Cultural aspects of vaginismus therapy: a case series of Arab-Muslim patients

Abstract

Vaginismus in one of the most frequent causes of non-consummation of marriage, and of infertility, in Arab-Muslim societies. Cognitive behavioural therapy (CBT) proved to be effective, but it is important to consider the cultural context of the patient attending CBT for vaginismus. The aim of our study was therefore to draw attention to the belief systems and behaviours linked to female sexuality and couple relationship in the Arab-Muslim culture. We present a series of four patients representative of the local culture and show how treatment strategies were adapted to fit these behaviours and belief systems, as well as environmental factors. We found that excessive closeness of family members, allowing the family to be intrusive and exercising pressure on the couple, a strict education which highly values virginity, transmits fear of ‘the male’ and fear of sex, and which links sex with pain, were the common denominator of all patients of our case series. We adapted the classical CBT strategies for vaginismus to our cultural context. The educational component was enlarged. Cognitive techniques were used to modify specific traditional beliefs. The integration of the family, and not only of the partner, into the treatment process proved uniquely beneficial for the patients.

Women’s mental health: acute impact of COVID-19 pandemic on domestic violence

“…None of the women who experienced emotional abuse reported it. As it is the case in many countries especially developing ones, Tunisia has patriarchal and religious societal norms conducive to the normalization of gender-based violence (Zgueb et al 2019 ). As a matter of fact, more than half of Tunisian women interviewed in 2016 said violence is ordinary and not worth reporting (UNFPA 2017 ).…”

Genital Self-Image, Sexual Function, and Quality of Life Among Individuals with Vulvar and Non-Vulvar Inflammatory Dermatoses

“…This may involve modifications to sexual activity (e.g., masturbation or oral sex rather than penetrative intercourse; masturbating with one’s hand rather than a vibrator; addition of a lubricant), as well as thought exercises in reestablishing certain aspects of genital function that can be reclaimed or maintained (e.g., “My genitals can still help me to feel turned on” and “My body is still capable of experiencing orgasm”). These strategies could be incorporated into VID-specific cognitive behavioral therapy, couples therapy, or other treatment programs, as informed by successes in the vulvodynia/vestibulodynia and vaginismus literature (Brotto et al, 2013 , 2015a ; Brotto et al, 2015b ; Masheb et al, 2009 ; Zgueb et al, 2019 ). Mindfulness programs aimed at improving pain self-efficacy and reducing pain catastrophizing have been effective in provoked vestibulodynia (Brotto et al, 2013 , 2015a ) and could be adapted to support the subjective experience of VID-associated pain.…”

Cultural adaptations of CBT: a summary and discussion of the Special Issue on Cultural Adaptation of CBT

“…Three papers (c) address the issues of gender and sexuality. One paper discusses the application of dialectical behaviour therapy (DBT) with LGBTQ service users (Skerven et al, 2019), another describes a case series of vaginismus therapy in Tunisia (Zgueb et al, 2019), while the third paper reports use of behaviour therapy when working with gender and sexual minorities in the context of Islamic culture (Langroudi and Skinta, 2019). Three papers (d) focus on refugees, asylum seekers and the homeless.…”

“…Cultural aspects of vaginismus therapy: a case series of Arab-Muslim patients (Zgueb et al, 2019) This paper describes the use of CBT with four patients with vaginismus in Tunisia. All these patients had a strict religious upbringing and had dysfunctional beliefs underpinned by their cultural and religious values.…”