Marta Meana

A randomized comparison of group cognitive--behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis.

&NA; This study compared group cognitive–behavioral therapy (12‐week trial), surface electromyographic biofeedback (12‐week trial), and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Subjects were 78 women randomly assigned to one of three treatment conditions and assessed at pretreatment, posttreatment and 6‐month follow‐up via gynecological examinations, structured interviews and standard questionnaires pertaining to pain (Pain Rating Index and Sensory scale of the McGill Pain Questionnaire, vestibular pain index, pain during intercourse), sexual function (Sexual History Form, frequency of intercourse, Information subscale of the Derogatis Sexual Functioning Inventory), and psychological adjustment (Brief Symptom Inventory). As compared with pretreatment, study completers of all treatment groups reported statistically significant reductions on pain measures at posttreatment and 6‐month follow‐up, although the vestibulectomy group was significantly more successful than the two other groups. However, the apparent superiority of vestibulectomy needs to be interpreted with caution since seven women who had been assigned to this condition did not go ahead with the intervention. All three groups significantly improved on measures of psychological adjustment and sexual function from pretreatment to 6‐month follow‐up. Intent‐to‐treat analysis supported the general pattern of results of analysis by‐treatment‐received. Findings suggest that women with dyspareunia can benefit from both medical and behavioral interventions.

Elucidating Women's (hetero)Sexual Desire: Definitional Challenges and Content Expansion

The literature on womens sexual desire is reviewed with an emphasis on definitional challenges, an assessment of the empirical basis for the distinction between spontaneous and responsive desire, a reconsideration of the extent to which womens sexual desire is relational in nature, and an exploration of the incentive value of sex for women as a factor partially independent from the experience of sexual desire. Nine recommendations are made regarding research and diagnostic directions. The article concludes with an appeal for the inclusion of eroticism in research and clinical work on sexual desire.

Why Did Passion Wane? A Qualitative Study of Married Women's Attributions for Declines in Sexual Desire

The high prevalence of sexual desire complaints in women have led a number of researchers and theorists to argue for a reconceptualization of female sexual desire that deemphasizes the drive model and places more focus on relational factors. Lacking in this effort has been a critical mass of qualitative research that asks women to report on their causal attributions for low desire. In this study, the authors conducted open-ended interviews with 19 married women who had lost desire in their marriage and asked what causal attributions they made for their loss of sexual desire and what barriers they perceived to be blocking its reinstatement. Three core themes emerged from the data, all of which represented forces dragging down on sexual desire in the present sample: (a) institutionalization of the relationship, (b) over-familiarity, and (c) the de-sexualization of roles in these relationships. Interpersonal and intrapersonal sexual dynamics featured more prominently than did relationship problems in womens attributions. The authors discuss the results in terms of clinical implications in the psychosocial component of treatment for hypoactive sexual desire disorder.

Chronic Pain: The Extra Burden on Canadian Women

Health IssueChronic pain is a major health problem associated with significant costs to both afflicted individuals and society as a whole. These costs seem to be disproportionately borne by women, who generally have higher prevalence rates for chronic pain than do men.Key findingsData obtained from 125,574 respondents to the Canadian Community Health Survey (2000–2001) indicated that 18% of Canadian women suffered from chronic pain, compared to 14% of men. This gender discrepancy, however, seemed to be linked primarily to differences in age, income, and education between adult men and women in this large sample. Age, income, depression and functional interference with activities were strongly associated with chronic pain in general. No gender differences were found in the intensity of pain experienced. Ethnicity was not strongly associated with chronic pain prevalence, although Asians were the group with the highest chronic pain prevalence in the over-65 age group and Aboriginal Canadians had the highest prevalence in the under-65 age group.Data Gaps and RecommendationsCurrent gaps in our knowledge include the types of chronic pain women experience, their impact on domestic responsibilities and parenting and health care utilization patterns of women with chronic pain. Data sources such as provincial databases of billing claims may be useful in the future to enrich our knowledge of health care utilization and analgesic medication use. Enhanced surveillance, assessment, and early identification of pain disorders are recommended to improve outcomes. Considering current demographic patterns toward an older population, there is also some urgency to the development of patient education and self-management programs.

The future of sex therapy: specialization or marginalization?

Sex therapy’s claims to specialization may be exaggerated and ultimately damaging to the integrated treatment of sexual dysfunction. In fact, sex therapy does not have a unified underlying theory, a unique set of practices, or an empirically demonstrated efficacious treatment outcome. Paradoxically, the practice of sex therapy has gained widespread professional and popular acceptance since the publication in 1970 of Human Sexual Inadequacy by Masters and Johnson. Consequences of the widespread acceptance of this supposed specialization include the marginalization of sex therapy from other forms of treatment and the perpetuation of the notion that sex therapy is a special form of therapy requiring highly specialized training. This specialization focus also helps to perpetuate societal discomfort with sexuality. The very modest empirical success of most so-called sex therapy interventions and the lack of theoretical development suggest that sex therapy needs a recalibration in order to survive. It is suggested that the treatment of sexual dysfunction be integrated into the general psychotherapy enterprise and into a multidisciplinary biopsychosocial framework.

Early Dyspareunia Experience in Young Women: Confusion, Consequences, and Help-seeking Barriers

INTRODUCTION Recurrent painful intercourse or dyspareunia is a highly prevalent health problem associated with impairments in sexual function and psychosocial well-being. Despite its particularly high prevalence in young women, little is known about how young women experience the onset of dyspareunia and how they attempt to manage or address the problem. AIMS To explore the subjective experience of early dyspareunia symptoms in young women so as to model its cognitive, emotional, behavioral, and help-seeking trajectory. METHODS Using a qualitative methodology broadly based on grounded theory, 14 young women reporting recurrent entry and/or deep pain with intercourse underwent in-depth semistructured interviews asking them to describe their personal experience with dyspareunia symptoms. MAIN OUTCOME MEASURES The Female Sexual Function Index was used to screen women with symptoms of dyspareunia. The main outcome measure was a semistructured interview inquiring about the cognitions and emotions associated with the experience of pain with intercourse, causal attributions for the pain, interference with personal, relational, and sexual well-being, and help-seeking decisions. RESULTS The model/theory that emerged suggested a sequence of experiences that began with confusion about the onset of pain and a relatively fruitless search for causal attributions. Attempts to self-manage the pain via a number of cognitive and behavioral strategies provided little relief. Deleterious consequences on sexual function, well-being, and relationships ensued, and women reported a number of barriers to help-seeking. CONCLUSION The findings from this study suggest that a lack of public health information about dyspareunia and the reluctance of health care providers to inquire about sexual problems may contribute to many young women delaying treatment for a serious sexual health problem with potentially negative biopsychosocial outcomes.

Priorities for Endometriosis Research A Proposed Focus on Deep Dyspareunia

Women with endometriosis have a substantial increase in risk of deep dyspareunia with respect to the general female population of corresponding age. This symptom has personal and intimate implications, including unfavorable emotional impact in partners. Deep dyspareunia caused by endometriosis can be viewed as an originally visceral type of pain secondary to chronic inflammation (nociception) but with several superimposed components, including hyperalgesia, abnormal cortical perception, and psychological factors. Therefore, a simplistic biometric approach does not allow a comprehensive and elaborated assessment of the global impact of the symptom on women’s sexual function, psychological well-being, body-image, self-esteem, and relational adjustment. We suggest 10 specific issues to be addressed in future research on a clinically as well as scientifically neglected aspect of female health. Time has come to address this physically and psychologically distressing affliction without embarrassment and with a decidedly multidisciplinary perspective.

Influences on breast cancer screening behaviors in Tamil immigrant women 50 years old and over.

Objective To investigate, using the Health Belief Model as a theoretical framework, the incentives and barriers to breast cancer screening in a recent immigrant group, older Tamil women from Sri Lanka. Method Tamil women who had had a mammogram and Tamil women who had never had a mammogram were compared on the following variables: socio-demographics, personal risk estimates for breast cancer, risk-reduction expectancies, beliefs and knowledge about breast cancer and screening recommendations, and acculturation. Results Groups differed significantly in terms of education, years living in North America, acculturation, and beliefs/knowledge about breast cancer. When education and acculturation were controlled, perceived barriers to mammography were most predictive of mammography utilization. Discussion Results are discussed with a view to developing culture-appropriate educational campaigns.

The meeting of pain and depression: comorbidity in women.

The higher prevalence of depression in women is coupled with a higher prevalence of pain complaints. Growing evidence suggests that the comorbidity of these conditions is also proportionately higher in women than men. This paper critically reviews the empirical findings relating to gender differences in comorbid pain and depression as well as findings in support of hypothesized etiologic factors that could explain why women may be more susceptible than men to comorbidity. The empirical evidence for biogenic, psychogenic, and sociogenic explanatory models is presented, and an integration of these models is proposed as a guideline to both research and clinical practice. In conclusion, it is argued that gender-differentiated treatment strategies are not clinically indicated at this time.

Negative Affect and Somatically Focused Anxiety in Young Women Reporting Pain With Intercourse

After a long history of privileging psychosexual etiological factors over pain and physiological processes, dyspareunia has enjoyed 1 decade of pointed research focused on the presenting problem of pain. Although it is generally acknowledged that certain affective and cognitive styles may play a role in an individuals experience of pain in general, investigations into these questions specifically as they pertain to pain that occurs during sex are relatively scarce. To add to this growing body of knowledge, 759 women aged 18 to 29 completed questionnaires about current sexual functioning, gynecologic history, expectations about intercourse, and various personality and health-related anxiety measures. One-hundred-one women (14% of the sample) reported pain during intercourse on at least 50% of attempts. This group of women significantly differed from 536 women reporting pain on less than 10% of intercourse attempts on personality constructs related to emotional and relational well-being (e.g., neuroticism, extraversion, agreeableness), as well as anxiety sensitivity, anxiety related to physical health concerns, and the amplification of somatosensory experiences. This affective and cognitive profile is consistent with previous studies that have found an attentional hypervigilance to health and pain-related information in women with dyspareunia, all of which could prove germane to cognitive-behavioral treatments targeting this disorder.