Psychosexual aspects of vulvar disease (original) (raw)
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The Impact of Vulvar Cancer on Psychosocial and Sexual Functioning: A Literature Review
Cancers, 2021
Women who are diagnosed and treated for vulvar cancer are at higher risk of psychological distress, sexual dysfunction and dissatisfaction with partner relationships. The aim of this article is to provide a review of the psychological, relational and sexual issues experienced by women with vulvar cancer in order to highlight the importance of this issue and improve the quality of care offered to these patients. A review of the literature was performed using PubMed, CINAHL, PsycINFO, and the Cochrane Library. The results are presented as a narrative synthesis and highlight the massive impact of vulvar cancer: depressive and anxiety symptoms were more frequent in these women, and vulvar cancer may have a negative effect on sexuality from a physical, psychological and behavioural point of view. Factors that may negatively affect these women’s lives are shame, insecurity or difficulties in self-care and daily activities. This review highlights the psychosocial and psychosexual issues fa...
2010
The many different health issues related to the vulva takes an interdisciplinary and holistic approach as medical, psychological, sexological and existential aspects are intimately interwoven. Often vulval problems are chronic and the patients have them for many years. In this paper we suggest holistic sexology to be an important intervention for a long series of vulval health problems. We argue that the vulva carries immense symbolic meaning making it a focus point in the body of the most difficult feelings and emotions, making the vulva more exposed to psychosomatic problems that any other organ of the body. We recommend as an important tool what have been called "clinical medicine"-curing the patient through the growth of self-insight coming from the physicians and the patient's common exploration and investigation into her life, body, gender, sexuality, and feelings associated to her inner and outer genitals. A surprisingly number of different diseases and disorders can be cured in this simple way: Vaginal infections (non-STDs), skin problems such as lichen sclerosus, lichen planus, and lichen simplex chronicus, vulvovaginitis/inflammation/chronic infection/vaginosis of the vulva and vagina, chronic pain, (burning, irritation, pruritus), vulvodynia and pelvic pain syndromes, sterile and non-sterile urinary tract inflammations, PMS, amenorrhea, and sexological dysfunctions including sexual aversion syndrome and psychosexual developmental disturbances, lack of genital self esteem. NNT=2 estimated from the literature. Tools are talk therapy and therapeutic touch including five tools of holistic manual sexology i.e. including the sexological examination. Finally the ethics of the vulva clinic is discussed.
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVES: This study was undertaken to assess sexual function and quality of life of women after evaluation and treatment of vulvovaginal problems at a University Center. STUDY DESIGN: Subjects were mailed a cover letter and follow-up survey. All new patients (322) referred for evaluation of vulvar problems at a University Vulvar Specialty Clinic between January 1, 1996, and December 31, 1999, were mailed a survey instrument containing specific questions concerning general, vulvar, and sexual health. Medical records from clinic visits were manually abstracted. Groups defined with descriptive statistics and proportional change in symptoms analyzed with χ 2 statistics. RESULTS: Of the 322 women who met the study criteria, 195 returned valid surveys for an overall response rate of 60.5%. The mean duration of follow-up was 28 months. The most common presenting symptoms were vulvar pain (86%), dyspareunia (71%), itching (35%), and skin changes (20%). At follow-up, 128 (66%) reported improvement in symptoms compared with 14 (7%) that worsened (P < .001). Although subjects did not report an increase in the frequency of sexual activity, significantly more women reported an increase in enjoyment (n = 77, 43%) of sexual activity than a decrease (n = 30, 17%, P < .001). CONCLUSION: Most women presenting for evaluation of vulvar pain will report improvement in symptoms and sexual function after treatment in a Vulvar Specialty
Psychosexual adjustment after vulvar surgery
Obstetrics and gynecology, 1983
Fifteen patients treated surgically for vulvar cancer from two institutions participated in semistructured interviews and objective assessment to examine postoperative psychologic, social, marital, and sexual adjustment. Descriptive statistics indicate that after vulvar surgery patients report mild distress, but they report reasonable levels of and satisfaction with their free-time and social activities. Mild levels of marital distress may exist. Sexual functioning and body image appear to undergo major disruption despite the fact that intercourse remains possible. Women reported levels of sexual arousal at the eighth percentile and body image at the fourth percentile. Although replication of these findings is clearly necessary, this investigation provides the first substantive look at the posttreatment life circumstances for these patients and offers a data base for future investigation.
Focal vulvitis: a psychosexual problem for which surgery is not the answer
Journal of Psychosomatic Obstetrics & Gynecology, 1995
In the last decadefocal vulvitis has been ident$ied as a distinct syndrome, characterized by unexplained burning vulvar pain and superficial dyspareunia. A 'Woodruf perineoplasty' has been recommended as a treatment method. A research project was conducted, investigating the longterm results of surgical treatment and the etiology offocal vulvitis. Results showed that the great majority of women continued to sufer from focal vulvitis after the operation, which leads to the conclusion that the procedure should be abandoned. Retrospective data revealed several immediate causes of mechanical and chemical irritation of the vulva. All women exhibited 'inadequate sexual behavior': having intercourse without a suicient amount of lubrication and/ or in the presence of hypertonia ofthe pelvicjloor: Psychosexual processes were further characterized by deterioration of sexual and general well-being, resulting in lack of libido and depression, which contributed considerably to the problem. A n integrated approach to treatment is recommended, which incorporates protection ofthe vulvar skin, relaxation of pelvic muscles and sexological treatment of the psychosexual and relational aspects.
Journal of Psychosomatic Obstetrics & Gynecology, 2020
Introduction: Vulvar lichen planus (LP) and vulvar lichen sclerosus (LS) are chronic inflammatory diseases that affect women's sexual health. In this study, our aim was to investigate sexual function, anxiety level and genital self-image in vulvar LP and vulvar LS patients. Methods: This study was conducted on a total of 178 women who presented to the gynecology clinic between February 2019 and January 2020. The patients were divided into the following groups: group 1, vulvar LP (n ¼ 21); group 2, vulvar LS (n ¼ 59); group 3, fungal vulvitis controls (n ¼ 48); and group 4, healthy controls (n ¼ 50). The validated Female Sexual Function Index (FSFI), Beck Anxiety Index (BAI), and Female Genital Self-Image Scale (FGSIS) questionnaires were assessed in all women. Results: There were no significant differences among the groups with respect to age, parity, menopausal status, body mass index (BMI), vaginal intercourse past 1 month, marital status or educational status (p > .05). There were statistically significant differences between the vulvar LP and vulvar LS groups compared to control groups in terms of FSFI total scores and subscores (p < .001). When FGSIS and BAI scores were analyzed, significant statistical differences were found among the study groups (p < .001). A positive correlation was found between the FSFI and FGSIS scores in patients with vulvar LP and LS. Additionally, a negative correlation was found between the FSFI and BAI scores in patients with vulvar LP and LS. Conclusions: Our study showed that sexual function, genital self-image and anxiety level were associated in vulvar LP and vulvar LS patients. Vulvar LP and vulvar LS patients with worse genital self-image have more sexual problems and anxious conditions.