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Yitzchak M. Binik - One of the best experts on this subject based on the ideXlab platform.
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Can Fear, Pain, and Muscle Tension Discriminate Vaginismus from Dyspareunia/Provoked Vestibulodynia? Implications for the New DSM-5 Diagnosis of Genito-Pelvic Pain/Penetration Disorder
Archives of Sexual Behavior, 2015Co-Authors: Marie-andrée Lahaie, Rhonda Amsel, Samir Khalifé, Stephanie Boyer, Marie Faaborg-andersen, Yitzchak M. BinikAbstract:Fear has been suggested as the crucial diagnostic variable that may distinguish vaginismus from Dyspareunia. Unfortunately, this has not been systematically investigated. The primary purpose of this study, therefore, was to investigate whether fear as evaluated by subjective, behavioral, and psychophysiological measures could differentiate women with vaginismus from those with Dyspareunia/provoked vestibulodynia (PVD) and controls. A second aim was to re-examine whether genital pain and pelvic floor muscle tension differed between vaginismus and Dyspareunia/PVD sufferers. Fifty women with vaginismus, 50 women with Dyspareunia/PVD, and 43 controls participated in an experimental session comprising a structured interview, pain sensitivity testing, a filmed gynecological examination, and several self-report measures. Results demonstrated that fear and vaginal muscle tension were significantly greater in the vaginismus group as compared to the Dyspareunia/PVD and no-pain control groups. Moreover, behavioral measures of fear and vaginal muscle tension were found to discriminate the vaginismus group from the Dyspareunia/PVD and no-pain control groups. Genital pain did not differ significantly between the vaginismus and Dyspareunia/PVD groups; however, genital pain was found to discriminate both clinical groups from controls. Despite significant statistical differences on fear and vaginal muscle tension variables between women suffering from vaginismus and Dyspareunia/PVD, a large overlap was observed between these conditions. These findings may explain the great difficulty health professionals experience in attempting to reliably differentiate vaginismus from Dyspareunia/PVD. The implications of these data for the new DSM-5 diagnosis of Genito-Pelvic Pain/Penetration Disorder are discussed.
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can fear pain and muscle tension discriminate vaginismus from Dyspareunia provoked vestibulodynia implications for the new dsm 5 diagnosis of genito pelvic pain penetration disorder
Archives of Sexual Behavior, 2015Co-Authors: Marie-andrée Lahaie, Rhonda Amsel, Samir Khalifé, Stephanie C Boyer, Marie Faaborgandersen, Yitzchak M. BinikAbstract:Fear has been suggested as the crucial diagnostic variable that may distinguish vaginismus from Dyspareunia. Unfortunately, this has not been systematically investigated. The primary purpose of this study, therefore, was to investigate whether fear as evaluated by subjective, behavioral, and psychophysiological measures could differentiate women with vaginismus from those with Dyspareunia/provoked vestibulodynia (PVD) and controls. A second aim was to re-examine whether genital pain and pelvic floor muscle tension differed between vaginismus and Dyspareunia/PVD sufferers. Fifty women with vaginismus, 50 women with Dyspareunia/PVD, and 43 controls participated in an experimental session comprising a structured interview, pain sensitivity testing, a filmed gynecological examination, and several self-report measures. Results demonstrated that fear and vaginal muscle tension were significantly greater in the vaginismus group as compared to the Dyspareunia/PVD and no-pain control groups. Moreover, behavioral measures of fear and vaginal muscle tension were found to discriminate the vaginismus group from the Dyspareunia/PVD and no-pain control groups. Genital pain did not differ significantly between the vaginismus and Dyspareunia/PVD groups; however, genital pain was found to discriminate both clinical groups from controls. Despite significant statistical differences on fear and vaginal muscle tension variables between women suffering from vaginismus and Dyspareunia/PVD, a large overlap was observed between these conditions. These findings may explain the great difficulty health professionals experience in attempting to reliably differentiate vaginismus from Dyspareunia/PVD. The implications of these data for the new DSM-5 diagnosis of Genito-Pelvic Pain/Penetration Disorder are discussed.
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biopsychosocial predictors of postmenopausal Dyspareunia the role of steroid hormones vulvovaginal atrophy cognitive emotional factors and dyadic adjustment
The Journal of Sexual Medicine, 2012Co-Authors: Yitzchak M. Binik, Deana Funaro, Rhonda Amsel, Nathalie Leroux, Samir KhaliféAbstract:ABSTRACT Introduction Although Dyspareunia experienced after menopause is widely attributed to declining estrogen levels and vulvovaginal atrophy, critical reviews of the literature have suggested that these factors are incomplete as explanatory mechanisms. Little is known about psychosocial factors that may also be implicated in postmenopausal dyspareunic pain. Aim To determine the extent to which levels of estrogens and progesterone, vulvovaginal atrophy, cognitive‐emotional factors, and dyadic adjustment are predictive of postmenopausal dyspareunic pain intensity. Methods A total of 182 postmenopausal Dyspareunia sufferers underwent a structured interview concerning sociodemographic status as well as medical and pain histories, gynecological examination, cytological evaluation, a blood draw, and answered a series of self‐report questionnaires. Given the large number of genital and pelvic pain variables measured, a principal components analysis was undertaken to identify a smaller number of components representing meaningful dimensions of genital and pelvic pain. Main Outcome Measures Pain severity ratings during intercourse were obtained using the McGill Pain Questionnaire. Pain ratings were also obtained during gynecological assessment. Serum estrone, estradiol, and progesterone levels were measured via immunoassay. The Vaginal Atrophy Index and maturation value were used to determine vulvovaginal atrophy severity. Participants completed the Pain Catastrophizing Scale, State‐Trait Anxiety Inventory, The Beck Depression Inventory‐II, and Dyadic Adjustment Scale. Results Hormone levels were not found to be consistent predictors of pain severity. Maturation value and cognitive‐emotional variables (e.g., catastrophization, depression, anxiety) were significant predictors of vestibular pain, which affected over 90% of our sample. Relationship adjustment variables were inversely associated with pain severity within several genital locations. Conclusions Results suggest that the traditional hypoestrogen and vulvovaginal atrophy conceptualization of postmenopausal Dyspareunia is an insufficient explanatory model, and that pain is also influenced by cognitive, affective, and dyadic factors. Kao A, Binik YM, Amsel R, Funaro D, Leroux N, and Khalife S. Biopsychosocial predictors of postmenopausal Dyspareunia: The role of steroid hormones, vulvovaginal atrophy, cognitive‐emotional factors, and dyadic adjustment. J Sex Med 2012;9:2066–2076.
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challenging atrophied perspectives on postmenopausal Dyspareunia a systematic description and synthesis of clinical pain characteristics
Journal of Sex & Marital Therapy, 2012Co-Authors: Alina Kao, Deana Funaro, Yitzchak M. Binik, Rhonda Amsel, Nathalie Leroux, Samir KhaliféAbstract:This study investigated the clinical attributes of postmenopausal Dyspareunia. The authors obtained a systematic description of pain symptomatology from 182 postmenopausal Dyspareunia sufferers using a structured interview, quantitative sensory testing, a standardized pain measure, and gynecological examination. The authors conducted a cluster analysis to examine whether sufferers could be categorized using clinical pain and gynecological factors. The authors delineated 6 subgroups, each exhibiting distinct combinations of pain and gynecological characteristics. The results support the hypothesis that, similarly to premenopausal Dyspareunia, postmenopausal Dyspareunia is a heterogeneous condition.
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The DSM Diagnostic Criteria for Dyspareunia
Archives of Sexual Behavior, 2010Co-Authors: Yitzchak M. BinikAbstract:The DSM-IV-TR attempted to create a unitary category of Dyspareunia based on the criterion of genital pain that interfered with sexual intercourse. This classificatory emphasis of interference with intercourse is reviewed and evaluated from both theoretical and empirical points of view. Neither of these points of view was found to support the notion of Dyspareunia as a unitary disorder or its inclusion in the DSM-V as a sexual dysfunction. It seems highly likely that there are different syndromes of Dyspareunia and that what is currently termed “superficial Dyspareunia” cannot be differentiated reliably from vaginismus. It is proposed that the diagnoses of vaginismus and Dyspareunia be collapsed into a single diagnostic entity called genito-pelvic pain/penetration disorder. This diagnostic category is defined according to five dimensions: percentage success of vaginal penetration; pain with vaginal penetration; fear of vaginal penetration or of genito-pelvic pain during vaginal penetration; pelvic floor muscle dysfunction; medical co-morbidity.
Paul J. Yong - One of the best experts on this subject based on the ideXlab platform.
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Dyspareunia in their own words a qualitative description of endometriosis associated sexual pain
Sexual Medicine, 2021Co-Authors: Kate J. Wahl, Paul J. Yong, Michelle Lisonek, Kelly B Smith, Shermeen Imtiaz, K.s. Joseph, Susan M CoxAbstract:Abstract Introduction Dyspareunia has been called the neglected symptom of endometriosis and is underexplored in clinical and research contexts. Understanding the physical experience and patient-important aspects of endometriosis-associated sexual pain can help advance valid measurement of this symptom. Aims The goal of this research was to characterize the physical experience of endometriosis-associated Dyspareunia in the words of people affected by this condition. Methods This was a qualitative descriptive study that included participants with current or previous endometriosis-associated Dyspareunia recruited from a data registry. Data collection involved semistructured interviews that began with an open-ended question about Dyspareunia followed by prompts related to the nature of sexual pain. Main Outcome Measures Interviews transcripts were subjected to qualitative content analysis using a priori (pain site, onset, character, radiation, associations, time course, and exacerbating/relieving factors) and emergent themes. Results A total of 17 participants completed interviews. Mean participant age was 33.3 years and most were identified as white, college-educated, heterosexual, and partnered. Location, onset, and character were important; interrelated features of endometriosis-associated Dyspareunia were: (i) introital pain began with initial penetration and had pulling, burning, and stinging qualities and (ii) pelvic pain was experienced with deep penetration or in certain positions and was described as sharp, stabbing, and cramping. Dyspareunia ranged from mild to severe, had a marked psychosocial impact for some participants, and was managed using a variety of treatments and strategies. Conclusion The endometriosis-associated Dyspareunia experienced by participants was heterogenous in presentation, severity, and impact. Our findings have implications for the development of valid patient-reported outcome measures of this symptom. Wahl KJ, Imtiaz S, Lisonek M, et al. Dyspareunia in Their Own Words: A Qualitative Description of Endometriosis-Associated Sexual Pain. Sex Med 2020;9:100274.
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Dyspareunia in their own words: A comprehensive qualitative description of endometriosis-associated sexual pain
2019Co-Authors: Kate J. Wahl, Paul J. Yong, Kelly B Smith, Shermeen Imtiaz, K.s. Joseph, Susan M CoxAbstract:Background Dyspareunia is a classic symptom of endometriosis but is neglected in research and clinical contexts. This study explored the experience of this endometriosis-associated sexual pain. Methods This was a qualitative descriptive study that included people who had experienced endometriosis-associated Dyspareunia alone or with a partner. Data collection involved semi- structured interviews with a female researcher that began with an open-ended question about Dyspareunia and included interview prompts related to the nature of sexual pain. Interviews were recorded, transcribed verbatim, and analysed for themes. Results 17 participants completed interviews. The mean participant age was 33.3 (SD=7.2) and most participants identified as white (82%), were college-educated (71%), identified as heterosexual (65%), and were partnered (59%). Location, onset, and character emerged as important, interrelated features of endometriosis-associated Dyspareunia, as did severity and impact. Dyspareunia occurred at the vaginal opening (n=7) and in the abdomen/pelvis (n=13). Pain at the vaginal opening began with initial penetration and had pulling, burning and stinging qualities. Pain in the pelvis was typically experienced with deep penetration or in certain position and was described as sharp, stabbing and/or cramping. Dyspareunia ranged from mild to severe, and for some participants had a marked psychosocial impact. Conclusions Dyspareunia is a heterogeneous symptom of endometriosis that ranges in severity and impact. Disaggregating Dyspareunia into superficial and deep types may better reflect the etiologies of this pain, thereby improving outcome measurement in intervention studies and clinical care.
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Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities
Sexual medicine reviews, 2019Co-Authors: Natasha L. Orr, Kate J. Wahl, Angela Joannou, Dee Hartmann, Lisa Valle, Paul J. YongAbstract:Abstract Introduction Dyspareunia has been traditionally divided into superficial (introital) Dyspareunia and deep Dyspareunia (pain with deep penetration). While deep Dyspareunia can coexist with a variety of conditions, recent work in endometriosis has demonstrated that coexistence does not necessarily imply causation. Therefore, a reconsideration of the literature is required to clarify the pathophysiology of deep Dyspareunia. Aims To review the pathophysiology of deep Dyspareunia, and to propose future research priorities. Methods A narrative review after appraisal of published frameworks and literature search with the terms (Dyspareunia AND endometriosis), (Dyspareunia AND deep), (Dyspareunia AND (pathophysiology OR etiology)). Main Outcome Variable Deep Dyspareunia (present/absent or along a pain severity scale). Results The narrative review demonstrates potential etiologies for deep Dyspareunia, including gynecologic-, urologic-, gastrointestinal-, nervous system-, psychological-, and musculoskeletal system-related disorders. These etiologies can be classified according to anatomic mechanism, such as contact with a tender pouch of Douglas, uterus-cervix, bladder, or pelvic floor, with deep penetration. Etiologies of deep Dyspareunia can also be stratified into 4 categories, as previously proposed for endometriosis specifically, to personalize management: type I (primarily gynecologic), type II (nongynecologic comorbid conditions), type III (central sensitization and genito-pelvic pain/penetration disorder), and type IV (mixed). We also identified gaps in the literature, such as lack of a validated patient-reported questionnaire or an objective measurement tool for deep Dyspareunia and clinical trials not powered for sexual outcomes. Conclusion We propose the following research priorities for deep Dyspareunia: deep Dyspareunia measurement tools, inclusion of the population avoiding intercourse due to deep Dyspareunia, nongynecologic conditions in the generation of deep Dyspareunia, exploration of sociocultural factors, clinical trials with adequate power for deep Dyspareunia outcomes, partner variables, female sexual response, pathways between psychological factors and deep Dyspareunia, and personalized approaches to deep Dyspareunia. Orr N, Wahl K, Joannou A, et al. Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities. Sex Med Rev 2020;8:3–17.
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Prospective Cohort of Deep Dyspareunia in an Interdisciplinary Setting.
The journal of sexual medicine, 2018Co-Authors: Paul J. Yong, Christina Williams, Sonja Bodmer-roy, Chukwuemeka Ezeigwe, Sean Zhu, Kristina Arion, Kristin Ambacher, Ali Yosef, Fontayne Wong, Heather NogaAbstract:Abstract Introduction Deep Dyspareunia is a common symptom in women, including in half of women with endometriosis, but little is known about its response to treatment and predictors of persistent deep Dyspareunia over time. Aim To follow up deep Dyspareunia severity over a 1-year prospective cohort at an interdisciplinary center, and to identify baseline predictors of more persistent deep Dyspareunia at 1 year. Methods Prospective 1-year cohort study at a tertiary referral center for pelvic pain and endometriosis, where a range of interdisciplinary treatments are provided at a single center (surgical, hormonal, physical, and psychological therapies). Exclusion criteria were menopause, age >50 years, and never previously sexually active. Primary outcome (deep Dyspareunia severity) and secondary outcome (sexual quality of life) were followed up over 1 year. Ordinal logistic regression was performed, controlling for baseline severity of deep Dyspareunia, to identify baseline predictors of deep Dyspareunia severity at 1 year. Main Outcome Measure Primary outcome was severity of deep Dyspareunia on an 11-point numeric rating scale (0–10), categorized into absent-mild (0–3), moderate (4–6), and severe (7–10); secondary outcome was sexual quality of life measured by the Endometriosis Health Profile-30. Results 1-year follow-up was obtained for 278 subjects (56% response rate at 1 year; 278/497). Severity of deep Dyspareunia improved over the 1 year (McNemar test, P Clinical Implications Clinicians should consider employing an interdisciplinary approach for deep Dyspareunia, and screening for and treating depression symptoms in these women. Strength & Limitations Strengths of the study include its prospective nature, and assessment of deep Dyspareunia specifically (as opposed to superficial Dyspareunia). Limitations include non-randomized design, and the patients lost to follow-up over the 1 year. Conclusion Over 1 year in an interdisciplinary setting, improvements were observed in deep Dyspareunia and sexual quality of life, but younger women and those with more severe depression at baseline had more persistent deep Dyspareunia at 1 year. Yong PJ, Williams C, Bodmer-Roy S, et al. Prospective Cohort of Deep Dyspareunia in an Interdisciplinary Setting. J Sex Med 2018;15:1765–1775.
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Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis
Sexual medicine, 2018Co-Authors: Leona K. Shum, Christina Williams, Heather Noga, Mohamed A Bedaiwy, Catherine Allaire, Arianne Y K Albert, Sarka Lisonkova, Paul J. YongAbstract:Abstract Introduction Deep Dyspareunia occurs in half of women with endometriosis, a condition present in 10% of reproductive-age women and associated with negative effects on sexual quality of life (SQoL). However, women with endometriosis can have other clinical factors (eg, superficial Dyspareunia, other pelvic pains, and psychological or pain conditions) possibly affecting SQoL. Aims To determine whether deep Dyspareunia is associated with SQoL in women with endometriosis, independent of potential confounders. Methods This study involved a prospective patient registry of women at a tertiary-level referral center for endometriosis and pelvic pain. Inclusion criteria were (i) referrals to the center recruited into the registry from January 2014 through December 2016 and (ii) subsequent surgery at the center with histologic confirmation of endometriosis. Exclusion criteria included menopausal status, age at least 50 years, never sexually active, or did not answer Dyspareunia or SQoL questions. Bi-variable tests and multiple linear regression analysis were performed. Main Outcome Measures SQoL measured by the 5-item sexual intercourse subscale of the Endometriosis Health Profile-30 (EHP-30) modular questionnaire (0–100%, with higher scores indicating worse SQoL). Results Consent rate for the prospective registry was 87%; 277 women met the study criteria (mean age = 34.2 ± 7.1 years). Most women had stage I to II endometriosis at time of surgery (64%), with the remaining having stage III to IV endometriosis. Through regression analysis, worse SQoL (higher EHP-30 sexual intercourse subscale score) was independently associated with: more severe deep Dyspareunia (P Conclusion In women with endometriosis at a tertiary referral center, more severe deep Dyspareunia was associated with worse SQoL, independent of superficial Dyspareunia, psychological comorbidities, and other potential confounders. Shum LK, Bedaiwy MA, Allaire C, et al. Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis. Sex Med 2018;6:224–233.
Samir Khalifé - One of the best experts on this subject based on the ideXlab platform.
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Can Fear, Pain, and Muscle Tension Discriminate Vaginismus from Dyspareunia/Provoked Vestibulodynia? Implications for the New DSM-5 Diagnosis of Genito-Pelvic Pain/Penetration Disorder
Archives of Sexual Behavior, 2015Co-Authors: Marie-andrée Lahaie, Rhonda Amsel, Samir Khalifé, Stephanie Boyer, Marie Faaborg-andersen, Yitzchak M. BinikAbstract:Fear has been suggested as the crucial diagnostic variable that may distinguish vaginismus from Dyspareunia. Unfortunately, this has not been systematically investigated. The primary purpose of this study, therefore, was to investigate whether fear as evaluated by subjective, behavioral, and psychophysiological measures could differentiate women with vaginismus from those with Dyspareunia/provoked vestibulodynia (PVD) and controls. A second aim was to re-examine whether genital pain and pelvic floor muscle tension differed between vaginismus and Dyspareunia/PVD sufferers. Fifty women with vaginismus, 50 women with Dyspareunia/PVD, and 43 controls participated in an experimental session comprising a structured interview, pain sensitivity testing, a filmed gynecological examination, and several self-report measures. Results demonstrated that fear and vaginal muscle tension were significantly greater in the vaginismus group as compared to the Dyspareunia/PVD and no-pain control groups. Moreover, behavioral measures of fear and vaginal muscle tension were found to discriminate the vaginismus group from the Dyspareunia/PVD and no-pain control groups. Genital pain did not differ significantly between the vaginismus and Dyspareunia/PVD groups; however, genital pain was found to discriminate both clinical groups from controls. Despite significant statistical differences on fear and vaginal muscle tension variables between women suffering from vaginismus and Dyspareunia/PVD, a large overlap was observed between these conditions. These findings may explain the great difficulty health professionals experience in attempting to reliably differentiate vaginismus from Dyspareunia/PVD. The implications of these data for the new DSM-5 diagnosis of Genito-Pelvic Pain/Penetration Disorder are discussed.
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can fear pain and muscle tension discriminate vaginismus from Dyspareunia provoked vestibulodynia implications for the new dsm 5 diagnosis of genito pelvic pain penetration disorder
Archives of Sexual Behavior, 2015Co-Authors: Marie-andrée Lahaie, Rhonda Amsel, Samir Khalifé, Stephanie C Boyer, Marie Faaborgandersen, Yitzchak M. BinikAbstract:Fear has been suggested as the crucial diagnostic variable that may distinguish vaginismus from Dyspareunia. Unfortunately, this has not been systematically investigated. The primary purpose of this study, therefore, was to investigate whether fear as evaluated by subjective, behavioral, and psychophysiological measures could differentiate women with vaginismus from those with Dyspareunia/provoked vestibulodynia (PVD) and controls. A second aim was to re-examine whether genital pain and pelvic floor muscle tension differed between vaginismus and Dyspareunia/PVD sufferers. Fifty women with vaginismus, 50 women with Dyspareunia/PVD, and 43 controls participated in an experimental session comprising a structured interview, pain sensitivity testing, a filmed gynecological examination, and several self-report measures. Results demonstrated that fear and vaginal muscle tension were significantly greater in the vaginismus group as compared to the Dyspareunia/PVD and no-pain control groups. Moreover, behavioral measures of fear and vaginal muscle tension were found to discriminate the vaginismus group from the Dyspareunia/PVD and no-pain control groups. Genital pain did not differ significantly between the vaginismus and Dyspareunia/PVD groups; however, genital pain was found to discriminate both clinical groups from controls. Despite significant statistical differences on fear and vaginal muscle tension variables between women suffering from vaginismus and Dyspareunia/PVD, a large overlap was observed between these conditions. These findings may explain the great difficulty health professionals experience in attempting to reliably differentiate vaginismus from Dyspareunia/PVD. The implications of these data for the new DSM-5 diagnosis of Genito-Pelvic Pain/Penetration Disorder are discussed.
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biopsychosocial predictors of postmenopausal Dyspareunia the role of steroid hormones vulvovaginal atrophy cognitive emotional factors and dyadic adjustment
The Journal of Sexual Medicine, 2012Co-Authors: Yitzchak M. Binik, Deana Funaro, Rhonda Amsel, Nathalie Leroux, Samir KhaliféAbstract:ABSTRACT Introduction Although Dyspareunia experienced after menopause is widely attributed to declining estrogen levels and vulvovaginal atrophy, critical reviews of the literature have suggested that these factors are incomplete as explanatory mechanisms. Little is known about psychosocial factors that may also be implicated in postmenopausal dyspareunic pain. Aim To determine the extent to which levels of estrogens and progesterone, vulvovaginal atrophy, cognitive‐emotional factors, and dyadic adjustment are predictive of postmenopausal dyspareunic pain intensity. Methods A total of 182 postmenopausal Dyspareunia sufferers underwent a structured interview concerning sociodemographic status as well as medical and pain histories, gynecological examination, cytological evaluation, a blood draw, and answered a series of self‐report questionnaires. Given the large number of genital and pelvic pain variables measured, a principal components analysis was undertaken to identify a smaller number of components representing meaningful dimensions of genital and pelvic pain. Main Outcome Measures Pain severity ratings during intercourse were obtained using the McGill Pain Questionnaire. Pain ratings were also obtained during gynecological assessment. Serum estrone, estradiol, and progesterone levels were measured via immunoassay. The Vaginal Atrophy Index and maturation value were used to determine vulvovaginal atrophy severity. Participants completed the Pain Catastrophizing Scale, State‐Trait Anxiety Inventory, The Beck Depression Inventory‐II, and Dyadic Adjustment Scale. Results Hormone levels were not found to be consistent predictors of pain severity. Maturation value and cognitive‐emotional variables (e.g., catastrophization, depression, anxiety) were significant predictors of vestibular pain, which affected over 90% of our sample. Relationship adjustment variables were inversely associated with pain severity within several genital locations. Conclusions Results suggest that the traditional hypoestrogen and vulvovaginal atrophy conceptualization of postmenopausal Dyspareunia is an insufficient explanatory model, and that pain is also influenced by cognitive, affective, and dyadic factors. Kao A, Binik YM, Amsel R, Funaro D, Leroux N, and Khalife S. Biopsychosocial predictors of postmenopausal Dyspareunia: The role of steroid hormones, vulvovaginal atrophy, cognitive‐emotional factors, and dyadic adjustment. J Sex Med 2012;9:2066–2076.
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challenging atrophied perspectives on postmenopausal Dyspareunia a systematic description and synthesis of clinical pain characteristics
Journal of Sex & Marital Therapy, 2012Co-Authors: Alina Kao, Deana Funaro, Yitzchak M. Binik, Rhonda Amsel, Nathalie Leroux, Samir KhaliféAbstract:This study investigated the clinical attributes of postmenopausal Dyspareunia. The authors obtained a systematic description of pain symptomatology from 182 postmenopausal Dyspareunia sufferers using a structured interview, quantitative sensory testing, a standardized pain measure, and gynecological examination. The authors conducted a cluster analysis to examine whether sufferers could be categorized using clinical pain and gynecological factors. The authors delineated 6 subgroups, each exhibiting distinct combinations of pain and gynecological characteristics. The results support the hypothesis that, similarly to premenopausal Dyspareunia, postmenopausal Dyspareunia is a heterogeneous condition.
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Dyspareunia in postmenopausal women a critical review
Pain Research & Management, 2008Co-Authors: Alina Kao, Yitzchak M. Binik, Anita Kapuscinski, Samir KhaliféAbstract:BACKGROUND: Dyspareunia, or pain during sexual intercourse, is among the problems most frequently reported by postmenopausal women. Past literature has almost unanimously attributed dyspareunic pain occurring during or after the menopausal transition to declining estrogen levels and vaginal atrophy.
Lori A. Brotto - One of the best experts on this subject based on the ideXlab platform.
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concurrent deep superficial Dyspareunia prevalence associations and outcomes in a multidisciplinary vulvodynia program
The Journal of Sexual Medicine, 2015Co-Authors: Paul J. Yong, Leslie A. Sadownik, Lori A. BrottoAbstract:Abstract Introduction Little is known about women with concurrent diagnoses of deep Dyspareunia and superficial Dyspareunia. Aim The aim of this study was to determine the prevalence, associations, and outcome of women with concurrent deep–superficial Dyspareunia. Methods This is a prospective study of a multidisciplinary vulvodynia program (n = 150; mean age 28.7 ± 6.4 years). Women with superficial Dyspareunia due to provoked vestibulodynia were divided into two groups: those also having deep Dyspareunia (i.e., concurrent deep–superficial Dyspareunia) and those with only superficial Dyspareunia due to provoked vestibulodynia. Demographics, Dyspareunia‐related factors, other pain conditions, and psychological variables at pretreatment were tested for an association with concurrent deep–superficial Dyspareunia. Outcome in both groups was assessed to 6 months posttreatment. Main Outcome Measures Level of Dyspareunia pain (0–10) and Female Sexual Distress Scale were the main outcome measures. Results The prevalence of concurrent deep–superficial Dyspareunia was 44% (66/150) among women with superficial Dyspareunia due to provoked vestibulodynia. At pretreatment, on multiple logistic regression, concurrent deep–superficial Dyspareunia was independently associated with a higher level of Dyspareunia pain (odds ratio [OR] = 1.19 [1.01–1.39], P = 0.030), diagnosis of endometriosis (OR = 4.30 [1.16–15.90], P = 0.022), history of bladder problems (OR = 3.84 [1.37–10.76], P = 0.008), and more depression symptoms (OR = 1.07 [1.02–1.12], P = 0.007), with no difference in the Female Sexual Distress Scale. At 6 months posttreatment, women with concurrent deep–superficial Dyspareunia improved in the level of Dyspareunia pain and in the Female Sexual Distress Scale to the same degree as women with only superficial Dyspareunia due to provoked vestibulodynia. Conclusions Concurrent deep–superficial Dyspareunia is reported by almost half of women in a multidisciplinary vulvodynia program. In women with provoked vestibulodynia, concurrent deep–superficial Dyspareunia may be related to endometriosis or interstitial cystitis, and is associated with depression and more severe Dyspareunia symptoms. Standardized multidisciplinary care is effective for women with concurrent Dyspareunia. Yong PJ, Sadownik L, and Brotto LA. Concurrent deep–superficial Dyspareunia: Prevalence, associations, and outcomes in a multidisciplinary vulvodynia program. J Sex Med 2015;12:219–227.
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Concurrent Deep–Superficial Dyspareunia: Prevalence, Associations, and Outcomes in a Multidisciplinary Vulvodynia Program
The journal of sexual medicine, 2014Co-Authors: Paul J. Yong, Leslie A. Sadownik, Lori A. BrottoAbstract:Abstract Introduction Little is known about women with concurrent diagnoses of deep Dyspareunia and superficial Dyspareunia. Aim The aim of this study was to determine the prevalence, associations, and outcome of women with concurrent deep–superficial Dyspareunia. Methods This is a prospective study of a multidisciplinary vulvodynia program (n = 150; mean age 28.7 ± 6.4 years). Women with superficial Dyspareunia due to provoked vestibulodynia were divided into two groups: those also having deep Dyspareunia (i.e., concurrent deep–superficial Dyspareunia) and those with only superficial Dyspareunia due to provoked vestibulodynia. Demographics, Dyspareunia‐related factors, other pain conditions, and psychological variables at pretreatment were tested for an association with concurrent deep–superficial Dyspareunia. Outcome in both groups was assessed to 6 months posttreatment. Main Outcome Measures Level of Dyspareunia pain (0–10) and Female Sexual Distress Scale were the main outcome measures. Results The prevalence of concurrent deep–superficial Dyspareunia was 44% (66/150) among women with superficial Dyspareunia due to provoked vestibulodynia. At pretreatment, on multiple logistic regression, concurrent deep–superficial Dyspareunia was independently associated with a higher level of Dyspareunia pain (odds ratio [OR] = 1.19 [1.01–1.39], P = 0.030), diagnosis of endometriosis (OR = 4.30 [1.16–15.90], P = 0.022), history of bladder problems (OR = 3.84 [1.37–10.76], P = 0.008), and more depression symptoms (OR = 1.07 [1.02–1.12], P = 0.007), with no difference in the Female Sexual Distress Scale. At 6 months posttreatment, women with concurrent deep–superficial Dyspareunia improved in the level of Dyspareunia pain and in the Female Sexual Distress Scale to the same degree as women with only superficial Dyspareunia due to provoked vestibulodynia. Conclusions Concurrent deep–superficial Dyspareunia is reported by almost half of women in a multidisciplinary vulvodynia program. In women with provoked vestibulodynia, concurrent deep–superficial Dyspareunia may be related to endometriosis or interstitial cystitis, and is associated with depression and more severe Dyspareunia symptoms. Standardized multidisciplinary care is effective for women with concurrent Dyspareunia. Yong PJ, Sadownik L, and Brotto LA. Concurrent deep–superficial Dyspareunia: Prevalence, associations, and outcomes in a multidisciplinary vulvodynia program. J Sex Med 2015;12:219–227.
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Incidence of perineal pain and Dyspareunia following spontaneous vaginal birth: a systematic review and meta-analysis
International Urogynecology Journal, 2019Co-Authors: Margarita Manresa, Ana Pereda, Eduardo Bataller, Carmen Terre-rull, Khaled M. Ismail, Sara S. WebbAbstract:Introduction and hypothesis Perineal pain and Dyspareunia are experienced by women undergoing a vaginal birth that can have short and longer term physical and psychological morbidities. This review aimed to determine the incidence of perineal pain and Dyspareunia following spontaneous vaginal birth (SVB) with intact perineum, first and second-degree perineal trauma or episiotomy. Methods Searches of MEDLINE, EMBASE, CINAHL, AMED and MIDIRS (inception – December 2017) were undertaken with selection criteria of any study evaluating the effect of intact perineum, first- or second-degree perineal trauma on perineal pain or Dyspareunia in women with SVB. Results Eighteen studies (8 RCTs and 10 NRSs) were included. Fourteen and 12 studies were undertaken to assess perineal pain and Dyspareunia after SVB, respectively. Meta-analysis of 16 studies (3133 women) demonstrated that women at 2 days postpartum experienced nearly the same incidence of perineal pain whether perineal trauma existed or not. At 4–10 days postpartum there was a significant reduction in the incidence of perineal pain for both presence and absence of any perineal trauma. Episiotomy was associated with the highest rate of perineal pain. The incidence of Dyspareunia was high at resumption of sexual intercourse following SVB with an intact perineum. At 12 months, women still experienced Dyspareunia whether perineal trauma existed or not. Conclusions Women experience perineal pain and Dyspareunia regardless of the presence or absence of perineal trauma after SVB; nonetheless, the reported incidence is higher if perineal trauma occurred.
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incidence of perineal pain and Dyspareunia following spontaneous vaginal birth a systematic review and meta analysis
International Urogynecology Journal, 2019Co-Authors: Margarita Manresa, Ana Pereda, Eduardo Bataller, Khaled M. Ismail, Carmen Terrerull, Sara S. WebbAbstract:Perineal pain and Dyspareunia are experienced by women undergoing a vaginal birth that can have short and longer term physical and psychological morbidities. This review aimed to determine the incidence of perineal pain and Dyspareunia following spontaneous vaginal birth (SVB) with intact perineum, first and second-degree perineal trauma or episiotomy. Searches of MEDLINE, EMBASE, CINAHL, AMED and MIDIRS (inception – December 2017) were undertaken with selection criteria of any study evaluating the effect of intact perineum, first- or second-degree perineal trauma on perineal pain or Dyspareunia in women with SVB. Eighteen studies (8 RCTs and 10 NRSs) were included. Fourteen and 12 studies were undertaken to assess perineal pain and Dyspareunia after SVB, respectively. Meta-analysis of 16 studies (3133 women) demonstrated that women at 2 days postpartum experienced nearly the same incidence of perineal pain whether perineal trauma existed or not. At 4–10 days postpartum there was a significant reduction in the incidence of perineal pain for both presence and absence of any perineal trauma. Episiotomy was associated with the highest rate of perineal pain. The incidence of Dyspareunia was high at resumption of sexual intercourse following SVB with an intact perineum. At 12 months, women still experienced Dyspareunia whether perineal trauma existed or not. Women experience perineal pain and Dyspareunia regardless of the presence or absence of perineal trauma after SVB; nonetheless, the reported incidence is higher if perineal trauma occurred.