How to Read a Visualization Research Paper: Extracting the Essentials

Introduction. Women's sexual pain disorders include dyspareunia and vaginismus and there is need for state-of-the-art information in this area. Aim. To update the scientific evidence published in 2004, from the 2nd International Consultation on Sexual Medicine pertaining to the diagnosis and treatment of women's sexual pain disorders. Methods. An expert committee, invited from six countries by the 3rd International Consultation, was comprised of eight researchers and clinicians from biological and social science disciplines, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of women's sexual pain disorders. Main Outcome Measure. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee discussion, public presentation, and debate. Results. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence-based recommendations for assessment of women's sexual pain disorders are reviewed. An evidence-based approach to management of these disorders is provided. Conclusions. Continued efforts are warranted to conduct research and scientific reporting on the optimal assessment and management of women's sexual pain disorders, including multidisciplinary approaches. van Lankveld JJDM, Granot M, Weijmar Schultz WCM, Binik YM, Wesselmann U, Pukall CF, Bohm-Starke N, and Achtrari C. Women's sexual pain disorders. J Sex Med 2010;7:615-631

Changes in (risk) behavior and HPV knowledge among Dutch girls eligible for HPV vaccination: an observational cohort study.

Implementation of human papillomavirus (HPV) vaccination raised concerns that vaccination could lead to riskier sexual behavior. This study explored how possible differences in sexual behavior and HPV knowledge developed over time between HPV-vaccinated and unvaccinated girls

Sexual Health of Dutch Medical Students:Nothing to Worry about

Introduction. Little is known about the sexual lives and development of medical students because of relatively small sample sizes and, in particular, low response rates in research. Enhancing medical students' awareness and understanding of sexual behavior is imperative, as gaps in knowledge might impede effective sexual health consultations in their later professional practice. Aim. The aim of this study was to provide insight into the sexual lives and development of medical students. Main Outcome Measures. The main outcome measures of this study are demographic, contextual, and sexual data based on validated surveys. Methods. Preclinical medical students aged under 26 years were approached during scheduled classes and by e-mail to complete a web-based questionnaire. Our results were compared with international and Dutch normative data. Ordinal regression analysis and Pearson's correlation analysis were used to assess relationships between variables. Results. A total of 1,598 questionnaires were returned (response rate 52%: 1,198 by women, 400 by men). There were 719 first-year students (mean age 19.17 years) and 879 third-year students (mean age 21.5 years). Gender distribution differences were seen in all the cohorts and were corrected for. Compared with international and Dutch (88%) normative data, our first- (62.7%; P <0.001) and third-year (79.9%; P = 0.018) medical students had less sexual experience and showed different advancements in sexual behavior. However, these differences decreased, which suggests that medical students "catch-up" as their age increases. Sexual behavior in our sample did not differ from international data, except for a strikingly high sexual satisfaction (80%). We also confirmed that social and environmental characteristics change with alterations in sexual behavior. Although contraceptive measures were used more frequently (98%; P = 0.006), sexually transmitted diseases were more common (4.6%; P = 0.008), which suggests inappropriate use of protective measures. Independent predictive determinants for protective sexual behavior were the form of relationship (P <0.001; OR = 1.97) and sexual orientation (P = 0.009; odds ratio = 2.26). Conclusion. These data provide insight into the sexuality of medical students. The results of this study reliably clarify previous findings and form a solid basis for further research. Fickweiler F, Keers JC, and Weijmar Schultz WCM. Sexual health of dutch medical students: Nothing to worry about. J Sex Med 2011;8:2450-2460

Dynamic Clinical Measurements of Voluntary Vaginal Contractions and Autonomic Vaginal Reflexes

IntroductionThe vaginal canal is an active and responsive canal. It has pressure variations along its length and shows reflex activity. At present, the prevailing idea is that the vaginal canal does not have a sphincter mechanism. It is hypothesized that an active vaginal muscular mechanism exists and might be involved in the pathophysiology of genito-pelvic pain/penetration disorder. AimThe aim of this study was to detect the presence of a canalicular vaginal sphincter mechanism by measuring intravaginal pressure at different levels of the vaginal canal during voluntary pelvic floor contractions and during induced reflexive contractions. MethodsSixteen nulliparous women, without sexual dysfunction and pelvic floor trauma, were included in the study. High-resolution solid-state circumferential catheters were used to measure intravaginal pressures and vaginal contractions at different levels in the vaginal canal. Voluntary intravaginal pressure measurements were performed in the left lateral recumbent position only, while reflexive intravaginal pressure measurements during slow inflation of a vaginal balloon were performed in the left lateral recumbent position and in the sitting position. Main Outcome MeasuresIntravaginal pressures and vaginal contractions were the main outcome measures. In addition, a general demographic and medical history questionnaire was administered to gain insight into the characteristics of the study population. ResultsFifteen out of the sixteen women had deep and superficial vaginal high-pressure zones. In one woman, no superficial high-pressure zone was found. The basal and maximum pressures, as well as the duration of the autonomic reflexive contractions significantly exceeded the pressures and the duration of the voluntary contractions. There were no significant differences between the reflexive measurements obtained in the left lateral recumbent and the sitting position. ConclusionThe two high-pressure zones found in this study, as a result of voluntary contractions and, even more pronounced, as a result of reflexive contractions on intravaginal stimulation, support the hypothesis that the vaginal canal has an active and passive canalicular sphincter mechanism. Further investigation of this sphincter mechanism is required to identify its role in the sexual response and genito-pelvic pain/penetration disorder. Broens PMA, Spoelstra SK, and Weijmar Schultz WCM. Dynamic clinical measurements of voluntary vaginal contractions and autonomic vaginal reflexes. J Sex Med 2014;11:2966-2975

Female genito-pelvic reflexes: an overview

The female reproductive system includes an active and responsive genital tract that shows involuntary activity triggered by sexual arousal, genital stimulation and/or orgasm. This pelvic and perineal somatic and autonomic reflex muscle activity ("genito-pelvic reflexes") may be an important constituent of the female sexual response. The aim of this study was to review the literature critically on female genito-pelvic reflexes. Only a small number of studies (15) have been published on this issue. More neurophysiological research is needed to search for the implications of these genito-pelvic reflexes for female sexual (dys)function

Surgery for an "Acute Erection Angle," When Counseling Fails

Introduction. During erection, the penis increases in volume, rigidity, and angle. Textbooks of urology and sexology provide only very limited information about erection angle dysfunction. In some men, this angle is too tight toward their belly, causing problems with intercourse. Aim. We reported two cases of an acute erection angle and reviewed pertinent literature. Methods. Comprehensive literature review was performed using PubMed. We performed additional searches based on relevant books. Results. There is very limited knowledge about erection angles and the "acute erection angle." Our cases show that simple and safe surgical techniques can yield adequate results. Conclusion. Counseling a couple with complaints of sexual inadequacy, which has resulted specifically from the increased erection angle, should be based on objective reassuring information about anatomical and physiological facts. In selected cases surgical intervention can yield adequate results. Nugteren HM, Pascal AL, Weijmar Schultz WCM, and van Driel MF. Surgery for an "acute erection angle," when counseling fails. J Sex Med 2010;7:1311-1314

Long-Term Results of an Individualized, Multifaceted, and Multidisciplinary Therapeutic Approach to Provoked Vestibulodynia

Introduction. Although it is highly recommended to use a multifaceted approach to treat provoked vestibulodynia (PVD), the large majority of treatment studies on PVD used a one-dimensional approach. Aim. To evaluate the long-term treatment outcome of a multifaceted approach to vulvar pain, sexual functioning, sexually related personal distress, and relational sexual satisfaction in women with PVD. Methods. Retrospective questionnaire survey 3-7 years after treatment. Main Outcome Measures. Sexual functioning, sexually related personal distress, and relational sexual satisfaction were measured using the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and the Dutch Relationship Questionnaire (NRV), respectively. An additional questionnaire assessed socio-demographic variables, intercourse resumption, and the level to which the women would recommend the treatment to other women with PVD. Post-treatment vulvar pain scores were obtained using a visual analog scale (VAS). Pretreatment scores were reported in retrospect on a separate VAS. Results. The questionnaires were completed by 64 out of 70 women (91%). Mean follow-up was 5 years (range 3-7). Comparison of the mean pretreatment and post-treatment VAS scores showed a significant reduction in vulvar pain. Pain reduction was reported by 52 women (81%), whereas no change and pain increase were reported by 7 women (11%) and 5 women (8%), respectively. Post-treatment, 80% of the women had resumed intercourse. Only 5 women (8%) reported completely pain-free intercourse. Comparisons with age-related FSFI and FSDS Dutch norm data showed that scores for sexual functioning in the study group were significantly lower, while scores for sexually related personal distress were significantly higher. There were no significant differences in relational sexual satisfaction ratings between the study group and the NRV Dutch norm data. Conclusion. These retrospective data on long-term treatment outcome support the hypothesis that a multifaceted approach to PVD can lead to substantial improvements in vulvar pain and the resumption of intercourse. Spoelstra SK, Dijkstra JR, van Driel MF, and Weijmar Schultz WCM. Long-term results of an individualized, multifaceted, and multidisciplinary therapeutic approach to provoked vestibulodynia. J Sex Med 2011;8:489-496

Posttraumatic stress disorder, anxiety and depression following pregnancies conceived through fertility treatments: the effects of medically assisted conception on postpartum well-being

OBJECTIVE: To compare the postpartum prevalence of Posttraumatic Stress Disorder (PTSD), anxiety and depression in women who conceived via medically assisted conception (MAC) and women who conceived naturally. STUDY DESIGN: All women (n = 907) who delivered under supervision of four independent midwifery practices and three hospitals in the Netherlands during a 3-month period were asked to complete questionnaires on demographic, logistic, psychosocial and obstetric characteristics two to six months postpartum. In this cross-sectional study PTSD was measured with the Traumatic Event Scale-B; anxiety and depression were measured with the Hospital Anxiety and Depression Scale. RESULTS: The response rate was 47% (428 participants). No significant differences were found in the prevalence of PTSD (0.0% vs. 1.3%; odds ratio [OR] = 0.0, confidence interval [CI]: 0-infinity), anxiety (28.1% vs. 22.2%; OR = 1.4, CI: 0.6-3.1) and depression (9.4% vs. 14.6%; OR = 0.6, CI: 0.8-2.0) between the 32 women who conceived via MAC and the 396 women who conceived naturally. CONCLUSION: We did not find significant differences in the prevalence of PTSD, anxiety and depression between women who conceived via MAC and women who conceived naturally