Subject Areas :
Arezoo Rezaei 1 * , Mitra Tadayon 2 , Mitra Molaeinezhad 3 , Khadijeh Shiralinia 4
1 - Department of Midwifery, Islamic Azad University, Behbehan Branch, Behbehan, Iran.
2 - Department of Midwifery, Menopause and Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 - Department of Psychology, Najafabad Branch, Islamic Azad University،Esfahan، Iran
4 - Department of Counseling, Faculty of Educational Sciences and Psychology, Shahid Chamran University, Ahvaz, Iran.
Keywords: Cognitive Behavioral Therapy, Vaginismus, Sexual Dysfunction,
Abstract :
Vaginismus is one of the most common GenitoPelvic Pain/Penetration Disorders, which is classified as either lifelong (primary) or acquired (secondary). The present study aimed to investigate the efficacy of Cognitive Behavioral Therapy on women with lifelong vaginismus. During a single-case experimental trial of multiple-baseline type, four women were included and diagnosed with lifelong vaginismus by a psychiatrist in a psychosexual clinic in Ahvaz. Full intercourse was evaluated daily based on the self-reports of participants. Secondary outcome measures (i.e.catastrophic cognitions, tightening, helplessness, sexual adjustment, avoidance, and penetration motivation were assessed in participants by a multidimensional vaginal penetration disorder questionnaire at baseline and after intervention. The subjects were entered into an eight-week Cognitive Behavioral Therapy program. The decreasing curve is compared with the baseline for each variable and considered the recovery index. After the treatment, all participants reported successful intercourse without pain and fear. The findings investigated that catastrophic cognitions, tightening, helplessness, sexual adjustment, avoidance, penetration motivation, sexual information, hypervigilance, optimism, and thoughts about genital incompatibility significantly improved by Cognitive Behavioral Therapy in all participants(P < 0.05). Based on the results, Cognitive Behavioral Therapy can be considered an effective treatment for LLV. In addition, this study can enhance our knowledge about the fear-avoidance essence of vaginismus and develop treatment options for women with lifelong vaginismus. Future studies are recommended with larger sample sizes and control groups.
1- تدین، م.، رضایی خیرآبادی، آ.، ملایی¬نژاد، م.، شیرالی¬نیا، خ. (1395). اثربخشی رفتار درمانی شناختی بر افکار وحشتناک زنان مبتلا به واژینیسموس اولیه: یک کارآزمایی تک موردی. زنان مامایی و نازایی ایران، 19(39)، 25-34.
2- توانایی، ع.، آهی، ق.، و منصوری، ا. (1397). اثربخشی درمان شناختی رفتاری گروهی اختلال¬های جنسی و مشکلات زناشویی بر پویایی¬های رابطه جنسی و جاذبه جنسی زنان. پژوهش¬های روانشناسی بالینی و مشاوره، 8(2)، 5-22.
3- ثابت¬قدم، ش.، کرامت، ا.، ملاری، م.، رضایی چمنی، ص. (1398). مرور نظام¬مند مطالعات گزارش شیوع واژینیسموس. مجله دانشگاه علوم¬پزشکی و خدمات بهداشتی درمانی اردبیل، 19(3)، 263-271.
4- حیدریان، م.، غلامزاده جفره، م.، و شهبازی، م. (1400). تجربه زیسته زنان مبتلا به دیسپارونیا و واژینیسموس: مطالعه کیفی. پژوهش¬های مشاوره، 20(77)، 161-199.
5- خان محمدی اطاقسرا، ا. (1401). اثربخشی درمان شناختی- رفتاری در رشد خودپنداره جنسی زنان متأهل. علوم روانشناختی، 21(118)، 2053-2066.
6- دیهیمی، م.، کریمیان، ن.، و آزادفر، ز. (1398). اثربخشی درمان شناختی- رفتاری بر نگرش¬های ناکارآمد و باورهای غیرمنطقی زنان نابارور. رویش روانشناسی، 8(12)، 99-106.
7- رستمخانی، ف.، قمری، م.، باباخانی، و.، مرقاتی خوبیف ع. (1399). اثربخشی درمان شناختی-رفتاری بر عملکرد و طرحواره¬های جنسی زنان یائسه. مدیریت ارتقای سلامت، 9(6)، 96-107.
8- رئیسی، ل.، ضیایی، س.، محمدی، ع.، و حاجی¬زاده، ا. (1399). تبیین فرایند تشخیصی واژینیسموس: یک مطالعه تحلیل محتوا. فصلنامه سلامت و مراقبت، 21(1)، 53-64.
9- عیوضی، ع.، سرلاتی، م.، محمدی، گ.، عیوضی، ف.، و پوربندبنی، م. (1398). درمان دو بیمار مبتلا به واژینیسموس با نازایی طولانی مدت با رویکرد شناختی-رفتاری: گزارش مورد. روان¬پرستاری، 7(2)، 10-14.
10- نصرت¬آبادی، م.، و افضلی گروه، ع. (1399). اثربخشی طرحواره¬درمانی بر کاهش اضطراب و افسردگی و بهبود عملکرد جنسی زنان مبتلا به واژینیسموس. روانشناسی بالینی و شخصیت، 18(2)، 11-19.
11- یگانه، ط.، فراهانی، م. ن.، فرزاد، و.، و مقدسین، م. (1397). بررسی عوامل مرتبط با اختلال واژینیسموس در زنان متأهل سال 1397: یک مطالعه کیفی. دانشگاه علوم¬پزشکی رفسنجان، 18، 997-1016.
12- Abdnezhad, R., & Simbar, M. (2021). A review of Vaginismus Treatments. The Iranian Journal of Obstetrics, Gynecology and Infertility, 24(7), 83-97.
13- Allen, B. (2018). Implementing trauma-focused cognitive-behavioral therapy (TF-CBT) with preteen children displaying problematic sexual behavior. Cognitive and Behavioral Practice, 25(2), 240-249.
14- Anğın, A. D., Gün, İ., Sakin, Ö., Çıkman, M. S., Eserdağ, S., & Anğın, P. (2020). Effects of predisposing factors on the success and treatment period in vaginismus. JBRA assisted reproduction, 24(2), 180.
15- Antle, B. F., Owen, J. J., Eells, T. D., Wells, M. J., Harris, L. M., Cappiccie, A., ... & Wright, J. H. (2019). Dissemination of computer-assisted cognitive-behavior therapy for depression in primary care. Contemporary Clinical Trials, 78, 46-52.
16- Çankaya, S., & Aslantaş, B. N. (2022). Determination of sexual attitude, sexual self-consciousness, and sociocultural status in women with and without lifelong Vaginismus: a case-control study. Clinical Nursing Research, 31(7), 1340-1351.
17- Elrassas, H., Saad, A., Fekry, M., Elkholy, H., Mansour, O., & Azzam, L. (2022). Psychiatric comorbidity in a sample of Egyptian women with vaginismus. Middle East Current Psychiatry, 29(1), 39.
18- Erfanifar, E., Latifi, S. M., & Abbaspoor, Z. (2022). The effectiveness of cognitive-behavioural consultation on sexual function and sexual self-efficacy of women after childbirth. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 15, 100157.
19- Eserdag, S., Ezberci Akgün, M., & Şükrü Gürbüz, F. (2023). Outcomes of Vaginismus Therapy Assessed by Penetrative Intercourse, Psychiatric Symptoms, and Marital Satisfaction. Journal of Sex & Marital Therapy, 49(4), 412-419.
20- Everhart Newman, J. L., Falligant, J. M., Thompson, K. R., Gomez, M. D., & Burkhart, B. R. (2018). Trauma-focused cognitive behavioral therapy with adolescents with illegal sexual behavior in a secure residential treatment facility. Children and Youth Services Review.
21- Işık, C., & Aslan, E. (2023). The effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment: a randomized controlled study. International Urogynecology Journal, 34(3), 683-692.
22- Jenkins, C. S., Grimm, J. R., Shier, E. K., van Dooren, S., Ciesar, E. R., & Reid-Quiñones, K. (2020). Preliminary findings of problematic sexual behavior-cognitive-behavioral therapy for adolescents in an outpatient treatment setting. Child Abuse & Neglect, 105, 104428.
23- Khan, S., Amjad, A., & Rowland, D. (2019). Potential for long-term benefit of cognitive behavioral therapy as an adjunct treatment for men with erectile dysfunction. The Journal of Sexual Medicine, 16(2), 300-306.
24- Lerner, T., Bagnoli, V. R., Pereyra, E. A. G. D., Fonteles, L. P., Sorpreso, I. C. E., Soares Júnior, J. M., & Baracat, E. C. (2022). Cognitive-behavioral group therapy for women with hypoactive sexual desire: A pilot randomized study. Clinics, 77.
25- Mestre-Bach, G., Blycker, G. R., & Potenza, M. N. (2022). Behavioral therapies for treating female sexual dysfunctions: a state-of-the-art review. Journal of Clinical Medicine, 11(10), 2794.
26- Molaeinezhad, M., Roudsari, R. L., Yousefy, A., Salehi, M., & Khoei, E. M. (2014). Development and validation of the multidimensional vaginal penetration disorder questionnaire (MVPDQ) for assessment of lifelong vaginismus in a sample of Iranian women. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 19(4), 336.
27- Stout, M. E., Meints, S. M., & Hirsh, A. T. (2018). Loneliness mediates the relationship between pain during intercourse and depressive symptoms among young women. Archives of sexual behavior, 47, 1687-1696.
28- Tastan, K., Yoruk, N., & Memet, I. Ş. I. K. (2021). A Comparison of the Effectiveness of Hypnotherapy and Cognitive Behavioral Therapy in the Treatment of Primary Vaginismus. Konuralp Medical Journal, 13(3), 536-541.
29- Weinberger, J. M., Houman, J., Caron, A. T., & Anger, J. (2019). Female sexual dysfunction: a systematic review of outcomes across various treatment modalities. Sexual medicine reviews, 7(2), 223-250.
30- WHO. (2019). Behavioural syndromes associated with physiological disturbances and physical factors. ICD-10. Retrieved from https://icd.who.int/browse10/2016/en#/F50-F59.
31- Zgueb, Y., Ouali, U., Achour, R., Jomli, R., & Nacef, F. (2019). Cultural aspects of vaginismus therapy: a case series of Arab-Muslim patients. The Cognitive Behaviour Therapist, 12, e3.
32- Ziaei, T., Farahmand Rad, H., Rezaei Aval, M., & Roshandel, G. (2017). The Relationship between Sexual Self-concept and Sexual Function in Women of Reproductive Age Referred to Health Centers in Gorgan, North East of Iran. Journal of Midwifery and Reproductive Health, 5(3), 969-977.