Week 8 Flashcards
What are five sexual complaints women report?
Dyspareunia
Vaginismus
Orgasmic problems
Reduced sexual desire
Arousal problems
What is needed for a genito-pelvic pain / penetration disorder (GPPPD) diagnoses?
At least one of the following:
- difficulty with penetration
- vaginal or pelvic pain during (attempted) penetration
- anxiety about anticipation of pain / during penetration
- tensing of the pelvic floor during (attempted) penetration
and all the obvious DSM-5 criteria (significant distress, etc.)
What causes pain in dyspareunia?
Tampon, penis, finger, cycling, tight clothes, inserting/during/after penetration
What describes the pain in dyspareunia?
Burning
What is provoked vulvodynia (PVD)?
Specific type of dyspareunia, largest part of people with dyspareunia.
- Somatic cause excluded
- Localized; provoked; burning sensation; superficial (not deep); intermittent (not continuous)
What does the circle of pain look like?
Pain –> catastrophic thoughts –> pain-related fear –> decreased arousal + increased muscle tension –> decreased lubrication + increased tension pelvic floor –> mechanical friction –> vulvar skin irritated –> pain
What does the circle of pain result in?
Lowered sexual desire
What does assessment in dyspareunia look like?
- Physical research first
- Pain (intensity, onset, duration, location, what hurts)
- Cognitive-behavioral factors
- Partner and relationship factors
- Impact on sexual functioning
- Pelvic floor complaints (bladder and bowel routine)
- Earlier treatment
- Request for help
What is an important first step in CBT therapy for someone with dyspareunia?
Stopping painful behaviors first
What options are available for treating dyspareunia?
CBT, surgery, pelvic floor physiotherapy
What are the main goals in treating dyspareunia?
Reducing pain and improving sexual functioning
What are six important factors to focus on in treating dyspareunia?
- Pelvic floor relaxation
- Fear of pain
- Partner relationship
- Stopping the vicious circle of pain
- Self-efficacy
- Sexual desire and arousal
What are six treatments for dyspareunia?
- Vulvar skin creme
- Mindfulness and relaxation exercises
- Gradual exposure
- Psycho education
- Prohibition pain / intercourse
- Searching for sexual stimuli
What is vaginismus?
Not being able to put anything in the vagina, despite the wish to do so. Somatic cause is excluded.
What is the prevalence of vaginismus?
1 - 6 %
What social factors can induce or cause vaginismus (indirectly)? How?
Conservative religions. Women experience pressure or stress because of the strict rules for sex before marriage.
Vaginismus is a dysfunction of the pelvic floor. True or false?
False, but the pelvic floor is involved.
What moderates vaginismus?
History of sexual abuse
What does the circle of fear for vaginismus look like?
Penetration attempt –> catastrophic thoughts –> fear –> increased tension pelvic floor –> penetration impossible –> penetration attempt
What is an important consequence of fear in the circle of fear for vaginismus?
Avoidance
What are five forms of treatment for vaginismus?
- Gradual exposure
- Bibliotherapy (selfhelpbook with calls)
- Relaxation / mindfulness exercises
- Searching for sexual stimuli
- Psycho education
What kind of treatment has the best results for vaginismus? What is this related to in the circle of fear?
Penetration exposure. This is related to stopping with avoiding fearful behavior.
What is one thing exposure therapy does not help with?
Increasing positive beliefs
