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Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other object. Lifelong vaginismus occurs when a woman has never been able to have intercourse. A replicated single-case A-B-phase design was used to investigate the effectiveness of therapist-aided exposure for lifelong vaginismus. A baseline period (Phase A) was contrasted with exposure + follow-up (Phase B), using random switching between phases. The main outcome measure (intercourse ability) was assessed daily for 24 weeks. Ten women participated. The exposure consisted of a maximum of three 2-hr sessions during 1 week at a university hospital. The participant performed vaginal penetration exercises on herself, in the presence of a female therapist. Two follow-up sessions were scheduled over a 5-week period. Nine of the 10 participants reported having intercourse after treatment, and in 5 of the 9, intercourse was possible within the 1st week of treatment. The results remained at 1-year follow-up. Furthermore, exposure was successful in decreasing fear and negative penetration beliefs posttreatment and at 3-month and 1-year follow-ups. Therapist-aided exposure appears to be an effective treatment for lifelong vaginismus. (Contains 4 tables, 2 figures and 1 footnote.)

Reported prevalence rates of persistent postpartum pain (PPP) range from less than 1% to almost 20%. The aim of this study was to examine the prevalence of PPP in a Dutch cohort and to evaluate a possible causal role for specific risk factors on the development of chronic pain after childbirth. A questionnaire was sent to 960 postpartum women approximately 2 years after delivery. Primary outcome was pain that arose from childbirth at follow-up, and secondary outcomes included quality of life (QoL) and Hospital Anxiety and Depression Scale scores. Tested risk factors included mode of labor analgesia, history of negative effect, history of chronic pain, delivery route, parity, and ethnicity. A total of 495 (51.6%) women participated. At a mean time of 2.3 postpartum years, 7.3% of women reported any pain and 6.1% reported significant pain related to the delivery. Compared to spontaneous delivery, cesarean delivery provided protection against persistent pain (odds ratio, 0.12; 95% CI, 0.01-0.63, P,0.05). None of the other risk factors, including remifentanil use for labor pain, were of influence on the prevalence of persistent pain. Women with PPP experienced greater negative effects and had lower QoL scores compared to women without pain. In this cohort of Dutch patients, PPP is a serious problem with a great impact on the physical and mental health of women. [ABSTRACT FROM AUTHOR]

Introduction. Chronic pelvic pain (CPP) in women is a long lasting and often disabling condition. It seems reasonable to expect that as a result of the pain, extreme fatigue and/or emotional problems, women with CPP may report a variety of sexual problems. Aim. The present study investigated differences in the report of sexual problems in women with CPP compared with healthy controls, and whether the association of CPP with sexual problems was moderated or mediated by somatic and psychological factors as manifested in women suffering from CPP. Method. One hundred fifty-four women with CPP and 58 age-matched controls completed self-report measures for sexual functioning, pain, physical impairment, anxiety, depression, and sexual and physical abuse. Main Outcome Measure. Golombok Rust Inventory of Sexual Satisfaction. Results. Women with CPP reported higher levels of vaginistic complaints, sexual avoidance, nonsensuality and sexual dissatisfaction than healthy controls. Sexual problems were associated with anxiety, depression, and sexual abuse history but not with somatic factors as pain and physical impairment. Anxiety as well as depression, irrespective of the report of sexual abuse experiences, mediated the effect of CPP on sexual problems. Sexual abuse was a general predictor of sexual problems in both women with CPP and controls. Conclusions. Anxiety and depression constitute important factors in the evaluation of sexual problems in women with CPP. ter Kuile MM, Weijenborg PTM, and Spinhoven P. Sexual functioning in women with chronic pelvic pain: The role of anxiety and depression. J Sex Med 2010;7:1901–1910. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the prevalence of vulvar vestibulitis syndrome (VVS) in a sample of women suffering from lifelong vaginismus (N=91). Lifelong vaginismus is defined as "having a history of never having been able to experience penile entry of the vagina". The results with respect to VVS are compared with the results of women who are suffering from pain during intercourse (superficial dyspareunia) (N=84). Both patients groups were recruited from two treatment outcome studies. Using a standard physical examination, erythema was found in 77%, pain "on touch" in 69% and erythema and pain on the same location was seen in 56% of the patients with lifelong vaginismus. Furthermore, it was found that erythema (94%), pain (98%) and erythema and pain on the same location (92%) were more frequently found in patients with dyspareunia compared to women with lifelong vaginismus. It is concluded that pain is an integral part of the experiences in the majority of women with lifelong vaginismus. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the course of chronic pelvic pain (CPP) symptoms in women and to explore factors associated with changes in pain intensity and adjustment to pain in the long term. DESIGN: Follow-up study. METHOD: All women who had visited a Chronic Pelvic Pain team of a university hospital in the past were invited to participate. All completed a set of questionnaires at their first visit and follow-up. RESULTS: Of the 131 women who met the inclusion criteria, 84 (64%) consented to participation in this follow-up study. After a mean follow-up period of 3 years, significant changes were found as regards a reduction in pain intensity, an improvement in adjustment to pain (i.e., physical well-being and depressive symptoms), a reduction in catastrophizing pain and an increase in perceived pain control. Neither sociodemographic, clinical nor pain-related variables were associated with these changes. Pain appraisals and pain coping strategies at baseline did not predict changes from baseline in pain intensity. A reduction in catastrophizing pain, however, was associated with a reduction in pain intensity and adjustment to pain, especially as regards physical well-being and depressive symptoms. CONCLUSION: After 3 years' follow-up, an improvement in pain intensity was observed in women with CPP, and this was not associated with baseline pain appraisals and coping strategies. A reduction in catastrophizing pain was related to better outcome in the long term.

A follow-up study on a cohort of women with chronic pelvic pain (CPP) was conducted, to evaluate the clinical course and to identify factors associated with outcome. Participants were over 18 years of age and had initially visited a multidisciplinary CPP-team of a Gynaecological Department of a University Hospital. The course of chronic pelvic pain was evaluated using the Life Chart Interview (LCI) method. All participants completed questionnaires covering demographic and clinical characteristics, pain (McGill) and psychological distress (SCL-90) at baseline and follow up. The response rate was 60%. A survival analysis was conducted. After a mean follow-up period of 3.4 years, 18 women (25%) of the study sample (N=72) reported recovery from pelvic pain (i.e. pelvic pain for less than 3 months per year). Eight of these 18 women (11% of the total sample) reported no pain at all at follow up. Relapse of symptoms was not encountered. Not any demographic, clinical or pain related variable measured at baseline, nor any intervention between baseline and follow up, was associated with outcome. Our results indicate that chronic pelvic pain in women in secondary care is a longstanding condition. Further research is recommended to identify risk factors for persistence of symptoms.

Objective: To determine the intra- and interobserver reliability of evaluations during videotaped laparoscopy, with real-time laparoscopy as the "gold standard.", Design: Prospective evaluation., Setting: University hospital., Patient(s): Women who underwent laparoscopy for chronic pelvic pain, sterilization, or infertility workup., Intervention(s): Real-time laparoscopies were videotaped and scored then later reassessed., Main Outcome Measure(s): Intra- and interobserver levels of agreement between evaluations for endometriosis and adhesions., Result(s): With the use of reassessments on 90 (videotaped) laparoscopies, the intra- and interobserver levels of agreement between the scorings for endometriosis were found to be substantial, except for ovarian implantations. A high agreement was found in the staging of endometriotic disease. The intra- and interobserver levels of agreement for scoring adhesions were only fair to moderate, and a substantial number of differences between measurements in adhesion total scores was found. No systematic difference between the number of disagreements was observed in either setting., Conclusion(s): Although special attention has to be given to the assessments of ovarian lesions, the evaluations of videotaped laparoscopies for endometriosis were reliable and justified the use of recorded findings. Because evaluations of adhesions during videotaped laparoscopy are not reliable, in some cases a second laparoscopy may need to be performed.