This study compared group cognitive-behavioral therapy (12-week trial), surface electromyographic biofeedback (12-week trial), and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Subjects were 78 women randomly assigned to one of three treatment conditions and assessed at pretreatment, posttreatment and 6-month follow-up via gynecological examinations, structured interviews and standard questionnaires pertaining to pain (Pain Rating Index and Sensory scale of the McGill Pain Questionnaire, vestibular pain index, pain during intercourse), sexual function (Sexual History Form, frequency of intercourse, Information subscale of the Derogatis Sexual Functioning Inventory), and psychological adjustment (Brief Symptom Inventory). As compared with pretreatment, study completers of all treatment groups reported statistically significant reductions on pain measures at posttreatment and 6-month follow-up, although the vestibulectomy group was significantly more successful than the two other groups. However, the apparent superiority of vestibulectomy needs to be interpreted with caution since seven women who had been assigned to this condition did not go ahead with the intervention. All three groups significantly improved on measures of psychological adjustment and sexual function from pretreatment to 6-month follow-up. Intent-to-treat analysis supported the general pattern of results of analysis by-treatment-received. Findings suggest that women with dyspareunia can benefit from both medical and behavioral interventions.
The emotional impact of the intrusiveness of illness and patients' reduced control over several aspects of life were examined in the context of end-stage renal disease. A sample of thirty-five hemodialysis, ten continuous ambulatory peritoneal dialysis (CAPD), and twenty-five posttransplant patients participated in a standardized interview in which a series of eight self-report measures of positive and negative mood, life happiness, self-esteem, depression, and somatic symptoms of distress were obtained. Attending staff also completed a depression rating scale for each participant. Data reduction via principal-components analysis yielded two factors, corresponding to negative and positive mood, and these were submitted to covariance analyses in which age, general nonrenal health, and defensiveness were controlled statistically. Patients' perceptions of increased intrusiveness, and their perception of limited control over eleven life dimensions, each correlated significantly and uniquely with increased negative and decreased positive mood, suggesting that each of these two factors contributes importantly and independently to patients' distress. An "objective" continuum of intrusiveness, constructed by ranking the various treatment modalities represented in the sample, also related significantly to positive (but not to negative) mood levels.
This study investigated the roles of vaginal spasm, pain, and behavior in vaginismus and the ability of psychologists, gynecologists, and physical therapists to agree on a diagnosis of vaginismus. Eighty-seven women, matched on age, relationship status, and parity, were assigned to one of three groups: vaginismus, dyspareunia resulting from vulvar vestibulitis syndrome (VVS), and no pain with intercourse. Diagnostic agreement was poor for vaginismus; vaginal spasm and pain measures did not differentiate between women in the vaginismus and dyspareunia/VVS groups; however, women in the vaginismus group demonstrated significantly higher vaginal/pelvic muscle tone and lower muscle strength. Women in the vaginismus group also displayed a significantly higher frequency of defensive/avoidant distress behaviors during pelvic examinations and recalled past attempts at intercourse with more affective distress. These data suggest that the spasm-based definition of vaginismus is not adequate as a diagnostic marker for vaginismus. Pain and fear of pain, pelvic floor dysfunction, and behavioral avoidance need to be included in a multidimensional reconceptualization of vaginismus.
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