درمان واژینیسموس و بارداری متعاقب آن 18 سال پس از ازدواج: گزارش مورد

نوع مقاله : گزارش مورد

نویسندگان

1 استادیار گروه مامایی و سلامت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تهران، تهران، ایران.

2 دانشیار گروه نانوتکنولوژی، مرکز تحقیقات ریزفناوری زیستی، پژوهشکده فناوری‌های نوین علوم پزشکی- جهاد دانشگاهی ابن‌سینا، تهران، ایران.

3 کارشناس ارشد مامایی، مرکز درمان ناباروری ابن‌سینا، پژوهشگاه فناوری‌های نوین علوم پزشکی- جهاد دانشگاهی ابن‌سینا، تهران، ایران.

4 استادیار گروه نانوتکنولوژی، مرکز تحقیقات ریزفناوری زیستی، پژوهشکده فناوری‌های نوین علوم پزشکی- جهاد دانشگاهی ابن‌سینا، تهران، ایران.

چکیده

مقدمه: گاهی اوقات زوج با شکایت ناباروری طولانی‌مدت مراجعه می کنند، در حالی‌که مشکل اصلی آنها واژینیسموس و ناتوانی در نزدیکی است. این مطالعه به گزارش درمان یک بیمار واژینیسموس شدید طولانی‌مدت با استفاده از رویکرد شناختی رفتاری می پردازد.
معرفی بیمار: زوج با سابقه 18 سال ازدواج، بدون فرزند، درخواست استفاده از تکنیک‌های کمک باروری برای بچه‌دار شدن داشتند. در اولین ویزیت با توجه به ناتوانی زن از انجام معاینه واژینال و شرح‌حال ترس از نزدیکی، جهت درمان واژینیسموس به کلینیک سلامت جنسی ارجاع شدند. زن سابقه هایمنکتومی تحت بیهوشی داشت که در حل مشکل بی‌نتیجه بوده است. اضطراب و خجالت زن از بیان مشکل، بی‌رغبتی وی به درمان با پزشک مرد، ترس شوهر از بچه‌‌دار شدن به‌دلیل فوت مادرش در حین زایمان، از عوامل تداوم واژینیسموس در طول این سال‌ها بودند. با درمان شناختی- رفتاری، واژینیسموس 18 ساله در مدت کمتر از 3 ماه درمان شد. 3 ماه بعد از درمان واژینیسموس نیز بارداری خودبه‌خودی اتفاق افتاد.
نتیجه‌گیری: اخذ شرح‌حال دقیق جنسی و تشویق زوج به درمان واژینیسموس، از اقدامات تهاجمی کمک باروری جلوگیری می‌کند. طولانی بودن مشکل واژینیسموس نباید سبب ناامیدی زوج و درمانگر از درمان شود. روحیه شاد و امیدوار درمانگر در جلسه مشاوره، داشتن صبر و آرامش، طراحی درمان منطبق با سبک زندگی زوج، توجه به احساسات شوهر و جلب همراهی وی در درمان و ارتقاء خودباوری و خودمدیریتی در زوج، از عوامل موفقیت درمان واژینیسموس هستند. همچنین پیگیری مداوم و دادن بازخورد مثبت به بیمار در فضای مجازی، سبب سرعت گرفتن و پیوستگی روند درمان می‌شود.

کلیدواژه‌ها

عنوان مقاله [English]

Treatment of vaginismus and subsequent pregnancy after 18 years of marriage: a case report

نویسندگان [English]

  • Maryam Nekoolaltak 1
  • Seyed Ali Azin 2
  • Fataneh Nazari 3
  • Behzad Ghorbani 4
1 Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
2 Associate Professor, Department of Nanotechnology, Nanobiotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran.
3 M.Sc. in Midwifery, Avicenna Infertility Treatment Clinic, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran.
4 Assistant Professor, Department of Nanotechnology, Nanobiotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran.
چکیده [English]

Introduction: Sometimes couples refer with complaints of long-term infertility, while their main problem is vaginismus and inability to have  intercourse. This study reports the treatment of a patient with severe lifelong vaginismus using a cognitive-behavioral approach.
Case presentation: The couple with a history of 18 years of marriage, childless, had requested the use of assisted reproductive techniques for having a child. At first visit, due to the woman's inability to perform the vaginal examination and the history of fear of intercourse, they were referred to the sexual health clinic for treatment of vaginismus. The woman had a history of hymenectomy under anesthesia, which was ineffective in resolving the problem. Woman's anxiety and embarrassment of expressing the problem, her reluctance of treatment with a male doctor, and the husband's fear of having child due to the death of his mother during childbirth were the factors in the persistence of vasinismus during these years. The 18 years vaginismus was resolved with cognitive-behavioral therapy in less than 3 months. Spontaneous pregnancy occurred 3 months after treatment of vaginismus.
Conclusion: Taking an accurate sexual history and encouraging the couple to treat vaginismus prevents invasive assisted reproductive techniques. Prolonged vaginismus should not cause the couple and the therapist to be disappointed with the treatment. The happy and hopefull mood of the therapist in the counseling session, having patience and calmness, designing the treatment in accordance with the couple's lifestyle, paying attention to the husband's feelings and gaining his companionship in the treatment and promoting couple's self-confidence and self-management are among the success factors of vaginismus treatment. Also, continuous follow-up and giving positive feedback to the patient in cyberspace will speed up and continue the treatment process.

کلیدواژه‌ها [English]

  • Cognitive-behavioral therapy
  • Cyberspace
  • Feedback
  • Infertility
  • Vaginismus

مراجع

  1. Stout ME, Meints SM, Hirsh AT. Loneliness mediates the relationship between pain during intercourse and depressive symptoms among young women. Archives of sexual behavior 2018; 47(6):1687-96.
  2. ICD-10. Nonorganic vaginismus Chapter V, Mental and behavioural disorders,(F00-F99), Behavioural syndromes associated with physiological disturbances and physical factors(F50-F59): WHO; 2019 [cited 2021. Available from: https://icd.who.int/browse10/2019/en#/F52.5.
  3. Maria do Carmo B, Gusmão MC, Antunes RA, de Souza MM, Rito AL, Lira P, et al. Vaginismus in Assisted Reproductive Technology Centers: an invisible population in need of care. JBRA assisted reproduction 2018; 22(1):35.
  4. Bakhtiari A, Basirat Z, Nasiri-Amiri F. Sexual dysfunction in women undergoing fertility treatment in Iran: prevalence and associated risk factors. Journal of reproduction & infertility 2016; 17(1):26.
  5. Tayebi N, Ardakani SM. Incidence and prevalence of the sexual dysfunctions in infertile women. Eur J Gen Med 2009; 6(2):74-7.
  6. Zgueb Y, Ouali U, Achour R, Jomli R, Nacef F. Cultural aspects of vaginismus therapy: a case series of Arab-Muslim patients. The Cognitive Behaviour Therapist 2019; 12.
  7. Kadir ZS, Sidi H, Kumar J, Das S, Midin M, Baharuddin N. The neurobiology and psychiatric perspective of vaginismus: linking the pharmacological and psycho-social interventions. Current drug targets 2018; 19(8):916-26.
  8. Hamid N, Dehghanizadeh Z, Firuzi AA. Effects of cognitive-behavioral therapy on sexual function in women with vaginismus disorder. Iran J Obstet Gynecol Infertil 2012; 15(20):1-11.
  9. Tadayon M, Rezaei Kheirabadi A, Molaeinezhad M, Shiralinia K. Efficacy of Cognitive Behavioral Therapy on Catastrophic thoughts on Women with primary Vaginismus: A Single-Case trial. Iran J Obstet Gynecol Infertil 2017; 19(39):25-34.
  10. Achour R, Koch M, Zgueb Y, Ouali U, Hmid RB. Vaginismus and pregnancy: epidemiological profile and management difficulties. Psychology research and behavior management 2019; 12:137.
  11. Janghorban R, Latifnejad Roudsari R, Taghipour A, Abbasi M, Lottes I. The shadow of silence on the sexual rights of married Iranian women. BioMed research international 2015; 2015.
  12. Katz D, Tabisel RL. Is surgery the answer to vaginismus?. Obstetrics & Gynecology 2001; 97(4):S27.
  13. Ramli M, Nora MZ, Roszaman R, Hatta S. Vaginismus and subfertility: case reports on the association observed in clinical practice. Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia 2012; 7(1):24.
  14. Deliktas Demirci A, Kabukcuoglu K. “Being a Woman” in the Shadow of Vaginismus: The Implications of Vaginismus for Women. Current Psychiatry Research and Reviews Formerly: Current Psychiatry Reviews 2019; 15(4):231-6.
  15. Beach M. Relationship-centered care: A constructive reframing/М. Beach, Т. Inui, Relationship-Centered Care Research Team. Journal of General Internal Medicine 2006(21):53-8.
  16. Thom R. Learning to listen. The International Journal of Psychiatry in Medicine 2020; 55(1):35-41.
  17. Yildirim EA, Yildirim MH, Karaş H. Prevalence of depression and anxiety disorders and their relationship with sexual functions in women diagnosed with lifelong vaginismus. Turk Psikiyatri Dergisi 2019; 30(1):9.
  18. Bokaie M, Bostani Khalesi Z. Couple Therapy and Vaginismus: A single case approach. Journal of sex & marital therapy 2019; 45(8):667-72.
  19. Asoğlu M, Beginoğlu Ö, Demir M, Çelik H, Fedai Ü, Öznur AK, et al. Retrospective Analysis of Vaginismus Patients Referred to Psychiatric Outpatient Clinic in a University Hospital. Harran Üniversitesi Tıp Fakültesi Dergisi 2019; 16(3):569-72.
  20. McCarthy B, Wald Ross L. Expanding the types of clients receiving sex therapy and sexual health services. Journal of sex & marital therapy 2018; 44(1):96-101.
  21. Stasiak K, Fleming T, Lucassen MF, Shepherd MJ, Whittaker R, Merry SN. Computer-based and online therapy for depression and anxiety in children and adolescents. Journal of child and adolescent psychopharmacology 2016; 26(3):235-45.
  22. Lahaie MA, Boyer SC, Amsel R, Khalifé S, Binik YM. Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment. Women’s Health 2010; 6(5):705-19.
  23. Fageeh WM. Different treatment modalities for refractory vaginismus in western Saudi Arabia. The journal of sexual medicine 2011; 8(6):1735-9.
  24. Araújo-Soares V, Hankonen N, Presseau J, Rodrigues A, Sniehotta FF. Developing behavior change interventions for self-management in chronic illness. European Psychologist 2019; 24(1):7.
  25. Chui H, Hill CE. Keep calm and alert and carry on: therapist calmness and fatigue in relation to session process. Counselling Psychology Quarterly 2020; 33(1):66-78.
  26. Marthasari RS, Marlinata A, I’tishom R. Vaginismus and Infertility. Indonesian Andrology and Biomedical Journal 2020; 1(2):48-53.
  27. Mousavi Nasab M, Farnoosh Z. Management of vaginismus with cognitive–behavioral therapy, self-finger approach: a study of 70 cases. Iranian Journal of Medical Sciences 2015; 28(2):69-71.
  28. Rostami R, Ramesh S, Hemmat Boland E. Effectiveness of the Combination of Cognitive-Behavioral Therapy and Biofeedback in the Treatment Vaginismus:(Pilot Study). Community Health Journal 2017; 10(1):72-7.
  29. Eivazi A, Sarlati M, Mohammadi G, Eivazi F, Esmaeilpour-Bandboni M. Treatment of Two Cases of Vaginismus following Long-term Infertility with Cognitive Behavioral Therapy: Case Report. Iranian Journal of Psychiatric Nursing 2019; 7(2):10-14.
  30. Mutlu EA, Karlidağ R. Factors affecting the recovery time in vaginismus. Sağlık Akademisi Kastamonu 2021; 6(1):52-63.
مجله زنان، مامایی و نازایی ایران
دوره 24، شماره 4
تیر 1400
صفحه 108-119

فایل ها

هم رسانی

ارجاع به این مقاله

آمار