Bernard Lambert

Provoked Vestibulodynia: Mediators of the Associations Between Partner Responses, Pain, and Sexual Satisfaction

Provoked vestibulodynia (PVD) is a chronic, recurrent vulvo-vaginal pain condition affecting 12% of the general population, and is associated with sexual dysfunction, psychological distress, and reduced quality of life. There is growing interest in the role of interpersonal variables in PVD, which have been widely neglected. In a sample of 175 couples, the present study examined the mediating roles of partner and participant catastrophizing and self-efficacy in the association between solicitous partner responses and pain intensity, and that of dyadic adjustment in the association between solicitous and negative partner responses and sexual satisfaction. Couples completed measures of partner responses, catastrophizing, self-efficacy, dyadic adjustment, and depression. Women also completed measures of pain, sexual satisfaction, and sexual function. Controlling for depression and solicitousness perceived by the other member of the couple, catastrophizing and self-efficacy partially mediated the association between higher solicitous responses and higher pain during intercourse, accounting for 26 and 25% of the variance in this association for participant and partner-perceived responses, respectively. For both participant and partners, only pain catastrophizing was a unique mediator. Controlling for depression, sexual function and partner-perceived responses, dyadic adjustment partially mediated the association between higher participant-perceived solicitous responses and higher sexual satisfaction, and between higher participant-perceived negative responses and lower sexual satisfaction, accounting for 26% of the variance in each association. The current findings suggest that catastrophizing and dyadic adjustment may constitute a route by which partner responses exacerbate pain and increase or decrease sexual satisfaction in PVD couples.

Attachment, sexual assertiveness and sexual outcomes in women with provoked vestibulodynia and their partners : a mediation model

Provoked vestibulodynia (PVD) is a prevalent women’s sexual pain disorder, which is associated with sexual function difficulties. Attachment theory has been used to understand adult sexual outcomes, providing a useful framework for examining sexual adaptation in couples confronted with PVD. Research to date indicates that anxious and avoidant attachment dimensions correlate with worse sexual outcomes in community and clinical samples. The present study examined the association between attachment, pain, sexual function, and sexual satisfaction in a sample of 101 couples in which the women presented with PVD. The actor–partner interdependence model was used in order to investigate both actor and partner effects. This study also examined the role of sexual assertiveness as a mediator of these associations via structural equation modeling. Women completed measures of pain intensity and both members of the couple completed measures of romantic attachment, sexual assertiveness, sexual function, and satisfaction. Results indicated that attachment dimensions did not predict pain intensity. Both anxious and avoidant attachment were associated with lower sexual satisfaction. Only attachment avoidance predicted lower sexual function in women. Partner effects indicated that higher sexual assertiveness in women predicted higher sexual satisfaction in men. Finally, women’s sexual assertiveness was found to be a significant mediator of the relationship between their attachment dimensions, sexual function, and satisfaction. Findings highlight the importance of examining how anxious and avoidant attachment may lead to difficulties in sexual assertiveness and to less satisfying sexual interactions in couples where women suffer from PVD.

Women with provoked vestibulodynia experience clinically significant reductions in pain regardless of treatment : results from a 2-year follow up study

INTRODUCTION Provoked vestibulodynia (PVD) is a prevalent genital pain syndrome that has been assumed to be chronic, with little spontaneous remission. Despite this assumption, there is a dearth of empirical evidence regarding the progression of PVD in a natural setting. Although many treatments are available, there is no single treatment that has demonstrated efficacy above others. AIMS The aims of this secondary analysis of a prospective study were to (i) assess changes over a 2-year period in pain, depressive symptoms, and sexual outcomes in women with PVD; and (ii) examine changes based on treatment(s) type. METHODS Participants completed questionnaire packages at Time 1 and a follow-up package 2 years later. MAIN OUTCOME MEASURES Visual analog scale of genital pain, Global Measure of Sexual Satisfaction, Female Sexual Function Index, Beck Depression Inventory, Dyadic Adjustment Scale, and sexual intercourse attempts over the past month. RESULTS Two hundred thirty-nine women with PVD completed both time one and two questionnaires. For the sample as a whole, there was significant improvement over 2 years on pain ratings, sexual satisfaction, sexual function, and depressive symptoms. The most commonly received treatments were physical therapy, sex/psychotherapy, and medical treatment, although 41.0% did not undergo any treatment. Women receiving no treatment also improved significantly on pain ratings. No single treatment type predicted better outcome for any variable except depressive symptoms, in which women who underwent surgery were more likely to improve. DISCUSSION These results suggest that PVD may significantly reduce in severity over time. Participants demonstrated clinically significant pain improvement, even when they did not receive treatment. Furthermore, the only single treatment type predicting better outcomes was surgery, and only for depressive symptoms, accounting for only 2.3% of the variance. These data do not demonstrate the superiority of any one treatment and underscore the need to have control groups in PVD treatment trials, otherwise improvements may simply be the result of natural progression.

Body Image in Women with Primary and Secondary Provoked Vestibulodynia: A Controlled Study

INTRODUCTION Provoked vestibulodynia (PVD) is a womens genito-pelvic pain condition associated with psychosexual impairments, including depression. Body image (BI) has been found to be different in women with primary (PVD1) and secondary (PVD2) PVD. No controlled study has compared BI in women with PVD1 and PVD2 and investigated its associations with sexual satisfaction, sexual function, and pain. AIMS The aims of this study were to (i) compare BI in women with PVD1, PVD2, and asymptomatic controls and (ii) to examine associations between BI and sexual satisfaction, sexual function, and pain during intercourse in women with PVD. METHODS Fifty-seven women (20 with PVD1, 19 with PVD2, and 18 controls) completed measures of BI, sexual satisfaction, sexual function, pain during intercourse, and depression. MAIN OUTCOME MEASURES The main outcome measures were (i) Global Measure of Sexual Satisfaction Scale, (ii) Female Sexual Function Index, and (iii) pain numerical rating scale. RESULTS Controlling for depression, women with PVD1 reported more body exposure anxiety during sexual activities than women with PVD2 and controls F(2,51)=4.23, P=0.02. For women with PVD, more negative BI during sexual activities was associated with lower sexual satisfaction (β=-0.45, P=0.02) and function (β=-0.39, P=0.04) and higher pain during intercourse (β=0.59, P=0.004). More positive body esteem was associated with higher sexual function (β=0.34, P=0.05). CONCLUSIONS Findings suggest that women with PVD1 present more body exposure anxiety during sexual activities than women with PVD2 and asymptomatic women. Body esteem and general attitudes toward womens genitalia were not significantly different between groups. Higher body exposure anxiety during sexual activities was associated with poorer sexual outcomes in women with PVD. Further studies assessing interventions targeting BI during sexual activities in this population are needed, as improving BI during sexual interactions may enhance sexual outcomes in women with PVD.

Epidermoid cyst of the clitoris: a case report.

We report a rare case of spontaneous clitoral epidermal cyst without any declared previous female genital mutilation. This patient was successfully and surgically resected with good local and cosmetic results.

Predictive factors for positive or negative pathology in loop and laser conizations.

Objective The main purpose of this study is to predict positive-negative pathology in association with operative indications in laser and loop conizations. Materials and Methods This retrospective study comprises two groups of women, the first group composed of 74 loop conizations, the second of 78 laser cones. Positive endocervical curettage, unsatisfactory colposcopy with no visible lesion or junction, discrepant cytology and biopsy, suspicion of invasion, or a glandular lesion were considered as indications for cones. All cones were performed under local intramucous anesthesia, and 15 mm of endocervical mucosa was removed. Results Loop and laser cone outcomes were comparable for age, parity, and pathology with negative or positive margins. Endocervical curettage of lesions of cervical intraepithelial neoplasia grades 2 and 3 (CIN2 and CIN3) predicted both higher cone pathology (p =.048) and high-grade squamous intraepithelial lesions, as evidenced by preoperative cytology (p =.000). Among 32 negative-margins cases, 2 (6.3%) had CIN persistence as compared to 6 patients (24%) of 25 positive margins. Conclusions Laser and loop cones yield similar pathological results, and special care should be used for CIN1 endocervical curettage and low-grade squamous intraepithelial lesion cytology with conization indication, in regard to the high possibility of negative cone pathology.

Compared Randomized Roles and Pain Factor by Vabra and Wallach Endocell in Endometrial Evaluation

This randomized study was carried out to compare pain factors of Vabra and Endocell by an ordered classification of one to ten to evaluate the respective pathological yield and to establish the clinical acceptability. Patients had endometrial evaluation either for abnormal bleeding, abnormal endometrial line as demonstrated by echography or abnormal endometrial cells in the Pap smear. Age, gravidity, parity and hysterometry were similar in both groups, with abnormal bleeding being the most frequent indication (250/370 patients, 67.5%). Both techniques yielded equal results for insufficient tissue retrieval at 46/184 (25.0%) for Vabra and at 50/183 (27.3%) for Endocell. The pain score differed significantly in favor of Wallach Endocell at 4.36 ± 2.38 versus Vabra at 5.65 ± 2.41 (p = 0.001). Vabra and Endocell give similar pathological results; however, Endocell is significantly less painful and easier to manipulate and carry because of its weight (1.69 g vs. 37.80 g).

Responsabilité médicale en gynécologie

Abstract One hundred and twenty cases of medical responsibility in gynaecology from January 1973 to September 1996 are reviewed. Close to 50 percent of these cases were related to recto-vaginal fistulae, pregnancy following tubal ligation, vesico-vaginal fistulae, abnormal cervical smears and salpingitis after tubal ligation. Of these cases, 31 were assessed as avoidable (25,8%). Those cases with increased rates of being avoidable included forgotten surgical swabs (75,0%), abnormal cervical smears (57,1 %), undetected ectopic pregnancies (50,0%), pregnancies following tubal ligation (40,0%), medications errors (36,4%), uterine perforation (28,6%) and those cases related to informed consent (28,6%). These avoidable accidents must be closely monitored and eventually prevented by risk management strategies including comprehensive patient information and better informed consent, documentation on the patient file and enhancement of quality assurance of the gynaecological interventions.