tailieunhanh - Handbook of sexual dysfunction - part 9

Là co thắt không tự nguyện tái phát hoặc kéo dài của các hệ cơ của âm đạo ngoài của Thứ ba đó cản trở sự xâm nhập âm đạo, nào gây ra đau khổ cá nhân (1). Thay đổi phụ nữ rộng rãi hành vi tình dục Vaginistic trong tiết mục của họ: từ rất hạn chế đến rất rộng rãi. Trong một số trường hợp, | 274 Weijmar Schultz and Van de Wiel Step 3 Step 4 Step 5 Cognitive Therapy References 287 287 288 288 289 INTRODUCTION Vaginismus is defined as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration which causes personal distress 1 . Vaginistic women vary widely in their sexual behavior repertoire from very limited to very extensive. In some cases the desire to have children is first and foremost without there being any real motivation to work on the sexual relationship. The complaint can be situational or generalized. Vaginismus is not part of the sexual response cycle. Prevalence rates for vaginismus are scant without the benefit of multiple studies on specific populations. Prevalence estimates for vaginismus range from 1 to 6 2 . Vaginismus is a supreme example of the mandatory blending of mind and body. The precise etiology is often unclear. There are various theories on the causes of vaginismus each with its own therapeutic approach. In this chapter first the literature on the concept of vaginismus is reviewed secondly the different views on the origination of vaginismus are discussed followed by the various treatments. The chapter is concluded with a diagnostic and treatment protocol. THE DEFINITION The assumption that dyspareunia and vaginismus are distinct types of sexual pain disorders has recently been challenged 3-8 . Research has demonstrated persistent problems with the sensitivity and specificity of the differential diagnosis of these two phenomena. Both complaints may comprise to a smaller or larger extent 1 problems with muscle tension voluntary involuntary limited to vaginal sphincter or extending to pelvic floor adductor muscles back jaws or entire body 2 fear of sexual pain either specifically associated with genital touching intercourse or more generalized fear of pain or fear of sex and 3 propensity for behavioral approach or avoidance. All these three phenomena are