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Sexuality and Sexual Dysfunction
Published in Jane M. Ussher, Joan C. Chrisler, Janette Perz, Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
A review was recently conducted to evaluate the current state of research concerning medical and psychological interventions for vulvodynia (Goldstein et al., 2016). The authors suggested waiting for more empirical evidence before recommending medical treatments such as anti-inflammatory agents, hormonal agents, and anticonvulsant medications. They did not recommend lidocaine, topical corticosteroids, or antidepressant medication for the long-term management of vulvodynia, but acknowledged that capsaicin, botulinum toxin, and interferon can be considered second-line avenues in cases where other treatment options (e.g., pelvic-floor muscle therapy, psychological interventions) are not successful. Although the authors agreed that a vestibulectomy, which can include the excision of the mucosa of the entire vulvar vestibule or can be limited to the excision of the mucosa to the posterior vestibule (Tommola, Unkila-Kallio, & Paavonen, 2010), is not recommended as a first line of treatment for Provoked Vestibulodynia, studies suggest that it can be considered once other less invasive treatment options have failed (Goldstein et al., 2016).
Vulvar therapies
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Natalie Moulton-Levy, Howard I. Maibach
Severe or refractory vulvar vestibulitis that has failed medical treatment for 6 months can be treated surgically with vulvar vestibulectomy (9). Many surgeons remove all areas of the vestibule, including areas that do not exhibit pain, because vestibulectomy failures result in recurrences in the remaining vestibule tissue. Surgical excision has been curative or produced significant improvement of symptoms in 66%–85% of patients (9). However, hematoma, wound dehiscence, poor healing, symptom recurrence, or worsening of pain can occur after vestibulectomy. Flash lamp-excited dye laser treatment has been somewhat successful in reducing the need for resective surgery (4).
Vulvodynia
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
The modified vestibulectomy is the procedure of choice, involving excision of a horseshoe-shaped area of the vestibule and inner labial fold followed by dissection of the posterior vaginal wall [II]. The vaginal tissue is then advanced to cover the skin defect. The complete response rate is around 60 percent. Women who respond to lidocaine gel prior to sex have a more successful outcome.15 The response rate can be further improved with post-operative psychosexual counselling, which is likely to help overcome the fear of sex after surgery [II].13
Tending to painful sex: applying the neuroscience of trauma and anxiety using mindfulness and somatic embodiment in working with genito-pelvic pain and penetration disorders
Published in Sexual and Relationship Therapy, 2023
Mindfulness (Brotto et al., 2016) and somatic interventions (Levine, 2015; Rothschild, 2017; van der Kolk, 2014) offer potentially less threatening opportunities to work with and explore embedded trauma, stress and anxieties which may be especially useful in sexual contexts (Ventegodt et al., 2006). Such practices can reduce the effects of embedded trauma and sexual anxiety by offering more alternatives to standard GPP/PD treatments namely: psychological interventionspelvic floor physiotherapy (including dialators)botulinum toxin injections (Graziottin, 2008) andvestibulectomy (Spoelstra et al., 2019)allowing clients to lead a richer life (Siegel, 2010a) both in daily tasks and in eroticism. For the purposes of this paper, my interest will be focused on the intersections of trauma and sexual pleasure among women struggling with painful vaginal penetration. This article will offer a theoretical overview of the effects of sexual/emotional trauma and anxiety on the brain, body and corresponding nervous systems, as well as a framework for applying a neuroscience centered, trauma-informed intervention to assist clients in processing effects of sexual/emotional trauma, anxiety and non-organic GPP/PD, leading potentially to greater pleasure.
Recovering from provoked vestibulodynia: Experiences from encounters with somatocognitive therapy
Published in Physiotherapy Theory and Practice, 2019
Kristine Grimen Danielsen, Tone Dahl-Michelsen, Elin Håkonsen, Gro Killi Haugstad
There is a lack of efficient and well-documented treatment options for women with PVD (Andrews, 2011). Vestibulectomy, a surgical procedure where part of the painful vestibular mucosa is excised, is normally only considered after more conservative approaches have proved unsuccessful (Landry, Bergeron, Dupuis, and Desrochers, 2008). Although the use of vestibulectomy has some support in the literature (Andrews, 2011; Landry, Bergeron, Dupuis, and Desrochers, 2008), there is concern that surgical interventions do not take the full complexity of this condition into account (Basson, 2012; Sadownik, 2014). Recent studies indicate that multimodal treatment forms, such as cognitive behavioral therapy (CBT), and multidisciplinary interventions, which integrate psychological skills training, pelvic floor physiotherapy and medical management, offer potential for the treatment of PVD. A wide array of different physiotherapeutic approaches have been tested on women with chronic gynaecological pain including: psychosomatic physiotherapy, stretching, trigger point therapy, Thiele massage, and somatocognitive therapy (SCT) (Loving, Nordling, Jaszczak, and Thomsen, 2012). Loving, Nordling, Jaszczak, and Thomsen (2012) have emphasized that SCT is particularly promising.
Vulvodynia – an evolving disease
Published in Climacteric, 2022
Surgical interventions should always be the last resort, after all else has failed. The procedure is a vestibulectomy, which entails excision of vestibular skin down to subcutaneous tissue from the region of the painful part of the vestibule to the lateral vestibular walls at Hart’s line. Excision should include all tender parts extending to the anterior vestibule, if necessary. Alternatively, a horseshoe-shaped excision of the posterior vestibular wall extending up the lateral walls of the vestibule up to clitoris may be needed. Success varies between 60 and 80% [55].