to treatment at youth clinics and what may have contributed to change regarding their sexual script.  Semi-structured interviews were conducted with nine women between the ages of 19-24 years from different cities of Sweden who had been received treatment at youth clinics. A semi-structured interview format was used with themes related to the aim of the study. The study utilized scripting theory to analyze and understand how young women act sexually by themselves and with partners. One main theme emerged: The agency to choose. This theme is indicated by the desire of young women to be able to make their own choices as in taking responsibility for their treatment, sexually, and/or for themselves. Important findings were the clinician’s, availability and personal treatment; support and their communication with partners; increased knowledge and awareness of their own body, and ability to focus on their own needs. The result also indicated that there were an awareness of norms regarding vaginal sex, but there is still ambivalence considering alternative ways of having sex with partner. The participants who expressed acceptance and empower were regarded most satisfied with the treatment. Youth clinics should also strive for making it favourable for young women to explore their sexual script in offering continuity in their treatment. This should include early interventions and offering of multiprofessional treatments to contribute increased knowledge and support for own sexual agency.   Keywords: adolescents, counselling, sexuality, sexual script, treatment, vulvar pain

Women with chronic vulvar pain report reduced sexual function in comparison to non-affected women, including decreased sexual arousal. Experimentally induced sexual arousal has been examined in women with and without chronic vulvar pain, with contradictory results: some studies have found that only subjective arousal is affected in women with versus without vulvar pain, while other research has suggested that only genital responsiveness is affected in women with pain. As a result of these inconsistent findings, the role of arousal mechanisms in the causation and maintenance of provoked vestibulodynia (PVD) remains unclear. Thirty women with (n = 15) and without PVD (n = 15) were recruited to examine the relationship among physiological and subjective arousal, pain sensitivity and psychological/sexual function. Laser Doppler imaging (LDI) directly measured blood flow to the external genitals in response to an erotic film, and pain sensitivity was assessed before and after imaging. The PVD group had significantly lower blood flow than the control group during the erotic film when baseline blood flow levels were controlled; there were, however, no group differences in ratings of subjective arousal during the erotic film. Vestibular pain thresholds were significantly lower in the PVD group before and after the erotic film compared to the control group. In contrast, pain intensity ratings were significantly higher pre-erotic film in the PVD group, but there was no group difference post-erotic film. Pain thresholds did not significantly change in either group following exposure to the erotic film. Lastly, the PVD group had significantly lower sexual and psychological function in comparison to the control group, and intercourse frequency and pain catastrophizing significantly predicted genital responsiveness in the PVD group. The results suggest that women with PVD show an attenuated physiological response to erotic stimuli in an experimental setting, in the absence of differences in subjective arousal. The findings thus support the role of arousal in the maintenance of PVD, potentially in interaction with other physical and psychological factors. The study also has implications for the assessment and treatment of PVD, whereby arousal processes should be explicitly and separately managed in women with this condition. / Thesis (Master, Psychology) -- Queen's University, 2009-09-10 12:17:44.952

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Provoked vestibulodynia (PVD) is the most common form of vulvodynia affecting 12% of pre-menopausal women in the general population. It is commonly described as a sharp or burning pain at the entrance of the vagina in response to contact or pressure to the vulvar vestibule. PVD has negative impacts on sexual functioning, relationship adjustment, psychological well-being, and overall quality of life. Studies suggest that increased muscle tension in the pelvic floor of women with PVD may play an important role in maintaining and exacerbating their pain. Despite this finding, no prospective studies of pelvic floor physiotherapy (PFP) for PVD have been carried out. The purpose of the current study was to prospectively examine the effectiveness of a comprehensive PFP intervention in treating the physical and psychosexual components of PVD. Thirteen women with PVD completed 8 sessions of PFP. Women were assessed at pre- and post-treatment via gynecological examinations, vestibular pain threshold testing, structured interviews and standardized questionnaires measuring pain variables (pain during intercourse, McGill Pain Questionnaire, Pain Disability Index), cognitive variables (Pain Catastrophizing Scale, Pain Anxiety Symptom Scale-20, coping strategies), and sexual function (frequency of intercourse, Female Sexual Function Index). To-date, ten women have also completed a 3-month follow-up interview. Results indicated that vestibular pain thresholds significantly increased from pre- to post-treatment, indicating reduced pain sensitivity. As compared with pre-treatment, women reported significant reductions in pain intensity during the gynecological examination and during intercourse. Women also significantly improved on measures of negative pain cognitions and various components of sexual function. There were no changes with respect to mental health or quality of life. The treatment was considered to be successful for 10 (77%) of the 13 women and treatment satisfaction was rated very high. Predictors of successful treatment outcome at the follow-up period were a longer period of time in treatment and decreases in pain catastrophizing and pain-related anxiety. Results provide preliminary support for the effectiveness of PFP in treating the physical and psychosexual components of PVD. These findings indicate the need for large-scale, randomized studies of the effectiveness of PFP in comparison and in conjunction with other treatment options. / Thesis (Master, Psychology) -- Queen's University, 2008-09-12 11:04:06.501

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

Based on thirteen months of ethnographic fieldwork in a large research hospital in the U.S., this dissertation analyzes the experiences of eighty American women seeking relief for chronic genital pain. Through extended interviews with diagnosed women, and participant-observation in a vulvar speciality clinic, I investigate the barriers--linguistic, cultural and corporeal--faced by patients who must engender greater familiarity and comfort with their sexual and genital bodies in order to successfully recover from their symptoms. Written as a cultural analysis of the vulva, the dissertation examines the ambivalent relationships between female external genitalia, U.S. dominant culture, and an autonomous female sexuality. Attentive to the transgression, confusion and disorder evoked by the symptoms of vulvar pain, the dissertation redefines the clinical diagnostic phrase "other causes of genital discomfort" in sociolcultural terms. The concepts of "genital dis-ease" and "unwanted genital experience" are introduced and analyzed as corporeo-cultural phenomena that contribute to a profound sense of alienation between many diagnosed women and their genital bodies. In addition to an extended introduction and a description of both the clinical fieldsite and conditions under investigation, the dissertation uses four progressive chapters--Accumulation, Manifestation, Integration and Generation--to theorize the lived experience of vulvar pain. Through a critical dialogue with current clinical literature, through which vulvar pain is understood in increasingly physiological terms, the dissertation argues that an acknowledgment of collective and cultural genital "discomfort" must be included in the emerging diagnostic and treatment regimens for women with chronic and unexplained genital pain. / text