Women's sexual pain and its management.
BACKGROUND
Approximately 15% of women have chronic dyspareunia that is poorly understood, infrequently cured, often highly problematic, and distressing. Chronic dyspareunia is an urgent health issue.


OBJECTIVE
To provide recommendations/guidelines concerning state-of-the-art knowledge for the assessment and management of women's sexual pain disorders.


METHODS
An international consultation, in collaboration with the major sexual medicine associations, assembled over 200 multidisciplinary experts from 60 countries into 17 committees. One six-member committee focused on women's sexual pain disorders, developing recommendations over a 2-year period.


METHODS
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.


RESULTS
There is increasing evidence for the role of neuropathic pain mechanisms in the pathophysiology of sexual pain disorders. Empirical literature has demonstrated the comorbid presence of clinical psychopathology. With regard to the pathophysiologic role of the pelvic floor and sexual pain disorders, studies reveal that (i) differentiation between vaginismus and dyspareunia using clinical tools is difficult; (ii) vaginal spasms have not been identified; (iii) physical therapists can differentiate vaginismic women from matched controls based on muscle tone/strength differences; (iv) the traditional treatment of vaginismus with vaginal "dilatation" plus psycho-education, desensitization, and so forth is not evidence-based; (v) pelvic floor muscle tone/strength measures for women suffering from vulvar vestibulitis syndrome are intermediate between those of women with vaginismus and no-pain controls; and (vi) the pelvic floor musculature is indirectly innervated by the limbic system and highly reactive to emotional stimuli and states. Pelvic floor therapies for dyspareunia may be effective.


CONCLUSIONS
Recommendations include (i) revising the definitions of vaginismus and dyspareunia; (ii) integration of treatment approaches; (iii) validation of nonspecific treatment effects; (iv) controlled studies to test interventions; and (v) sexuality education to help prevent sexual pain.
Weijmar Schultz
Willibrord
W
Department of Gynecology and Obstetrics, University of Groningen Medical Center, Groningen, the Netherlands. w.c.m.weijmar.schultz@og.umcg.nl
Basson
Rosemary
R
Binik
Yitzchak
Y
Eschenbach
David
D
Wesselmann
Ursula
U
Van Lankveld
Jacques
J
D000928:Antidepressive Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003376:Counseling; D004414:Dyspareunia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004576:Electromyography; D005260:Female; D006287:Health Planning Guidelines; D006801:Humans; D007391:International Cooperation; D018482:Muscle, Skeletal / Q000503:physiopathology; D017773:Pelvic Floor / Q000503:physiopathology; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D014621:Vagina / Q000294:innervation
D000928:Antidepressive Agents