ter Kuile Moniek M, van Lankveld Jacques J D M, de Groot Ellen, Melles Reinhilde, Neffs Janneke, Zandbergen Maartje
Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands.
Behav Res Ther. 2007 Feb;45(2):359-73. doi: 10.1016/j.brat.2006.03.013. Epub 2006 May 15.
Cognitive-behavioral therapy (CBT) seems an effective treatment of lifelong vaginismus, but mechanisms of action have not yet been established. The present study explored whether the effect of CBT for lifelong vaginismus is mediated by changes in fear of penetration and avoidance behavior, which CBT explicitly aims to alter. A second aim of this study was to predict treatment outcome on the basis of pre-treatment variables. Participants with lifelong vaginismus were allocated at random to a 3-months CBT (n=81) or a waiting-list control condition (n=36). Full vaginal penetration with the penis of the partner constituted the primary outcome measure. Change scores in successful 'non-coital penetrative-behavior' and 'fear of coitus' were used to measure the mediating variables. Treatment resulted in an increase of intercourse (outcome), a decrease in fear of coitus, and an enhancement of successful non-coital penetration behavior, compared with no treatment. Outcome (intercourse) was partly mediated by changes in fear of coitus and changes in avoidance behavior. No treatment predictors could be detected in this study sample. It is concluded that techniques such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear, constitute an important avenue of change in the treatment of lifelong vaginismus.
认知行为疗法（CBT）似乎是治疗终身性阴道痉挛的有效方法，但作用机制尚未明确。本研究探讨了CBT对终身性阴道痉挛的疗效是否通过对插入恐惧和回避行为的改变来介导，而CBT明确旨在改变这些方面。本研究的第二个目的是根据治疗前变量预测治疗结果。患有终身性阴道痉挛的参与者被随机分配到为期3个月的CBT组（n = 81）或等待名单对照组（n = 36）。以伴侣阴茎完全插入阴道作为主要结局指标。成功的“非性交插入行为”和“性交恐惧”的变化分数用于测量中介变量。与未接受治疗相比，治疗导致性交（结局）增加、性交恐惧减少以及成功的非性交插入行为增强。结局（性交）部分由性交恐惧的变化和回避行为的变化介导。在本研究样本中未检测到治疗预测因素。得出的结论是，诸如逐步暴露等旨在减少回避行为和插入恐惧的技术，是治疗终身性阴道痉挛的重要改变途径。
