This study compared group cognitive-behavioral therapy (12-week trial), surface electromyographic biofeedback (12-week trial), and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Subjects were 78 women randomly assigned to one of three treatment conditions and assessed at pretreatment, posttreatment and 6-month follow-up via gynecological examinations, structured interviews and standard questionnaires pertaining to pain (Pain Rating Index and Sensory scale of the McGill Pain Questionnaire, vestibular pain index, pain during intercourse), sexual function (Sexual History Form, frequency of intercourse, Information subscale of the Derogatis Sexual Functioning Inventory), and psychological adjustment (Brief Symptom Inventory). As compared with pretreatment, study completers of all treatment groups reported statistically significant reductions on pain measures at posttreatment and 6-month follow-up, although the vestibulectomy group was significantly more successful than the two other groups. However, the apparent superiority of vestibulectomy needs to be interpreted with caution since seven women who had been assigned to this condition did not go ahead with the intervention. All three groups significantly improved on measures of psychological adjustment and sexual function from pretreatment to 6-month follow-up. Intent-to-treat analysis supported the general pattern of results of analysis by-treatment-received. Findings suggest that women with dyspareunia can benefit from both medical and behavioral interventions.

No abstract

As an undifferentiated group, women with dyspareunia have more physical pathology, psychologic distress, sexual dysfunction, and relationship problems. However, this pattern of differences appears to vary depending on the presence and type of physical findings evident on examination. Dyspareunia is a heterogeneous disorder requiring comprehensive gynecologic and psychosocial assessment to determine differentiated treatment strategies.

It has been suggested that sex differences in the processing of erotic material (e.g., memory, genital arousal, brain activation patterns) may also be reflected by differential attention to visual cues in erotic material. To test this hypothesis, we presented 20 heterosexual men and 20 heterosexual women with erotic and non-erotic images of heterosexual couples and tracked their eye movements during scene presentation. Results supported previous findings that erotic and non-erotic information was visually processed in a different manner by both men and women. Men looked at opposite sex figures significantly longer than did women, and women looked at same sex figures significantly longer than did men. Within-sex analyses suggested that men had a strong visual attention preference for opposite sex figures as compared to same sex figures, whereas women appeared to disperse their attention evenly between opposite and same sex figures. These differences, however, were not limited to erotic images but evidenced in non-erotic images as well. No significant sex differences were found for attention to the contextual region of the scenes. Results were interpreted as potentially supportive of recent studies showing a greater non-specificity of sexual arousal in women. This interpretation assumes there is an erotic valence to images of the sex to which one orients, even when the image is not explicitly erotic. It also assumes a relationship between visual attention and erotic valence.

The grounded theory proposes that the extent to which patients successfully negotiate tension-generating changes may be a major determinant in the long-term outcome of gastric bypass, both weight loss and psychosocial adjustment.