治疗师辅助暴露疗法治疗女性终身阴道痉挛：一项关于疗效的随机等待名单对照试验。

Therapist-aided exposure for women with lifelong vaginismus: a randomized waiting-list control trial of efficacy.

机构信息

Outpatient Clinic of Psychosomatic Gynecology and Sexology, Gynecology Department, Leiden University Medical Center.

Outpatient Clinic of Sexology, Maastricht University Medical Center.

出版信息

J Consult Clin Psychol. 2013 Dec;81(6):1127-1136. doi: 10.1037/a0034292. Epub 2013 Sep 23.

DOI:10.1037/a0034292

PMID:24060195

Abstract

OBJECTIVE

Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other "objects" (e.g., tampons, fingers, speculum). Lifelong vaginismus is diagnosed when a woman has never been able to have intercourse. The aim of this study was to investigate the efficacy of therapist-aided exposure for lifelong vaginismus.

METHOD

Seventy women and their partners were randomly allocated to exposure or a waiting-list control period of 3 months. The main outcome measure (intercourse ability) was assessed daily during 12 weeks. Secondary outcome measures were complaints about vaginismus, coital pain, coital fear, sexual distress, and sexual functioning. The exposure treatment consisted of a maximum of three 2-hr sessions during 1 week at a university hospital. Each participant performed vaginal penetration exercises herself, in the presence of her partner and a female therapist. Two follow-up sessions were scheduled over a 5-week period.

RESULTS

Thirty-one out of 35 (89%; 95% CI [72%, 96%]) participants reported having had sexual intercourse at posttreatment compared with 4 out of 35 (11%; 95% CI [4%, 28%]) participants in the control condition. In most of the successfully treated women (90%), intercourse was possible within the first 2 weeks of treatment. Moreover, treatment resulted in clinical improvement regarding other symptoms related to vaginismus, coital fear, coital pain, and sexual distress. No treatment effects were found regarding other aspects of sexual functioning in women or their partners.

CONCLUSIONS

This study provides evidence of the efficacy of therapist-aided exposure therapy for women with lifelong vaginismus.

摘要

目的

阴道痉挛通常被描述为阴道难以容纳阴茎或其他“物体”（如卫生棉条、手指、窥器）进入。当女性从未有过性交时，就会被诊断为终身阴道痉挛。本研究旨在探讨治疗师辅助暴露疗法对终身阴道痉挛的疗效。

方法

70 名女性及其伴侣被随机分配到暴露组或等待名单对照组，为期 3 个月。主要结局测量（性交能力）在 12 周内每天评估。次要结局测量包括阴道痉挛的抱怨、性交疼痛、性交恐惧、性困扰和性功能。暴露治疗包括在大学医院的 1 周内最多进行 3 次 2 小时的治疗。每个参与者在伴侣和女性治疗师的陪同下，自己进行阴道插入练习。在接下来的 5 周内安排了 2 次随访治疗。

结果

35 名治疗组参与者中有 31 名（89%；95%CI[72%，96%]）报告在治疗后有过性行为，而对照组 35 名参与者中有 4 名（11%；95%CI[4%，28%]）有过性行为。在大多数成功治疗的女性（90%）中，在治疗的前 2 周内就可以进行性交。此外，治疗还改善了与阴道痉挛、性交恐惧、性交疼痛和性困扰相关的其他症状。但在女性或其伴侣的其他性行为方面，没有发现治疗效果。