اثرات درمان واژینیسموس و بارداری متعاقب آن: یک بررسی گروه موردی

نوع مقاله : گزارش مورد

نویسندگان

1 دکترای تخصصی سلامت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی کاشان، کاشان، ایران.

2 دکترای آموزش بهداشت و ارتقاء سلامت، مرکز تحقیقات یائسگی، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

3 دکترای تخصصی بهداشت باروری، هسته تحقیقاتی سلامت خانواده و رشد جمعیت، پژوهشکده سلامت، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

10.22038/ijogi.2024.79212.6057

چکیده

مقدمه: با توجه به تأثیرات منفی واژینیسموس بر کیفیت زندگی زوجین و ایجاد تأخیر در بارداری، مطالعه حاضر به صورت گروه موردی و با هدف بررسی روند درمان بیماران مبتلا به واژینیسموس و بارداری متعاقب درمان انجام شد.
معرفی بیماران: در این مطالعه توصیفی 12 بیمار مبتلا به واژینیسموس از مهر ماه 1400 تا آذر ماه 1402 مورد بررسی قرار گرفتند. پس از شرح‌حال و ارزیابی اولیه، بر اساس مقیاس لاموت، واژینیسموس درجه 3 و 4 در معاینه بیماران تشخیص داده شد. بیماران شرکت کننده در این مطالعه در فاصله سنی 35-20 سال بودند. میانگین مدت ابتلاء به این بیماری و میانگین مدت نازایی در آنها به‌ترتیب 3/4 سال و 1/4 سال بود و 5 نفر (6/41%) از بیماران خواستار روش­ های کمک باروری بودند. بیماران در طی این مدت چندین درمان ناکارآمد و غیرعلمی را دریافت کرده بودند. روند درمان بیماران به صورت تیمی انجام گردید. درمان توسط متخصص سلامت باروری و جنسی آغاز شد. آموزش‌ها، پیگیری بیماران و ارجاع به اعضای تیم نیز توسط ایشان صورت گرفت. این پروسه شامل درمان شناختی رفتاری و دیلاتور بود که در طی روند درمان، ورزش کگل و حس‌یابی غیرجنسی نیز توسط بیمار انجام شد. جلسات به‌صورت هفتگی انجام و کل دوره درمان 3-2 ماه به طول انجامید. پس از پایان درمان، بیماران موفق به برقراری ارتباط جنسی بدون درد شدند و 12-3 ماه پس از درمان باردار شدند.
نتیجه ­گیری: یکی از مشکلات زنان مبتلا به واژینیسموس، ناباروری است و می ­توان با درمان­های علمی، تیمی و ترکیبی و مداومت بر روند درمان، این مشکل بیماران را به‌صورت کامل حل کرد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

The effects of vaginismus treatment and subsequent pregnancy: A case group study

نویسندگان [English]

  • Zahra Karimian 1
  • Marzieh Araban 2
  • Arezoo Haseli 3
1 PhD, Department of Reproductive Health, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran.
2 PhD, Department of Health Education and Health Promotion, Menopause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
3 PhD, Department of Reproductive Health, Family Health and Population Growth Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
چکیده [English]

Introduction: Considering the negative effects of vaginismus on the quality of life of couples and delay in pregnancy, this case group study was conducted with aim to investigate the process of treatment of patients with vaginismus and subsequent pregnancy.
Cases presentation: In this descriptive study, 12 patients with vaginismus were evaluated from October 2021 to December 2023. After history and initial evaluation, vaginismus grades 3 and 4 were diagnosed based on the Lamotte scale in the examination of the patients. The participants aged 20-35 years old. The mean duration of this disease and the mean duration of infertility were 4.3 years and 4.1 years, respectively, and 5 patients (41.6%) wanted assisted reproductive methods. During this period, the patients had received several ineffective and unscientific treatments. The process of treatment was done as a team. The treatment was started by the reproductive and sexual health specialist, the trainings, follow-up of the patients and referral to the team members were also done by the same specialist. The process included cognitive behavioral therapy and dilators that during the treatment process, Kegel exercises and non-sexual sensation were also performed by the patient. The sessions were held weekly and treatment period lasted two to three months. After end of treatment, the patients were able to have sexual intercourse without pain and became pregnant 3 to 12 months after the treatment.
Conclusion: One of the problems in women with vaginismus is infertility and this problem can be completely solved with scientific, team and combined treatments and persistence in the treatment process.

کلیدواژه‌ها [English]

  • Case group
  • Infertility
  • Pregnancy
  • Vaginismus
  1. American Psychiatric Association DS, American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American psychiatric association; 2013.
  2. World Health Organization. Chapter V: Mental and behavioural disorders (F00-F99). ICD-10 International Statistical Classification of Diseases and Related Health Problems: Tenth Revision. Geneva, Switzerland: Author. Retrieved from http://apps. WHO. int/classifications/icd10/browse/2010/en#/V. 2004.
  3. Oniz A, Keskinoglu P, Bezircioglu I. The prevalence and causes of sexual problems among premenopausal Turkish women. The journal of sexual medicine 2007; 4(6):1575-81.
  4. Reissing ED, Binik YM, Khalifé S. Does vaginismus exist?: a critical review of the literature. The Journal of nervous and mental disease 1999; 187(5):261-74.
  5. Christensen BS, Grønbæk M, Osler M, Pedersen BV, Graugaard C, Frisch M. Sexual dysfunctions and difficulties in Denmark: Prevalence and associated sociodemographic factors. Archives of sexual behavior 2011; 40:121-32.
  6. Tayebi N, Ardakani SM. Incidence and prevalence of the sexual dysfunctions in infertile women. Eur J Gen Med 2009; 6(2):74-7.
  7. Trudel G. Sexuality and marital life: Results of a survey. Journal of Sex &Marital Therapy 2002; 28(3):229-49.
  8. Yeganeh T, Farahani MN, Moghadasin M. Identifying psychological factors associated with vaginismus in married women in 2018: a qualitative study. Journal of Rafsanjan University of Medical Sciences 2020; 18(10):997-1016.
  9. Foroutan SK, Jadid Milani M. The prevalence of sexual dysfunction among divorce requested. Daneshvar Medicine 2008; 15(5):39-44.
  10. Nekoolaltak M, Azin SA, Nazari F, Ghorbani B. Treatment of vaginismus and subsequent pregnancy after 18 years of marriage: a case report. The Iranian Journal of Obstetrics, Gynecology and Infertility 2021; 24(4):108-19.
  11. Pacik PT. Vaginismus: review of current concepts and treatment using botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia. Aesthetic plastic surgery 2011; 35:1160-4.
  12. Rosenbaum T. Addressing anxiety in vivo in physiotherapy treatment of women with severe vaginismus: a clinical approach. Journal of sex & marital therapy 2011; 37(2):89-93.
  13. Abdnezhad R, Simbar M. A review of Vaginismus Treatments. The Iranian Journal of Obstetrics, Gynecology and Infertility 2021; 24(7):83-97.
  14. Akhavan-Taghavi MH, Asghari-Moghaddam MA, Froutan SK, Jadid-Milani M. Vaginismus in Iran: a single center report of 7 years experience. Nephro-urology monthly 2015; 7(6).
  15. Zhang X, Sherman L, Foster M. Patients’ and providers’ perspectives on sexual health discussion in the United States: A scoping review. Patient education and counseling 2020; 103(11):2205-13.
  16. Semnani Y, Razzaghizadeh B. Management of an unconsummated marriage after 14 years. Journal of Inflammatory Diseases 2003; 7(4):89-92.
  17. Cavkaytar S, Kokanali MK, Topcu HO, Aksakal OS, Doğanay M. Effect of home-based Kegel exercises on quality of life in women with stress and mixed urinary incontinence. Journal of Obstetrics and Gynaecology 2015; 35(4):407-10.
  18. Kaplan HS. New sex therapy: Active treatment of sexual dysfunctions. Routledge; 2013.
  19. Katz D, Tabisel RL. Is surgery the answer to vaginismus?. Obstetrics & Gynecology 2001; 97(4):S27.
  20. Akhavan-Taghavi MH, Asghari-Moghaddam MA, Froutan SK, Jadid-Milani M. Vaginismus in Iran: a single center report of 7 years experience. Nephro-urology monthly 2015; 7(6).
  21. Pacik PT. Understanding and treating vaginismus: a multimodal approach. International urogynecology journal 2014; 25:1613-20.
  22. Blackburn AG, Mullings JL, Marquart JW. Sexual assault in prison and beyond: Toward an understanding of lifetime sexual assault among incarcerated women. The Prison Journal 2008; 88(3):351-77.
  23. Satinsky S, Fisher C, Stupiansky N, Dodge B, Alexander A, Herbenick D, et al. Sexual compulsivity among men in a decentralized MSM community of the Midwestern United States. AIDS Patient Care and STDs 2008; 22(7):553-60.
  24. Logie CH. Sexual rights and sexual pleasure: sustainable development goals and the omitted dimensions of the leave no one behind sexual health agenda. Global Public Health 2023; 18(1):1953559.
  25. Shirpak KR, Chinichian M, Ardebili HE, Porreza A, Khanali R. Assessment of sexual health in women attending family planning health centers in Tehran. Payesh 2010; 9(3):251-60.
  26. Reza S. The relationship between midwifery students' attitudes towards couples' sexual relationships and their clinical skills in providing sexual health of counseling services. Reproductive Health 2016; 4(1):530-9.
  27. Maasoumi R, Lamyian M, Khalajabadi FF, Montazeri A. Women’s perception of sexual socialization in Iran: A qualitative study. J Qual Res Health Sci 2013; 2(3):221-33.
  28. Mohseni M, Riazi H, Karimian Z, Nasiri M. providing sexual health services by midwives in comprehensive health centers: A qualitative study from Iran. Payesh (Health Monitor) 2023; 22(1):61-72.
  29. Rasotra R, Shanthakumar K. Effect of Invasive Pelvic Floor Management in Vaginismus among Reproductive Aged Females-A Case Study. InBIO Web of Conferences 2024; 86:01008.
  30. Pacik PT, Geletta S. Vaginismus treatment: clinical trials follow up 241 patients. Sexual medicine 2017; 5(2):e114-23.
  31. Nejat M, Tarzimoghadam M. The effectiveness of functional electrical stimulation-biofeedback with sexual cognitive-behavioral therapy in the treatment of grade 3 and 4 Lamont vaginismus and pregnancy rate of treated individuals. Sarem Journal of Medical research 2020; 5(2):67-74.
  32. Baktriya F, Rafieinia P, Sabahi P, Nazari L. The effect of hypnotherapy on sexual function, pain catastrophizing and irrational beliefs about fear of sex in women with vaginismus (genito-pelvic pain/penetration disorder). Journal of Urmia Nursing and Midwifery Faculty 2020; 17(124):907-18.
  33. Elsheikh AH. Botox injection for treatment of refractory vaginismus in Egyptian Women. Life Science Journal 2018; 15(1):45-50.