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Moniek M Ter Kuile - One of the best experts on this subject based on the ideXlab platform.
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a woman who never could have coitus treatment of lifelong Vaginismus
2017Co-Authors: Moniek M Ter Kuile, Philomeen WeijenborgAbstract:Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other “objects” (e.g., tampons, fingers, speculum), despite the woman’s expressed wish to do so. Lifelong Vaginismus is diagnosed when a woman has never been able to have intercourse. The prevalence rates vary between 0.4 and 6.0% in a general population. Research on the etiology of Vaginismus is scarce, and no definitive cause has been identified. A fear-avoidance model for Vaginismus is described. Gradual exposure therapy is nearly always combined with relaxation instruction. Only a few randomized and controlled effect studies have been conducted until now. The success (intercourse is possible) of these few studies varied greatly. The treatment success of exposure-type treatments is significantly greater than that of therapies that combine multiple treatment techniques.
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therapist aided exposure for women with lifelong Vaginismus mediators of treatment outcome a randomized waiting list control trial
The Journal of Sexual Medicine, 2015Co-Authors: Moniek M Ter Kuile, Reinhilde Melles, Charlotte C Tuijnmanraasveld, Helen E De Groot, Jacques Van LankveldAbstract:Abstract Introduction Therapist‐aided exposure seems an effective treatment for lifelong Vaginismus, but mechanisms of action have not yet been established. Aim The purpose of the present study was to investigate whether treatment outcome of a therapist‐aided exposure treatment was mediated by changes in positive and negative penetration beliefs or feelings of sexual disgust. Methods Participants with lifelong Vaginismus were allocated at random to a 3‐month exposure (n = 35) or a waiting list control condition (n = 35). Main Outcome Measure Full intercourse was assessed daily during 12 weeks. Secondary outcome measures (complaints about Vaginismus and coital pain) were assessed at baseline and after 12 weeks. Possible mediators: penetration beliefs (catastrophic pain beliefs, genital incompatibility beliefs, perceived control beliefs) and feelings of sexual disgust were assessed at baseline and 6 weeks. Results Treatment outcome (coital frequency, symptoms of Vaginismus, and coital pain) at 12 weeks was mediated by changes in negative and positive penetration beliefs at 6 weeks, in particular by more pronounced reduction of catastrophic pain penetration beliefs. No evidence was found that changes in feelings of sexual disgust mediated treatment outcome. Conclusion The results strongly suggest that therapist‐aided exposure affects negative penetration beliefs and that these changes in negative penetration beliefs mediate treatment outcome in women with lifelong Vaginismus. Implications for treatment are discussed. N = 4850 words. Ter Kuile MM, Melles RJ, Tuijnman‐Raasveld CC, de Groot HE, and van Lankveld JJDM. Therapist‐aided exposure for women with lifelong Vaginismus: Mediators of treatment outcome: A randomized waiting list control trial. J Sex Med 2015;12:1807–1819.
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automatic and deliberate affective associations with sexual stimuli in women with lifelong Vaginismus before and after therapist aided exposure treatment
The Journal of Sexual Medicine, 2014Co-Authors: Reinhilde Melles, Moniek M Ter Kuile, Jacques Van Lankveld, Marieke Dewitte, Marieke Brauer, Peter J De JongAbstract:Abstract Introduction The intense fear response to vaginal penetration in women with lifelong Vaginismus, who have never been able to experience coitus, may reflect negative automatic and deliberate appraisals of vaginal penetration stimuli which might be modified by exposure treatment. Aims The aim of this study is to examine whether (i) sexual stimuli elicit relatively strong automatic and deliberate threat associations in women with Vaginismus, as well as relatively negative automatic and deliberate global affective associations, compared with symptom‐free women; and (ii) these automatic and more deliberate attitudes can be modified by therapist‐aided exposure treatment. Methods A single target Implicit Association Test (st‐IAT) was used to index automatic threat associations, and an Affective Simon Task (AST) to index global automatic affective associations. Participants were women with lifelong Vaginismus (N = 68) and women without sexual problems (N = 70). The Vaginismus group was randomly allocated to treatment (n = 34) and a waiting list control condition (n = 34). Main Outcome Measures Indices of automatic threat were obtained by the st‐IAT and automatic global affective associations by the AST, visual analogue scales (VAS) were used to assess deliberate appraisals of the sexual pictures (fear and global positive affect). Results More deliberate fear and less global positive affective associations with sexual stimuli were found in women with Vaginismus. Following therapist‐aided exposure treatment, the strength of fear was strongly reduced, whereas global positive affective associations were strengthened. Automatic associations did not differ between women with and without Vaginismus and did not change following treatment. Conclusions Relatively stronger negative (threat or global affect) associations with sexual stimuli in Vaginismus appeared restricted to the deliberate level. Therapist‐aided exposure treatment was effective in reducing subjective fear of sexual penetration stimuli and led to more global positive affective associations with sexual stimuli. The impact of exposure might be further improved by strengthening the association between vaginal penetration and positive affect (e.g., by using counter‐conditioning techniques). Melles RJ, ter Kuile MM, Dewitte M, van Lankveld JJDM, Brauer M, and de Jong PJ. Automatic and deliberate affective associations with sexual stimuli in women with lifelong Vaginismus before and after therapist‐aided exposure treatment. J Sex Med 2014;11:786–799.
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therapist aided exposure for women with lifelong Vaginismus a randomized waiting list control trial of efficacy
Journal of Consulting and Clinical Psychology, 2013Co-Authors: Moniek M Ter Kuile, Reinhilde Melles, Ellen H De Groot, Charlotte C Tuijnmanraasveld, Jacques Van LankveldAbstract:Objective Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other "objects" (e.g., tampons, fingers, speculum). Lifelong Vaginismus is diagnosed when a woman has never been able to have intercourse. The aim of this study was to investigate the efficacy of therapist-aided exposure for lifelong Vaginismus. Method Seventy women and their partners were randomly allocated to exposure or a waiting-list control period of 3 months. The main outcome measure (intercourse ability) was assessed daily during 12 weeks. Secondary outcome measures were complaints about Vaginismus, coital pain, coital fear, sexual distress, and sexual functioning. The exposure treatment consisted of a maximum of three 2-hr sessions during 1 week at a university hospital. Each participant performed vaginal penetration exercises herself, in the presence of her partner and a female therapist. Two follow-up sessions were scheduled over a 5-week period. Results Thirty-one out of 35 (89%; 95% CI [72%, 96%]) participants reported having had sexual intercourse at posttreatment compared with 4 out of 35 (11%; 95% CI [4%, 28%]) participants in the control condition. In most of the successfully treated women (90%), intercourse was possible within the first 2 weeks of treatment. Moreover, treatment resulted in clinical improvement regarding other symptoms related to Vaginismus, coital fear, coital pain, and sexual distress. No treatment effects were found regarding other aspects of sexual functioning in women or their partners. Conclusions This study provides evidence of the efficacy of therapist-aided exposure therapy for women with lifelong Vaginismus.
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the sexual disgust questionnaire a psychometric study and a first exploration in patients with sexual dysfunctions
The Journal of Sexual Medicine, 2013Co-Authors: Mark Van Overveld, Madelon L Peters, Peter J De Jong, Jacques Van Lankveld, Reinhilde Melles, Moniek M Ter KuileAbstract:ABSTRACT Introduction Disgust may be involved in sexual problems by disrupting sexual arousal and motivating avoidance of sexual intercourse. To test whether heightened disgust for sexual contaminants is related to sexual dysfunctions, the Sexual Disgust Questionnaire (SDQ) has recently been developed. Previous research showed that particularly women with Vaginismus display a generally heightened dispositional disgust propensity and heightened disgust toward stimuli depicting sexual intercourse. Aim To determine the psychometric properties of the SDQ and test whether heightened disgust toward sexual stimuli is specific to Vaginismus or can be observed in other sexual dysfunctions as well. Methods First, a large sample of undergraduates and university employees completed the SDQ (N = 762) and several trait disgust indices. Next, women with Vaginismus (N = 39), dyspareunia (N = 45), and men with erectile disorder (N = 28) completed the SDQ and were compared to participants without sexual problems (N = 70). Main Outcome Measure SDQ to index sexual disgust. Results The SDQ proved a valid and reliable index to establish disgust propensity for sexual stimuli. Supporting construct validity of the SDQ, sexual disgust correlated with established trait indices. Furthermore, sexual disgust and willingness to handle sexually contaminated stimuli were associated with sexual functioning in women, but not in men. Specifically women with Vaginismus displayed heightened sexual disgust compared to women without sexual problems, while men with erectile disorders demonstrated a lower willingness to handle sexually contaminated stimuli compared to men without sexual problems. Conclusions The SDQ appears a valid and reliable measure of sexual disgust. The pattern of SDQ‐scores across males and females with and without sexual dysfunctions corroborates earlier research suggesting that disgust appraisals are involved especially in Vaginismus and supports the view that the difficulty with vaginal penetration experienced by women in Vaginismus may partly be due to disgust‐induced defensive reflexes that could disrupt sexual arousal. van Overveld M, de Jong PJ, Peters ML, van Lankveld J, Melles R, and ter Kuile MM. The Sexual Disgust Questionnaire; a psychometric study and a first exploration in patients with sexual dysfunctions. J Sex Med **;**:**–**.
Jacques Van Lankveld - One of the best experts on this subject based on the ideXlab platform.
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therapist aided exposure for women with lifelong Vaginismus mediators of treatment outcome a randomized waiting list control trial
The Journal of Sexual Medicine, 2015Co-Authors: Moniek M Ter Kuile, Reinhilde Melles, Charlotte C Tuijnmanraasveld, Helen E De Groot, Jacques Van LankveldAbstract:Abstract Introduction Therapist‐aided exposure seems an effective treatment for lifelong Vaginismus, but mechanisms of action have not yet been established. Aim The purpose of the present study was to investigate whether treatment outcome of a therapist‐aided exposure treatment was mediated by changes in positive and negative penetration beliefs or feelings of sexual disgust. Methods Participants with lifelong Vaginismus were allocated at random to a 3‐month exposure (n = 35) or a waiting list control condition (n = 35). Main Outcome Measure Full intercourse was assessed daily during 12 weeks. Secondary outcome measures (complaints about Vaginismus and coital pain) were assessed at baseline and after 12 weeks. Possible mediators: penetration beliefs (catastrophic pain beliefs, genital incompatibility beliefs, perceived control beliefs) and feelings of sexual disgust were assessed at baseline and 6 weeks. Results Treatment outcome (coital frequency, symptoms of Vaginismus, and coital pain) at 12 weeks was mediated by changes in negative and positive penetration beliefs at 6 weeks, in particular by more pronounced reduction of catastrophic pain penetration beliefs. No evidence was found that changes in feelings of sexual disgust mediated treatment outcome. Conclusion The results strongly suggest that therapist‐aided exposure affects negative penetration beliefs and that these changes in negative penetration beliefs mediate treatment outcome in women with lifelong Vaginismus. Implications for treatment are discussed. N = 4850 words. Ter Kuile MM, Melles RJ, Tuijnman‐Raasveld CC, de Groot HE, and van Lankveld JJDM. Therapist‐aided exposure for women with lifelong Vaginismus: Mediators of treatment outcome: A randomized waiting list control trial. J Sex Med 2015;12:1807–1819.
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automatic and deliberate affective associations with sexual stimuli in women with lifelong Vaginismus before and after therapist aided exposure treatment
The Journal of Sexual Medicine, 2014Co-Authors: Reinhilde Melles, Moniek M Ter Kuile, Jacques Van Lankveld, Marieke Dewitte, Marieke Brauer, Peter J De JongAbstract:Abstract Introduction The intense fear response to vaginal penetration in women with lifelong Vaginismus, who have never been able to experience coitus, may reflect negative automatic and deliberate appraisals of vaginal penetration stimuli which might be modified by exposure treatment. Aims The aim of this study is to examine whether (i) sexual stimuli elicit relatively strong automatic and deliberate threat associations in women with Vaginismus, as well as relatively negative automatic and deliberate global affective associations, compared with symptom‐free women; and (ii) these automatic and more deliberate attitudes can be modified by therapist‐aided exposure treatment. Methods A single target Implicit Association Test (st‐IAT) was used to index automatic threat associations, and an Affective Simon Task (AST) to index global automatic affective associations. Participants were women with lifelong Vaginismus (N = 68) and women without sexual problems (N = 70). The Vaginismus group was randomly allocated to treatment (n = 34) and a waiting list control condition (n = 34). Main Outcome Measures Indices of automatic threat were obtained by the st‐IAT and automatic global affective associations by the AST, visual analogue scales (VAS) were used to assess deliberate appraisals of the sexual pictures (fear and global positive affect). Results More deliberate fear and less global positive affective associations with sexual stimuli were found in women with Vaginismus. Following therapist‐aided exposure treatment, the strength of fear was strongly reduced, whereas global positive affective associations were strengthened. Automatic associations did not differ between women with and without Vaginismus and did not change following treatment. Conclusions Relatively stronger negative (threat or global affect) associations with sexual stimuli in Vaginismus appeared restricted to the deliberate level. Therapist‐aided exposure treatment was effective in reducing subjective fear of sexual penetration stimuli and led to more global positive affective associations with sexual stimuli. The impact of exposure might be further improved by strengthening the association between vaginal penetration and positive affect (e.g., by using counter‐conditioning techniques). Melles RJ, ter Kuile MM, Dewitte M, van Lankveld JJDM, Brauer M, and de Jong PJ. Automatic and deliberate affective associations with sexual stimuli in women with lifelong Vaginismus before and after therapist‐aided exposure treatment. J Sex Med 2014;11:786–799.
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therapist aided exposure for women with lifelong Vaginismus a randomized waiting list control trial of efficacy
Journal of Consulting and Clinical Psychology, 2013Co-Authors: Moniek M Ter Kuile, Reinhilde Melles, Ellen H De Groot, Charlotte C Tuijnmanraasveld, Jacques Van LankveldAbstract:Objective Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other "objects" (e.g., tampons, fingers, speculum). Lifelong Vaginismus is diagnosed when a woman has never been able to have intercourse. The aim of this study was to investigate the efficacy of therapist-aided exposure for lifelong Vaginismus. Method Seventy women and their partners were randomly allocated to exposure or a waiting-list control period of 3 months. The main outcome measure (intercourse ability) was assessed daily during 12 weeks. Secondary outcome measures were complaints about Vaginismus, coital pain, coital fear, sexual distress, and sexual functioning. The exposure treatment consisted of a maximum of three 2-hr sessions during 1 week at a university hospital. Each participant performed vaginal penetration exercises herself, in the presence of her partner and a female therapist. Two follow-up sessions were scheduled over a 5-week period. Results Thirty-one out of 35 (89%; 95% CI [72%, 96%]) participants reported having had sexual intercourse at posttreatment compared with 4 out of 35 (11%; 95% CI [4%, 28%]) participants in the control condition. In most of the successfully treated women (90%), intercourse was possible within the first 2 weeks of treatment. Moreover, treatment resulted in clinical improvement regarding other symptoms related to Vaginismus, coital fear, coital pain, and sexual distress. No treatment effects were found regarding other aspects of sexual functioning in women or their partners. Conclusions This study provides evidence of the efficacy of therapist-aided exposure therapy for women with lifelong Vaginismus.
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the sexual disgust questionnaire a psychometric study and a first exploration in patients with sexual dysfunctions
The Journal of Sexual Medicine, 2013Co-Authors: Mark Van Overveld, Madelon L Peters, Peter J De Jong, Jacques Van Lankveld, Reinhilde Melles, Moniek M Ter KuileAbstract:ABSTRACT Introduction Disgust may be involved in sexual problems by disrupting sexual arousal and motivating avoidance of sexual intercourse. To test whether heightened disgust for sexual contaminants is related to sexual dysfunctions, the Sexual Disgust Questionnaire (SDQ) has recently been developed. Previous research showed that particularly women with Vaginismus display a generally heightened dispositional disgust propensity and heightened disgust toward stimuli depicting sexual intercourse. Aim To determine the psychometric properties of the SDQ and test whether heightened disgust toward sexual stimuli is specific to Vaginismus or can be observed in other sexual dysfunctions as well. Methods First, a large sample of undergraduates and university employees completed the SDQ (N = 762) and several trait disgust indices. Next, women with Vaginismus (N = 39), dyspareunia (N = 45), and men with erectile disorder (N = 28) completed the SDQ and were compared to participants without sexual problems (N = 70). Main Outcome Measure SDQ to index sexual disgust. Results The SDQ proved a valid and reliable index to establish disgust propensity for sexual stimuli. Supporting construct validity of the SDQ, sexual disgust correlated with established trait indices. Furthermore, sexual disgust and willingness to handle sexually contaminated stimuli were associated with sexual functioning in women, but not in men. Specifically women with Vaginismus displayed heightened sexual disgust compared to women without sexual problems, while men with erectile disorders demonstrated a lower willingness to handle sexually contaminated stimuli compared to men without sexual problems. Conclusions The SDQ appears a valid and reliable measure of sexual disgust. The pattern of SDQ‐scores across males and females with and without sexual dysfunctions corroborates earlier research suggesting that disgust appraisals are involved especially in Vaginismus and supports the view that the difficulty with vaginal penetration experienced by women in Vaginismus may partly be due to disgust‐induced defensive reflexes that could disrupt sexual arousal. van Overveld M, de Jong PJ, Peters ML, van Lankveld J, Melles R, and ter Kuile MM. The Sexual Disgust Questionnaire; a psychometric study and a first exploration in patients with sexual dysfunctions. J Sex Med **;**:**–**.
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cognitive behavioral therapy for women with lifelong Vaginismus process and prognostic factors
Behaviour Research and Therapy, 2007Co-Authors: Moniek M Ter Kuile, Jacques Van Lankveld, Reinhilde Melles, Ellen De Groot, Janneke Neffs, Maartje ZandbergenAbstract:Cognitive-behavioral therapy (CBT) seems an effective treatment of lifelong Vaginismus, but mechanisms of action have not yet been established. The present study explored whether the effect of CBT for lifelong Vaginismus is mediated by changes in fear of penetration and avoidance behavior, which CBT explicitly aims to alter. A second aim of this study was to predict treatment outcome on the basis of pre-treatment variables. Participants with lifelong Vaginismus were allocated at random to a 3-months CBT (n=81) or a waiting-list control condition (n=36). Full vaginal penetration with the penis of the partner constituted the primary outcome measure. Change scores in successful 'non-coital penetrative-behavior' and 'fear of coitus' were used to measure the mediating variables. Treatment resulted in an increase of intercourse (outcome), a decrease in fear of coitus, and an enhancement of successful non-coital penetration behavior, compared with no treatment. Outcome (intercourse) was partly mediated by changes in fear of coitus and changes in avoidance behavior. No treatment predictors could be detected in this study sample. It is concluded that techniques such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear, constitute an important avenue of change in the treatment of lifelong Vaginismus.
Yitzchak M. Binik - One of the best experts on this subject based on the ideXlab platform.
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Vaginismus when genito pelvic pain penetration disorder makes intercourse seem impossible
2016Co-Authors: Samara Perez, Claudia Brown, Yitzchak M. BinikAbstract:This chapter outlines the etiology, assessment, and treatment of women suffering from Vaginismus. Vaginismus is conceptualized here as the lifelong inability to experience vaginal penetration despite the woman’s expressed desire to do so. A case study using a variation of the ter Kuile et al.’s therapist-aided exposure approach will illustrate a highly effective evidence-based treatment option for women with Vaginismus.
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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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will Vaginismus remain a lifelong baby response to reissing et al 2014
Archives of Sexual Behavior, 2014Co-Authors: Yitzchak M. BinikAbstract:Having just become a grandfather, I am very attuned to baby allusions. You can imagine my distress to think that I might have caused the demise of any baby let alone the‘‘Vaginismus baby.’’ The ‘‘Vaginismus baby’’ is very dear to my heart and I have tried to lovingly bathe her with as much attention as possible during my career. Admittedly, my attempts have been spasmodicandIpleadguilty tosplashingaroundineffectively in many research backwaters trying to get that‘‘Vaginismus baby’’ clean. While appreciating my work (Binik, 2010) which contributed to the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) diagnosisofGenito-Pelvic/PainPenetrationDisorder(GPPPD), Reissing et al. (2014) raise significant and important criticisms of my‘‘splashy attempts’’ to understand what used to be called Vaginismus. I am very pleased with these criticisms because, during the DSM-5 process, there was a marked lack of response to the proposal to replace the diagnoses of Vaginismus and Dyspareunia with GPPPD and I worried that this was the result of lack of interest. I am heartened by the renewed interest and research and would like to address the important criticisms from both clinical and theoretical perspectives. Onapracticaldiagnostic level,Reissingetal. (2014)write the following: ‘‘...it should be clear that the diagnosis of lifelong Vaginismus can no longer be made on the basis of DSM-5. The current diagnosis focuses on ‘difficulties...(with) vaginal penetration during intercourse’ (American Psychiatric Association, 2013, p. 437) but does not provide for the inability to experience intercourse. In the new DSM-5, women with lifelong Vaginismus fall into a diagnostic void.’’ I am confused by this comment since previous classifications did not specifically deal with lifelong Vaginismus as defined by Reissing et al. (2014), i.e.,‘‘...women who have never been able to experience intercourse.’’ The DSM-IV-TR (American Psychiatric Association, 2000) defined Vaginismus as‘‘Recurrent or persistent involuntary spasm of the outer third of the vagina that interferes with sexual intercourse’’(p. 515). Sufferers could then be subtyped as lifelong or not. Nowhere did it specify a group of womenwhohaveneverbeenabletoexperienceintercourse.The new GPPPD diagnosis can account for this lifelong group as well or as badly as previous classifications. Women can be diagnosed with GPPPD if they are characterized with‘‘recurrent and persistent difficulties’’ with vaginal penetration during intercourse. The subtype of lifelong can then be applied. The name has changed but there is no other difference and no diagnostic void. I am particularly confused by Reissing et al.’s (2014) criticism that the DSM-5‘‘...does not provide for the inability to experience intercourse.’’The term‘‘inability’’is never used in any DSM criteria or in any other classification of which I am aware. Inmyview, it isnot usedbecause it suggests that there is a category of women who cannot experience penile-vaginal penetration under any circumstances. This does not make sense tome.It ishorrible tocontemplate thisscenariobutabrutal rapist wouldprobablybeable topenetratealmost anywomansuffering fromlifelongVaginismus.Amorepalatableexampleisthebrilliant therapy outcome research by ter Kuile and colleagues (ter Kuile et al., 2009; ter Kuile, Melles, de Groot, Tuijnman-Raasveld, & van Lankveld, 2013), which elegantly demonstrated that women with lifelong Vaginismus can experience penetration after a few hours of exposure. Such examples suggest that motivational and contextualfactorshaveanimportanteffectonawoman’ssuccessin Y. M. Binik Department of Psychology, McGill University, Montreal, PQ, Canada
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Vaginismus a review of the literature on the classification diagnosis etiology and treatment
Women's Health, 2010Co-Authors: Marie-andrée Lahaie, Samir Khalifé, Rhonda Amsel, Stephanie C Boyer, Yitzchak M. BinikAbstract:Vaginismus is currently defined as an involuntary vaginal muscle spasm interfering with sexual intercourse that is relatively easy to diagnose and treat. As a result, there has been a lack of research interest with very few well-controlled diagnostic, etiological or treatment outcome studies. Interestingly, the few empirical studies that have been conducted on Vaginismus do not support the view that it is easily diagnosed or treated and have shed little light on potential etiology. A review of the literature on the classification/diagnosis, etiology and treatment of Vaginismus will be presented with a focus on the latest empirical findings. This article suggests that Vaginismus cannot be easily differentiated from dyspareunia and should be treated from a multidisciplinary point of view.
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The DSM Diagnostic Criteria for Vaginismus
Archives of Sexual Behavior, 2010Co-Authors: Yitzchak M. BinikAbstract:Vaginal spasm has been considered the defining diagnostic characteristic of Vaginismus for approximately 150 years. This remarkable consensus, based primarily on expert clinical opinion, is preserved in the DSM-IV-TR. The available empirical research, however, does not support this definition nor does it support the validity of the DSM-IV-TR distinction between Vaginismus and dyspareunia. The small body of research concerning other possible ways or methods of diagnosing Vaginismus is critically reviewed. Based on this review, 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 the following 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.
Elke D. Reissing - One of the best experts on this subject based on the ideXlab platform.
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A Comparative Study of Sexual Function, Behavior, and Cognitions of Women with Lifelong Vaginismus
Archives of Sexual Behavior, 2013Co-Authors: Rebecca Cherner, Elke D. ReissingAbstract:Vaginismus is classified as a sexual dysfunction, yet limited research is available on the sexual function and behavior of women with this condition. Comparing women with lifelong Vaginismus to women with lifelong dyspareunia and women with no pain during intercourse, this study explored sexual function, anxiety, and behavior along with cognitions related to vaginal penetration. A total of 152 women completed an online survey that included a series of validated questionnaires. Main findings indicated that, relative to both comparison groups, women in the Vaginismus group reported a more limited range of sexual behavior across the lifespan and more maladaptive cognitions related to fear of losing control of one’s body and the situation during penetration. Compared to the no-pain group, both symptomatic groups reported more difficulties across several indicators of sexual function, more limited sexual behavior in the past year and past month, and more maladaptive cognitions related to vaginal penetration. However, women with Vaginismus reported more sexual desire and less difficulty with lubrication compared to women with dyspareunia. Numerous sexual problems extending beyond vaginal penetration difficulties were confirmed, suggesting a need for broader treatment approaches not limited to the experience of vaginal penetration. Results were discussed as they relate to the fear-avoidance model of Vaginismus.
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a psychophysiological investigation of sexual arousal in women with lifelong Vaginismus
The Journal of Sexual Medicine, 2013Co-Authors: Rebecca Cherner, Elke D. ReissingAbstract:Abstract Introduction Relatively little is known about the subjective reactions of women with lifelong Vaginismus to erotic stimuli and genital arousal has never been investigated. Reports of maladaptive cognitions and fears regarding sexuality and intercourse suggest that anxiety may interfere with sexual arousal in women with Vaginismus. Aims To examine the genital and subjective responses to sexually explicit film stimuli of women with lifelong Vaginismus compared with women with lifelong dyspareunia and women with no pain. Methods Forty‐five women (15 Vaginismus, 15 dyspareunia, and 15 no pain) viewed two neutral and two erotic film sets, one depicting sexual activity without vaginal penetration and the other depicting intercourse, over two testing sessions. Main Outcome Measures Vulvar temperature was recorded using an infrared camera. Participants completed a measure of subjective responses after viewing each film. Results All groups experienced increased vulvar temperature during the erotic films regardless of activity depicted. In response to the erotic films, the Vaginismus group reported less mental arousal than the no‐pain group and a range of negative subjective responses, including threat and disgust. Overall, participants showed concordance between peak subjective sexual arousal and temperature change from baseline to peak arousal. Conclusion Despite negative subjective responses, women with Vaginismus responded with increased genital sexual arousal to erotic films. The resilience of genital arousal may have resulted from moderate levels of anxiety experienced in the laboratory setting facilitating sexual response regardless of subjective appraisal; however, anxiety experienced in a dyadic context may interfere more substantially.
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pelvic floor physical therapy for lifelong Vaginismus a retrospective chart review and interview study
Journal of Sex & Marital Therapy, 2013Co-Authors: Elke D. Reissing, Heather L Armstrong, Caroline AllenAbstract:Pelvic floor physical therapy is used in the treatment of sexual pain disorders; however, women with lifelong Vaginismus have not yet been included in treatment studies or have not been differentiated from women with acquired Vaginismus and/or dyspareunia. This retrospective chart review and interview study was intended to obtain initial information on physical therapy interventions, course, and outcome in women who have never been able to experience vaginal intercourse. The files of 53 women, consecutively treated at one physical therapy clinic, were included in the chart review; 13 of these women volunteered to be interviewed. The chart review revealed significant pelvic floor pathology and an average treatment course of 29 sessions. Internal manual techniques were found to be most effective, followed by patient education, dilatation exercises, and home exercises. Although participants were very satisfied with the physical therapy, some symptoms, such as pain, anxiety/fear, and pelvic floor tension remained and scores on the Female Sexual Distress Scale and Female Sexual Function Index indicated clinical levels of sexual distress and impaired sexual function after treatment. Although there appears to be no linear relation between symptom reduction and healthy sexual function, this initial information suggests that physical therapy may be a promising treatment option for some women with lifelong Vaginismus and merits further evaluation.
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Consultation and Treatment History and Causal Attributions in an Online Sample of Women with Lifelong and Acquired Vaginismus
The journal of sexual medicine, 2011Co-Authors: Elke D. ReissingAbstract:ABSTRACT Introduction Very little information is available on the consultation and treatment histories of women with lifelong and acquired Vaginismus. Aim This study was conducted to address three areas of interest: first, to collect information on which health care professionals women with acquired and lifelong Vaginismus consult and how helpful such consultation were; second, to examine which treatments were typically received and how helpful patients rate such interventions; and third, to explore participants' causal attributions of the vaginal penetration problems as those are what appear to guide patients towards consulting specific health care professionals as well as affecting the openness towards different interventions. Methods An online survey was conducted with 212 participants. Data were analyzed using the responses of 93 women with acquired Vaginismus and 75 women with lifelong Vaginismus. Main Outcome Measures The main outcomes were the results of the online survey. Results Gynecologists and family doctors were most frequently consulted, but only gynecologists were rated as helpful. Psychologists and sex therapists were also frequently consulted and rated as helpful. Physiotherapists were consulted by fewer women but considered most helpful. Women with lifelong Vaginismus were significantly more likely to have received vaginal dilatation, sex education, and Kegel exercises as treatment. Women with acquired Vaginismus were more likely to have received pharmacological interventions and to have tried a greater range of interventions. Educational gynecological examinations, talking about the meaning of the penetration problem, vaginal dilatation, and sex education were rated as most helpful interventions. Causal attributions were pain and fear‐ and disgust‐based attributions for women with lifelong Vaginismus. Conclusions Results highlight the importance of a biopsychosocial conceptualization of and multidisciplinary treatment approach to lifelong and acquired Vaginismus. Reissing ED. Consultation and treatment history and causal attributions in an online sample of women with lifelong and acquired Vaginismus. J Sex Med 2012;9:251–258.
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What Is Sexual Pain? A Critique of DSM's Classification of Dyspareunia and Vaginismus
Journal of Psychology & Human Sexuality, 2006Co-Authors: Elke D. Reissing, Yitzchak M. Binik, Rhonda Amsel, Samir KhaliféAbstract:Abstract The Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) introduced the term “sexual pain disorder” to classify dyspareunia and Vaginismus as sexual dysfunctions (American Psychiatric Association, 1987). However, the notion of sexual pain as well as the diagnostic criteria for dyspareunia and Vaginismus are questionable both on theoretical and empirical grounds. Recent studies support the view that dyspareunia is better classified as a pain disorder and challenge the validity of the vaginal spasm criterion for Vaginismus. Alternative conceptualizations of these conditions are presented.
Peter J De Jong - One of the best experts on this subject based on the ideXlab platform.
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automatic and deliberate affective associations with sexual stimuli in women with lifelong Vaginismus before and after therapist aided exposure treatment
The Journal of Sexual Medicine, 2014Co-Authors: Reinhilde Melles, Moniek M Ter Kuile, Jacques Van Lankveld, Marieke Dewitte, Marieke Brauer, Peter J De JongAbstract:Abstract Introduction The intense fear response to vaginal penetration in women with lifelong Vaginismus, who have never been able to experience coitus, may reflect negative automatic and deliberate appraisals of vaginal penetration stimuli which might be modified by exposure treatment. Aims The aim of this study is to examine whether (i) sexual stimuli elicit relatively strong automatic and deliberate threat associations in women with Vaginismus, as well as relatively negative automatic and deliberate global affective associations, compared with symptom‐free women; and (ii) these automatic and more deliberate attitudes can be modified by therapist‐aided exposure treatment. Methods A single target Implicit Association Test (st‐IAT) was used to index automatic threat associations, and an Affective Simon Task (AST) to index global automatic affective associations. Participants were women with lifelong Vaginismus (N = 68) and women without sexual problems (N = 70). The Vaginismus group was randomly allocated to treatment (n = 34) and a waiting list control condition (n = 34). Main Outcome Measures Indices of automatic threat were obtained by the st‐IAT and automatic global affective associations by the AST, visual analogue scales (VAS) were used to assess deliberate appraisals of the sexual pictures (fear and global positive affect). Results More deliberate fear and less global positive affective associations with sexual stimuli were found in women with Vaginismus. Following therapist‐aided exposure treatment, the strength of fear was strongly reduced, whereas global positive affective associations were strengthened. Automatic associations did not differ between women with and without Vaginismus and did not change following treatment. Conclusions Relatively stronger negative (threat or global affect) associations with sexual stimuli in Vaginismus appeared restricted to the deliberate level. Therapist‐aided exposure treatment was effective in reducing subjective fear of sexual penetration stimuli and led to more global positive affective associations with sexual stimuli. The impact of exposure might be further improved by strengthening the association between vaginal penetration and positive affect (e.g., by using counter‐conditioning techniques). Melles RJ, ter Kuile MM, Dewitte M, van Lankveld JJDM, Brauer M, and de Jong PJ. Automatic and deliberate affective associations with sexual stimuli in women with lifelong Vaginismus before and after therapist‐aided exposure treatment. J Sex Med 2014;11:786–799.
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brain processing of visual stimuli representing sexual penetration versus core and animal reminder disgust in women with lifelong Vaginismus
PLOS ONE, 2014Co-Authors: Charmaine Borg, Willibrordus Weijmar Schultz, Janniko R Georgiadis, Remco J Renken, Symen K Spoelstra, Peter J De JongAbstract:It has been proposed that disgust evolved to protect humans from contamination. Through eliciting the overwhelming urge to withdraw from the disgusting stimuli, it would facilitate avoidance of contact with pathogens. The physical proximity implied in sexual intercourse provides ample opportunity for contamination and may thus set the stage for eliciting pathogen disgust. Building on this, it has been argued that the involuntary muscle contraction characteristic of Vaginismus (i.e., inability to have vaginal penetration) may be elicited by the prospect of penetration by potential contaminants. To further investigate this disgust-based interpretation of Vaginismus (in DSM-5 classified as a Genito-Pelvic Pain/Penetration Disorder, GPPPD) we used functional magnetic resonance imaging (fMRI) to examine if women with Vaginismus (n = 21) show relatively strong convergence in their brain responses towards sexual penetration- and disgust-related pictures compared to sexually asymptomatic women (n = 21) and women suffering from vulvar pain (dyspareunia/also classified as GPPPD in the DSM-5, n = 21). At the subjective level, both clinical groups rated penetration stimuli as more disgusting than asymptomatic women. However, the brain responses to penetration stimuli did not differ between groups. In addition, there was considerable conjoint brain activity in response to penetration and disgust pictures, which yield for both animal-reminder (e. g., mutilation) and core (e. g., rotten food) disgust domains. However, this overlap in brain activation was similar for all groups. A possible explanation for the lack of Vaginismus-specific brain responses lies in the alleged female ambiguity (procreation/pleasure vs. contamination/disgust) toward penetration: generally in women a (default) disgust response tendency may prevail in the absence of sexual readiness. Accordingly, a critical next step would be to examine the processing of penetration stimuli following the induction of sexual arousal.
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the sexual disgust questionnaire a psychometric study and a first exploration in patients with sexual dysfunctions
The Journal of Sexual Medicine, 2013Co-Authors: Mark Van Overveld, Madelon L Peters, Peter J De Jong, Jacques Van Lankveld, Reinhilde Melles, Moniek M Ter KuileAbstract:ABSTRACT Introduction Disgust may be involved in sexual problems by disrupting sexual arousal and motivating avoidance of sexual intercourse. To test whether heightened disgust for sexual contaminants is related to sexual dysfunctions, the Sexual Disgust Questionnaire (SDQ) has recently been developed. Previous research showed that particularly women with Vaginismus display a generally heightened dispositional disgust propensity and heightened disgust toward stimuli depicting sexual intercourse. Aim To determine the psychometric properties of the SDQ and test whether heightened disgust toward sexual stimuli is specific to Vaginismus or can be observed in other sexual dysfunctions as well. Methods First, a large sample of undergraduates and university employees completed the SDQ (N = 762) and several trait disgust indices. Next, women with Vaginismus (N = 39), dyspareunia (N = 45), and men with erectile disorder (N = 28) completed the SDQ and were compared to participants without sexual problems (N = 70). Main Outcome Measure SDQ to index sexual disgust. Results The SDQ proved a valid and reliable index to establish disgust propensity for sexual stimuli. Supporting construct validity of the SDQ, sexual disgust correlated with established trait indices. Furthermore, sexual disgust and willingness to handle sexually contaminated stimuli were associated with sexual functioning in women, but not in men. Specifically women with Vaginismus displayed heightened sexual disgust compared to women without sexual problems, while men with erectile disorders demonstrated a lower willingness to handle sexually contaminated stimuli compared to men without sexual problems. Conclusions The SDQ appears a valid and reliable measure of sexual disgust. The pattern of SDQ‐scores across males and females with and without sexual dysfunctions corroborates earlier research suggesting that disgust appraisals are involved especially in Vaginismus and supports the view that the difficulty with vaginal penetration experienced by women in Vaginismus may partly be due to disgust‐induced defensive reflexes that could disrupt sexual arousal. van Overveld M, de Jong PJ, Peters ML, van Lankveld J, Melles R, and ter Kuile MM. The Sexual Disgust Questionnaire; a psychometric study and a first exploration in patients with sexual dysfunctions. J Sex Med **;**:**–**.
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Vaginismus heightened harm avoidance and pain catastrophizing cognitions
The Journal of Sexual Medicine, 2012Co-Authors: Charmaine Borg, Madelon L Peters, Willibrord Weijmar C M Schultz, Peter J De JongAbstract:Introduction. Catastrophic appraisal of experienced pain may promote hypervigilance and intense pain, while the personality trait of harm avoidance (HA) might prevent the occurrence of correcting such experiences. Women inflicted with Vaginismus may enter a self-perpetuating downward spiral of increasing avoidance of (anticipated) pain. In Vaginismus the anticipation of pain may give rise to catastrophic pain ideation. This may establish hypervigilance toward painful sexual stimuli, which consequently results in negative appraisal of sexual cues. This process could impair genital and sexual responding, intensify pain and trigger avoidance, which in turn may contribute to the onset and persistence of symptoms in Vaginismus and to certain extent also in dyspareunia. Aims. To investigate whether women suffering from Vaginismus are characterized by heightened levels of habitual pain catastrophic cognitions, together with higher levels of HA. Methods. This study consisted of three groups: a lifelong Vaginismus group (N = 35, mean age = 28.4; standard deviation [SD] = 5.8), a dyspareunia group (N = 33, mean age = 26.7; SD = 6.8), and women without sexual complaints (N = 54, mean age = 26.5; SD = 6.7). Main Outcome Measures. HA scale of Cloninger's tridimensional personality questionnaire, and the pain catastrophizing scale. Results. Specifically women inflicted with Vaginismus showed significantly heightened levels of catastrophic pain cognitions compared with the other two groups, as well as significant enhanced HA vs. the control group, and a trend vs. the dyspareunia group. Both traits were shown to have cumulative predictive validity for the presence of Vaginismus. Conclusion. This study focused on the personality traits of catastrophizing pain cognitions and HA in women with lifelong Vaginismus. Our findings showed that indeed, women suffering from Vaginismus are characterized by trait of HA interwoven with habitual pain catastrophizing cognitions. This study could help in the refinement of the current conceptualization and might shed light on the already available treatment options for women with Vaginismus. Borg C, Peters ML, Weijmar SchultzW, and de Jong PJ. Vaginismus: Heightened harm avoidance and pain catastrophizing cognitions. J Sex Med 2012; 9: 558-567.
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automatic affective appraisal of sexual penetration stimuli in women with Vaginismus or dyspareunia
The Journal of Sexual Medicine, 2011Co-Authors: Charmaine Borg, Jorg Huijding, Willibrord Weijmarschultz, Peter J De JongAbstract:Introduction. Current psychological views are that negative appraisals of sexual stimuli lie at the core of sexual dysfunctions. It is important to differentiate between deliberate appraisals and more automatic appraisals, as research has shown that the former are most relevant to controllable behaviors, and the latter are most relevant to reflexive behaviors. Accordingly, it can be hypothesized that in women with Vaginismus, the persistent difficulty to allow vaginal entry is due to global negative automatic affective appraisals that trigger reflexive pelvic floor muscle contraction at the prospect of penetration. Aims. To test whether sexual penetration pictures elicited global negative automatic affective appraisals in women with Vaginismus or dyspareunia and to examine whether deliberate appraisals and automatic appraisals differed between the two patient groups. Methods. Women with persistent Vaginismus (N = 24), dyspareunia (N = 23), or no sexual complaints (N = 30) completed a pictorial Extrinsic Affective Simon Task (EAST), and then made a global affective assessment of the EAST stimuli using visual analogue scales (VAS). Main Outcome Measures. The EAST assessed global automatic affective appraisals of sexual penetration stimuli, while the VAS assessed global deliberate affective appraisals of these stimuli. Results. Automatic affective appraisals of sexual penetration stimuli tended to be positive, independent of the presence of sexual complaints. Deliberate appraisals of the same stimuli were significantly more negative in the women with Vaginismus than in the dyspareunia group and control group, while the latter two groups did not differ in their appraisals. Conclusion. Unexpectedly, deliberate appraisals seemed to be most important in Vaginismus, whereas dyspareunia did not seem to implicate negative deliberate or automatic affective appraisals. These findings dispute the view that global automatic affect lies at the core of Vaginismus and indicate that a useful element in therapeutic interventions may be the modification of deliberate global affective appraisals of sexual penetration (e.g., via counter-conditioning). Huijding J, Borg C, Weijmar-Schultz W, and de Jong PJ. Automatic affective appraisal of sexual penetration stimuli in women with Vaginismus or dyspareunia. J Sex Med 2011;8:806-813.
