Avhandling Maria

En avhandling om definition, symptom och behandling
Maria Engman har skirivit en avhandling om vestibulit: Partial vaginismus – definition, symptoms and treatment

Background: Vaginismus is a sexual pain disorder, where spasm of musculature of the outer
third of the vagina interferes with intercourse. Vaginismus exists in two forms: total
vaginismus, where intercourse is impossible, and the more seldom described partial
vaginismus, in which intercourse is possible but painful.

The aim of the thesis was to develop a useful definition of partial vaginismus for both
clinical and scientific purposes; to describe the prevalence of partial vaginismus among
women with superficial coital pain; to report on symptoms and clinical findings in women
with partial vaginismus; and to present treatment results for women with vaginismus.

Methods and findings:
In a clinical sample of 224 women with superficial coital pain, we
found a great overlap of the clinical diagnoses of partial vaginismus (PaV) and vulvar
vestibulitis (VVS) (nowadays called provoked vestibulodynia); 102 women had both PaV and
VVS. All women with VVS had vaginismus. Partial vaginismus was more common in all our
samples than total vaginismus.
sEMG of pelvic floor muscles was found to be of no value in distinguishing women
with partial vaginismus with or without vulvar vestibulitis (PaV+/-VVS) (n=47) from each
other or from an asymptomatic group (n=27).
Women with PaV+/-VVS (n=53) reported not only burning pain but also itch during a
standardized penetration situation (sEMG of pelvic floor muscles), while asymptomatic
women (n=27) did not. In most cases, the appearance of burning pain preceded the
appearance of itch.
In a retrospective interview study, 24 women with PaV+/-VVS reported pain after
intercourse more often than pain during penetration at the onset of the problem. When the
women ceased having intercourse, both symptoms were equally common. Intensity of pain
during penetration increased dramatically from very low at onset of the problem to very high
when the women ceased having intercourse, while intensity of pain after intercourse was
already high at onset of the problem and increased to very high when the women ceased
having intercourse.
Pain after intercourse in women with PaV+/-VVS was described as burning and/or
smarting and lasted in mean for two hours, while pain during penetration was described with
words like sharp/incisive/bursting and lasted for one minute.
At long-term follow-up (more than three years) of a group of women treated with
cognitive behaviour therapy for vaginismus (n=59, response rate 44/59 on a questionnaire), a
majority were able to have and enjoy intercourse. The proportion of women with positive
treatment outcome was, however, associated to the definition of treatment outcome. An ability
to have intercourse at end of therapy was maintained at follow-up. Every tenth women with
vaginismus healed spontaneously after thorough assessment.

Partial vaginismus was more common in our studies than total vaginismus, and
all women with vulvar vestibulitis had partial vaginismus. Women with PaV+/-VVS reported
not only burning pain during standardized penetration but also itch. When the problem started
in women with PaV+/-VVS, pain after intercourse was more common than pain during
penetration. Pain after intercourse was described as longlasting and burning and/or smarting,
while pain during penetration was described as short and sharp/incisive/bursting. Long-term
follow-up results of a series of women treated with CBT for vaginismus show good treatment

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