TY - JOUR
T1 - Psychosexual aspects of the evaluation and management of vulvar vestibulitis
AU - Schover, Leslie R.
AU - Youngs, David D.
AU - Cannata, Ruth
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 1992
Y1 - 1992
N2 - OBJECTIVE: This article describes the structure and outcome of a collaboration between a gynecologist and a psychologist in evaluating and treating 45 consecutive women with vulvar vestibulitis. STUDY DESIGN: Women were interviewed by the psychologist in a structured format and also filled out questionnaires. Vulvar lesions were defined by clinical examination and colposcopy, and a conservative local excision was performed, without mobilization of the vagina. Postoperatively, women were offered sexual counseling including Kegel exercises, vaginal dilation, and couple therapy. Follow-up data were gathered a mean of 8 months after treatment. RESULTS: Of the 32 women who had both surgical excision of vulvar lesions and contact with the psychologist, 50% were much improved in perceived pain, 41% were somewhat improved, and 9% were unimproved. Factors predictive of an improved outcome included wilingness to have psychologic treatment, higher socioeconomic status, and self-report of specific, localized areas of vulvar pain rather than vague, diffuse pain. Parous women were more likely to improve. Those who reported increased pain intensity premenstrually had poorer outcomes. CONCLUSIONS: Vulvar vestibulitis may be a syndrome that results from interacting pathophysiologic and psychologic factors, so that a comprehensive treatment approach is beneficial. Women who have diffuse genital pain or who refuse psychologic intervention may be poor candidates for surgery.
AB - OBJECTIVE: This article describes the structure and outcome of a collaboration between a gynecologist and a psychologist in evaluating and treating 45 consecutive women with vulvar vestibulitis. STUDY DESIGN: Women were interviewed by the psychologist in a structured format and also filled out questionnaires. Vulvar lesions were defined by clinical examination and colposcopy, and a conservative local excision was performed, without mobilization of the vagina. Postoperatively, women were offered sexual counseling including Kegel exercises, vaginal dilation, and couple therapy. Follow-up data were gathered a mean of 8 months after treatment. RESULTS: Of the 32 women who had both surgical excision of vulvar lesions and contact with the psychologist, 50% were much improved in perceived pain, 41% were somewhat improved, and 9% were unimproved. Factors predictive of an improved outcome included wilingness to have psychologic treatment, higher socioeconomic status, and self-report of specific, localized areas of vulvar pain rather than vague, diffuse pain. Parous women were more likely to improve. Those who reported increased pain intensity premenstrually had poorer outcomes. CONCLUSIONS: Vulvar vestibulitis may be a syndrome that results from interacting pathophysiologic and psychologic factors, so that a comprehensive treatment approach is beneficial. Women who have diffuse genital pain or who refuse psychologic intervention may be poor candidates for surgery.
KW - Vulvar vestibulitis
KW - psychologic sexual treatment
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U2 - 10.1016/S0002-9378(11)91562-2
DO - 10.1016/S0002-9378(11)91562-2
M3 - Article
C2 - 1530015
AN - SCOPUS:0026787722
SN - 0002-9378
VL - 167
SP - 630
EP - 636
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 3
ER -