Abordagens terapêuticas em pacientes com vaginismo: uma revisão de literatura / Therapeutic approaches in patients with vaginismus: a literature review

Sersie Lessa Antunes Costa Almeida, Igor Silva Matias, Bárbara Coelho Pereira, Camila Martins da Silva, Helena Guimarães Pires, Isadora Silveira Roza, Jéssica Lunardo Nóbrega, Lucas da Silva Molina, Maria Eduarda Mendonça Lisbôa, Mariane de Oliveira Diogo Scussel, Renzo Camara Arreguy

Abstract


INTRODUÇÃO: O vaginismo é uma disfunção do aparelho genital feminino na qual ocorre uma contração involuntária da musculatura pélvica, tendo uma etiologia multifatorial. Existem inúmeros fatores predisponentes ao sucesso do tratamento, no entanto há poucas publicações sobre o assunto. Portanto, o objetivo deste trabalho é avaliar a eficácia das diferentes intervenções terapêuticas no tratamento desse transtorno. METODOLOGIA: Trata-se de uma revisão integrativa realizada por meio da base de dados PubMed na qual foram selecionados 31 artigos entre os anos de 2011 a 2021.

RESULTADOS: Durante a revisão foram identificados diferentes métodos terapêuticos que auxiliam no tratamento do vaginismo, como a abordagem multidisciplinar associada à educação sexual, hipnoterapia, tratamento farmacológico (incluindo antidepressivos, ansiolíticos, anestésicos locais ou toxina botulínica), tratamento psicológico e combinações entre diferentes intervenções. DISCUSSÃO: Repercussões como depressão, dificuldade para engravidar, fobia a dor e resistência a atividades sexuais são comuns em pacientes com vaginismo e evidenciam a importância de um tratamento adequado. Os artigos abordam a importância de uma terapia personalizada para maior chance de eficácia no tratamento. CONCLUSÃO: Com intuito de diminuir os impactos psicológicos e interpessoais das pacientes com vaginismo e proporcionar maior qualidade de vida sexual é essencial uma abordagem terapêutica multimodal e multidisciplinar. 

 


Keywords


vaginismo, saúde sexual, terapêutica.

References


Pacik PT. Understanding and treating vaginismus: a multimodal approach. International Urogynecology Journal. 2014 Jun 04;25:1613–1620. doi: 10.1007/s00192-014-2421-y

Seehusen DA, Baird DC, Bode DV. Dyspareunia in women. Am Fam Physician. 2014 Oct 1;90(7):465-70. PMID: 25369624.

Ramli M, Nora M, Roszaman R, Hatta S. Vaginismus and subfertility: case reports on the association observed in clinical practice. Malays Fam Physician. 2012 Apr 30;7(1):24-7. PMID: 25606241; PMCID: PMC4170445.

Melnik T, Hawton K, McGuire H. Interventions for vaginismus. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD001760. DOI: 10.1002/14651858.CD001760.pub2.

LAHAIE, Marie-Andrée; AMSEL, Rhonda; KHALIFÉ, Samir; BOYER, Stephanie; FAABORG-ANDERSEN, Marie; BINIK, Yitzchak M.. Can Fear, Pain, and Muscle Tension Discriminate Vaginismus from Dyspareunia/Provoked Vestibulodynia? Implications for the New DSM-5 Diagnosis of Genito-Pelvic Pain/Penetration Disorder. Archives Of Sexual Behavior, [S.L.], v. 44, n. 6, p. 1537-1550, 15 nov. 2014. Springer Science and Business Media LLC. http://dx.doi.org/10.1007/s10508-014-0430-z.

Pacik PT. Vaginismus: review of current concepts and treatment using botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia. Aesthetic Plast Surg. 2011 Dec;35(6):1160-4. doi: 10.1007/s00266-011-9737-5. Epub 2011 May 10. PMID: 21556985.

Aslan M, Yavuzkır Ş, Baykara S. Is "Dilator Use" More Effective Than "Finger Use" in Exposure Therapy in Vaginismus Treatment? J Sex Marital Ther. 2020;46(4):354-360. doi: 10.1080/0092623X.2020.1716907. Epub 2020 Feb 13. PMID: 32052704.

Möller L, Josefsson A, Bladh M, Lilliecreutz C, Sydsjö G. Reproduction and mode of delivery in women with vaginismus or localised provoked vestibulodynia: a Swedish register-based study. BJOG. 2015 Feb;122(3):329-34. doi: 10.1111/1471-0528.12946. Epub 2014 Jul 3. PMID: 24990073.

Wells C, Farrah K. Injectable Botulinum Toxin for Pelvic Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019 Aug 22. PMID: 31697458.

Yaraghi M, Ghazizadeh S, Mohammadi F, Ashtiani EM, Bakhtiyari M, Mareshi SM, Sarfjoo FS, Eftekhar T. Comparing the effectiveness of functional electrical stimulation via sexual cognitive/behavioral therapy of pelvic floor muscles versus local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus: a randomized clinical trial. Int Urogynecol J. 2019 Nov;30(11):1821-1828. doi: 10.1007/s00192-018-3836-7.

Maseroli, E., Scavello, I., Rastrelli, G., Limoncin, E., Cipriani, S., Corona, G., ... & Vignozzi, L. (2018). Outcome of medical and psychosexual interventions for vaginismus: a systematic review and meta-analysis. The journal of sexual medicine, 15(12), 1752-1764.

BORG, Charmaine et al. Vaginismus: Heightened Harm Avoidance and Pain Catastrophizing Cognitions. J Sex Med, 2012 Feb;9(2):558-67. doi: 10.1111/j.1743-6109.2011.02535.

Maseroli E, Scavello I, Cipriani S, Palma M, Fambrini M, Corona G, Mannucci E, Maggi M, Vignozzi L. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med. 2017 Nov;14(11):1392-1402. doi: 10.1016/j.jsxm.2017.09.015. PMID: 29110807.

CHERNER, R. A., REISSING, E.D., AComparative Study of Sexual Function, Behavior, and Cognitions of Women with Lifelong Vaginismus, Arch Sex Behav, 2013 Nov;42(8):1605-14. doi: 10.1007/s10508-013-0111-3

PEIXOTO, Maria Manuela; NOBRE, Pedro. Prevalence and sociodemographic predictors of sexual problems in Portugal: a population-based study with women aged 18 to 79 years. Journal of sex & marital therapy, v. 41, n. 2, p. 169-180, 2015. doi: 10.1080/0092623X.2013.842195

ALIZADEH, Ameneh et al. Prevalence of and risk factors for genito-pelvic pain/penetration disorder: a Population-Based Study of Iranian Women. The journal of sexual medicine, v. 16, n. 7, p. 1068-1077, 2019. doi: 10.1016/j.jsxm.2019.04.019

BRAUER, Marieke; LAKEMAN, Mariëlle; VAN LUNSEN, Rik; LAAN, Ellen. Predictors of Task‐Persistent and Fear‐Avoiding Behaviors in Women with Sexual Pain Disorders. The Journal Of Sexual Medicine, [S.L.], v. 11, n. 12, p. 3051-3063, dez. 2014. Elsevier BV. http://dx.doi.org/10.1111/jsm.12697.

Turan Ş, Usta Sağlam NG, Bakay H, Gökler ME. Levels of Depression and Anxiety, Sexual Functions, and Affective Temperaments in Women With Lifelong Vaginismus and Their Male Partners. J Sex Med. 2020 Dec;17(12):2434-2445. doi: 10.1016/j.jsxm.2020.08.018. Epub 2020 Sep 25. PMID: 32981852.

Fadul R, Garcia R, Zapata-Boluda R, Aranda-Pastor C, Brotto L, Parron-Carreño T, Alarcon-Rodriguez R. Psychosocial Correlates of Vaginismus Diagnosis: A Case-Control Study. J Sex Marital Ther. 2019;45(1):73-83. doi: 10.1080/0092623X.2018.1484401.

Macey K, Gregory Angela, Nunns David, das Nair Roshan. Women’s experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study. BMC Women's Health. v. 15, n. 29, 2015. https://doi.org/10.1186/s12905-015-0201-6.

Farnam, F., Janghorbani, M., Merghati-Khoei, E. et al. Vaginismus and its correlates in an Iranian clinical sample. Int J Impot Res 26, 230–234 (2014). https://doi.org/10.1038/ijir.2014.16

Kleinplatz PJ. History of the Treatment of Female Sexual Dysfunction(s). Annu Rev Clin Psychol. 2018 May 7;14:29-54. doi: 10.1146/annurev-clinpsy-050817-084802. Epub 2018 Jan 22. PMID: 29356577.

Pereira, V.M., Arias-Carrión, O., Machado, S. et al. Sex therapy for female sexual dysfunction. Int Arch Med 6, 37 (2013). https://doi.org/10.1186/1755-7682-6-37.

WALLACE, Shannon L.; MILLER, Lucia D.; MISHRA, Kavita. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology, v. 31, n. 6, p. 485-493, 2019. doi: 10.1097/GCO.0000000000000584.

Anğın AD, Gün İ, Sakin Ö, Çıkman MS, Eserdağ S, Anğın P. Effects of predisposing factors on the success and treatment period in vaginismus. JBRA Assist Reprod. 2020 May 1;24(2):180-188. doi: 10.5935 / 1518-0557.20200018.

Gungor Ugurlucan, F., Yasa, C., Ates Tikiz, M. et al. Efeito da pandemia COVID-19 e medidas de distanciamento social nas funções sexuais de mulheres tratadas para vaginismo (dor genitopélvica / distúrbio de penetração). Int Urogynecol J (2021). https://doi.org/10.1007/s00192-020-04667-w.

Rahman S. Female Sexual Dysfunction Among Muslim Women: Increasing Awareness to Improve Overall Evaluation and Treatment. Sex Med Rev. 2018 Oct;6(4):535-547. doi: 10.1016/j.sxmr.2018.02.006. Epub 2018 Apr 18. PMID: 29678473.

Pacik PT, Geletta S. Vaginismus Treatment: Clinical Trials Follow Up 241 Patients. Sex Med. 2017 Jun;5(2):e114-e123. doi: 10.1016/j.esxm.2017.02.002. 2017 Mar 28. PMID: 28363809; PMCID: PMC5440634.

MELNIK, Tamara; HAWTON, Keith; MCGUIRE, Hugh. Interventions for Vaginismus. Cochrane Database Syst Rev. 2012. doi:10.1002/14651858.CD001760.pub2.

Ferreira JR, Souza RP. Botulinum toxin for vaginismus treatment. Pharmacology. 2012;89(5-6):256-9. doi: 10.1159/000337383. PMID: 22507920.

Fageeh WM. Different treatment modalities for refractory vaginismus in western Saudi Arabia. J Sex Med. 2011 Jun;8(6):1735-9. doi: 10.1111/j.1743-6109.2011.02247.x. Epub 2011 Apr 7. Erratum in: J Sex Med. 2012 Mar;9(3):945. PMID: 21477018.




DOI: https://doi.org/10.34117/bjdv7n7-073

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