T .EFTEKHAR TUMS Male partner of vaginismus women sexual dysfunction
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Male partner of vaginismus women sexual
dysfunction
T .EFTEKHAR
TUMS
is defined as the involuntary spasm of
the pelvic muscles surrounding the
outer third of the vagina, particularly
the perineal muscles and the levator ani
muscles
(Ellison, 1972; Jeng, 2004; Jeng et al., 2006; Kaplan,
1974; Masters & Johnson, 1970).Vaginismus is currently defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) as a "GenitoPelvic Pain/Penetration Disorder
the inability of a woman to achieve vaginal penetration despite a desire to do so This results in sexual and non‐sexual (gynecological examination, tampon,dilators) aversion to vaginal penetration owing to actual or anticipated pain
a history of severe pain during intercourse
intercourse being impossible.
A history of intercourse feeling like "Hitting a
brick wall" or "There is no hole down there" is
suggestive of vaginal spasm of the introitus and
is often diagnostic of severe vaginismus differentiation from Dyspareunia vulvodynia vestibulodynia.
refers to an inability to tolerate any vaginal
penetration and is commonly seen in the more
severe forms of vaginismus accompanied by
considerable fear and anxiety.
mild vaginismus
that patients who are able to tolerate some
forms of penetration and who have lower pain and
anxiety scores tend to be easier to treat in that
they are able to cooperate with the proposed
treatment the adductors of the thighs the rectus abdominis the gluteus muscles may be involved. This reflex contraction is triggered by imagined or anticipated attempts at penetration of the vagina or during the act of intromission or coitus (Jeng, 2004).
Compared to women with dyspareunia and women with vaginismus have reported more concerns about loss of control during penetration, negative self‐image as it relates to penetration, more catastrophic pain‐related cognitions, beliefs of genital incompatibility.
the importance of understanding vaginismus
as both a physical and a psychological
condition
women with vaginismus reported more
negative emotions, including disgust,
threat, worry, and anxiety, in response to
viewing erotic films depictingno significant differences in genital arousal compared
to women with dyspareunia and no pain controls.
Women with vaginismus reported less difficulty with
desire and lubrication compared to the Women in the
dyspareunia group.
Women with dyspareunia who continue to engage in
intercourse despite continued pain may experience a
decrease in desire and physiological arousal (lubrication Lamont grade 1 Patient is able to relax for pelvic examination Lamont grade 2 Patient is unable to relax for pelvic examination Lamont grade 3 Buttocks lift off table. Early retreat Lamont grade 4 Generalized retreat: buttocks lift up, thighs close, patient retreats Pacik grade 5 Generalized retreat as in level 4 plus visceral reaction, which may result in any one or more of the following: palpitations, hyperventilation, sweating, severe trembling, uncontrollable shaking, screaming, hysteria, wanting to jump off the table, a feeling of becoming unconscious, nausea, vomiting, and even a desire to attack the doctor
Women with primary (lifelong) vaginismus have
never had pain‐free intercourse,
whereas those with secondary vaginismus were
comfortable with intercourse at some time in their
lives and then progressed to painful intercourse
Situational vaginismus refers to an inability to
tolerate certain forms of penetration such as
intercourse, yet insertion of tampons or finger
penetration is possible vaginismus and sexual pain disorders in
females seem to have a cultural component
the true incidence of vaginismus is unknown,
although it is thought to affect 5– 17 % of women
in a clinical setting is unknown, may be a correlation with sexual molestation strict sexual or religious upbringing, waiting until marriage to have intercourse, fear of first‐time sex (pain, bleeding, tearing, ripping, penis too large, vagina too small,STD, pregnancy) fear of gynecological examinations hearing about these difficulties may manifest as a subsequent fear of penetration.
Undesirable penetration while being
restrained at a young age such
as urinary catheterization, enemas,
and stretching a vagina "that appeared too small“
may set the stage for later vaginismus, as noted by some of
our patients 1% suffered from vaginismic symptoms In
Scandinavian countries USA,3%-7% of women
reported dyspareunia or pain symptoms during
intercourse; (Fugl-Meyer & Fugl-Meyer, 2002; Laumann,
Paik, & Rosen, 1999; Ventegodt, 1998
27% for sexual pain symptoms in Iranian
women,
Safarinejad (2006) reported a prevalenc of
43% of Turkish women surveyed reported
pain symptoms during sexual intercourse. while
Oksuz and Malhan (2006) women with vaginismus have endorsed negative cognitions and expectations about vaginal penetration negative emotions in response to sexual stimuli anxiety and fear during sexual or non‐sexual vaginal penetration.
Vaginismus treatment variety of effective treatments
are available to help women overcome vaginismus.
the use of dilators
, physical therapy with or without biofeedback,
biofeedback,
sex counseling
psychotherapy
hypnotherapy
cognitive behavioral therapy.
post‐treatment counseling is usually needed regardless
of the type of treatment utilized, because of the
interplay of the physical and emotional aspects of
vaginismus Frequently, the male partner of vaginismic patients
develops secondary impotence as a reaction to their
partner’s disorder
However, Kaplan has reported that the man’s reaction to this
situation may vary depending on his psychological and sexual
vulnerability].
He might interpret her dysfunction as a rejection or be frustrated by his
inability to penetrate A more recently published systematic literature
review on vaginismus
pointed out that partners of women with
vaginismus can be described as passive and
unassertive men who frequently suffer from sexual
dysfunctions themselves (Lahaie et al., 2010). It is hypothesized that the majority of male
partners of women with vaginismus suffer from
sexual dysfunctions which predisposes these
men to avoid sexual behavior.
Furthermore, in most cases, a key component in
the formation of the couples is avoidance behavior
and a shared fear towards sexual activity. Turkish sample of male partners of women with
vaginismus (n D 32).
Male sexual dysfunction, especially premature
ejaculation and erectile dysfunction, was
actually reported by the majority of male
partners.
their sexual histories revealed that more
than 50% of the sample suffered from
insufficient sexual knowledge and sexual
problems during their first sexual experience. Current research results indicate that sexual
problems often concur in male and female
partners (e.g., Fugl‐Meyer & Fugl‐Meyer, 2002).
Therefore, certain therapeutic approaches for the
treatment of sexual dysfunctions emphasize that
sexual disorders emerge within a relationship, and
cannot necessarily be understood as a disorder of a
single person, even if only one partner displays
clinically relevant symptomsboth partners in couples with vaginismus seem to
avoid engaging in vaginal intercourse
the male partners have choosen because they are
passive and unassertive, and the couples are
involved in an unconscious collusion to avoid
intercourse.
The majority of men had little or no sexual experience
with women prior to their current relationships
a large proportion of male partners had never undergone
penile intercourse before the current relationship
. Furthermore, sexuality had been taboo
sex education had been almost non existent in most
families of origin Sexually hostile family environments lack of sex education are possibly related to consequences such as negative attitudes towards sexuality, negative body image negative concepts of masculinity
the lack of sexual experience such as petting
and sexual intercourse before the current
relationship could contribute to sexually
inhibited behavior.
study contradict the assumption that male and
female sexual dysfunctions cause each other. Erectile dysfunction was the most frequently reported
diagnosis in this sample
premature ejaculation.
A small percentage of participants reported incestuous
sexual experiences with their sister Malleson ,stated that male partners have roles
in the etiology of vaginismus by arguing that
the trouble is emotionally infectious
[
The male partners of vaginismus patients may
potentially cause or exacerbate vaginismus in
their female partners by being "under‐
competent, over‐anxious, or too forbearing". Non‐genital phase Stage 1. Touching your partner without genital contact and
for your own pleasure
Stage 2. Touching your partner without genital contact, for
your own AND your partner’s pleasure
Adding the genital component Stage 3. Touching with genital contact included
Stage 4. Simultaneous touching with genital contact The gradual inclusion of
vaginal intercourse
Stage 5 and 6. Vaginal containmentThe first stage of therapy, the “non‐genital phase” begins with an agreement between both partners to not attempt intercourse during the early treatment. The purposes of reducing performance anxiety high lighting the value of non‐genital experiences are explained.
when the duration of unconsummated coitus
lengthened, the incidence of sexual dysfunction in the
male partner was found to be greater.
This finding may indicate that male sexual dysfunction
appears to be a result of vaginismus.
results showed that the number of treatment sessions
was not related with the duration of unconsummated
coitus, suggesting that male sexual dysfunction does not
occur secondary to vaginismus. the largest sample size and shows a high rate of
sexual dysfunction in men,with the most
common problem being premature ejaculation.
According to our findings, we may conclude that
sexual dysfunction in male partners may arise as a
result of vaginismus.
Thus, sexual dysfunction in the male partner
should be carefully evaluated in the
management of vaginismus for optimal
outcome.Current research on vaginismus considers male sexual dysfunction in couples in which the woman suffers from vaginismus as resulting from rather than being a cause of vaginismus (e.g., Lamont, 1994). Incontrast, Masters and Johnson (1977) understood vaginismic symptoms as a response to male sexual dysfunction.
Living in a relationship with a woman with vaginismus could “protect” the male partner from having to deal with fears of failure and his own sexual dysfunction male partners are often treated as “the non‐present patient” in the individual therapy setting of women suffering from vaginismus. However, not only can the involvement of the partner in the treatment of vaginismus contribute to therapy success but also the defined treatment goals.
Most studies define penile‐vaginal penetration through intercourse as the therapy outcome success in intercourse as a therapy outcome may implicate the disre gard of women’s pleasure in sexual activities. Moreover, it bears the risk of worsening male sexual dysfunction, as final improvements in female symptoms may lead to an increase in the partner’s sexual difficulties
care of the couple after successful completion of therapy
should be an indispensable factor of the therapeutic
intervention in order to deal with potential delayed
sexual difficulties occurring after the reduction of
vaginismic symptomsThanks for your attention
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