Dyspareunia: More than bad sex

Dyspareunia is generally described, in both psychiatric nosologies and gynecological texts, as a recurrent acute pain experienced primarily during intercourse. A condition rare in men, dyspareunia affects an estimated 10–15% of sexually active women (Laumann et al., 1994). Despite the high estimated prevalence of this disorder, there has been little controlled research on it (Meana and Binik, 1994). The etiological theorizing has also been mostly dualistic, with gynecology focusing on cases associated with observable peripheral pathology and psychiatry/psychology focusing on cases where no such pathology was evident

The treatment of vulvar vestibulitis syndrome: Toward a multimodal approach

Vulvar vestibulitis syndrome (VVS) is currently thought to be the main cause of dyspareunia in pre-menopausal women (Friedrich, 1988; Meana et al., in press a), with reported prevalence rates of up to 15% in general gynecological practice (Goetsch, 1991). This syndrome is characterized by severe pain on vestibular touch or attempted vaginal entry, point tenderness to cotton-tip palpation of the vulvar vestibule, and physical findings confined to vestibular erythema and non-specific inflammation (Friedrich, 1987). Irritation and burning can persist for hours or days after sexual activity, and many patients also report localized pain from tampon use, finger insertion, gynecological examinations, wearing tight clothing and exercise. VVS is usually classified as one of the most common subsets of vulvodynia, a general condition of chronic, unexplained vulvar pain. Although it was probably described over a century ago (Skene, 1889), VVS has only recently been recognized as worthy of serious clinical and empirical consideration (e.g. Basson, 1994)

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

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

Association between cigarette smoking and ovarian reserve among women seeking fertility care.

IntroductionThis study examined the association of smoking with ovarian reserve in a cross-sectional study of 207 women enrolled in the Louisville Tobacco Smoke Exposure, Genetic Susceptibility, and Infertility (LOUSSI) Study and assessed effect modification by NAT2 acetylator phenotype.MethodsInformation on current smoking status was collected using a structured questionnaire and confirmed by cotinine assay. Serum anti-Müllerian hormone (AMH) levels were used to assess ovarian reserve. Diminished ovarian reserve (DOR) was defined as AMH ResultsCurrent smoking status, either passive or active as measured by urinary cotinine assay, was not significantly associated with DOR. For dose-response assessed using self-report, the odds of DOR increased significantly for every additional cigarette currently smoked (Odds ratio, OR:1.08; 95% confidence interval, 95%CI:1.01-1.15); additionally, every 1 pack-year increase in lifetime exposure was associated with an increased odds of DOR among women without PCOS (OR: 1.08 95%CI: 0.99-1.18). These trends appear to be driven by the heavy or long-term smokers. Effect modification by NAT2 genotype was not established.ConclusionA history of heavy smoking may indicate increased risk of diminished ovarian reserve