Rabinowitz David, Lowenstein Lior, Gruenwald Ilan
Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Rambam Maimonides Med J. 2017 Apr 28;8(2):e0016. doi: 10.5041/RMMJ.10293.
Functional sexual pain disorders in women are a particular challenge to the gynecologist, inasmuch as phobic avoidance and guarding on the part of the patient lead to difficulties in the gynecological examination and diagnosis. In some such cases examination may even be impossible. Vaginismus is the commonly diagnosed etiology of such cases. This article offers an overview of vaginismus and approaches to its treatment but also examines a subset of penetration-avoidant patients who do not appear to have a pain component. We have reviewed this separate category conceptually and clinically, and propose that this case subset be separated from the diagnosis of vaginismus and designated as vaginal penetration phobia (VPP).We further propose that this category be diagnosed as one of several possible presentations of phobic disorder, under the rubric of mental health disorder, and thus be separated from gynecology. The nosological implications are raised.
女性功能性性交疼痛障碍对妇科医生来说是一项特殊挑战，因为患者的恐惧回避和防卫行为会给妇科检查和诊断带来困难。在某些此类病例中，甚至无法进行检查。阴道痉挛是此类病例常见的诊断病因。本文概述了阴道痉挛及其治疗方法，同时也研究了一部分似乎没有疼痛因素的回避插入患者。我们从概念和临床角度对这一单独类别进行了审视，并建议将这一病例子集从阴道痉挛的诊断中分离出来，命名为阴道插入恐惧症（VPP）。我们还建议将这一类别诊断为恐惧症障碍的几种可能表现之一，归为精神健康障碍范畴，从而与妇科区分开来。这引发了疾病分类学上的问题。
