Gynecological Endocrinology Research Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
J Sex Med. 2017 Nov;14(11):1392-1402. doi: 10.1016/j.jsxm.2017.09.015.
Evidence concerning the determinants of vaginismus (V), in particular medical conditions, is inconclusive.
To investigate, in a cohort of subjects consulting for female sexual dysfunction, whether there is a difference in medical and psychosocial parameters between women with V and women with other sexual complaints.
A series of 255 women attending our clinic for female sexual dysfunction was consecutively recruited. V was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Lifelong and acquired V cases were included.
Patients underwent a structured interview and physical, gynecologic, laboratory, and clitoral ultrasound examinations; they completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire, the Female Sexual Distress Scale-Revised (FSDS), and the Body Uneasiness Test.
V was diagnosed in 20 patients (7.8%). Women with V were significantly younger than the rest of the sample (P < .05). No differences were found for traditional risk factors such as a history of sexual abuse, relational parameters, or gynecologic diseases or for newly investigated parameters (ie, neurologic, hormonal, and metabolic alterations). Women with V showed significantly higher histrionic-hysterical symptoms and traits (as detected by MHQ-H score; P < .05) compared with subjects with other sexual complaints. When the scores of all MHQ subscales were simultaneously introduced in a logistic model, the association between V and MHQ-H score was confirmed (P = .013). Women with V also showed higher FSFI pain and FSDS total scores, even after adjusting for age (P < .05). In an age-adjusted model, FSDS total score increased as a function of the years of duration of V (P = .032) but not as a function of its severity. All observations were confirmed in a case-control study (ratio = 1:3).
Our data demonstrate that some novel contributors of V should be investigated, namely histrionic-hysterical traits. This psychological comorbidity could offer valuable insights for intervention and managing complications.
This is the first study to assess the role of many metabolic and hormonal parameters as potential determinants of V. The main limitation is its exploratory and cross-sectional nature; our data need to be confirmed in larger, more systematic analyses.
V was associated with histrionic-hysterical traits, FSFI pain domain, and sex-related distress. A history of abuse, relational parameters, gynecologic diseases, and hormonal and metabolic alterations do not seem to play a role in the development of V. Maseroli E, Scavello I, Cipriani S, et al. Psychobiological Correlates of Vaginismus: An Exploratory Analysis. J Sex Med 2017;14:1392-1402.
关于阴道痉挛（V）决定因素的证据，特别是医学状况的证据，尚无定论。
在因女性性功能障碍就诊的受试者队列中，调查 V 与其他性抱怨的女性之间在医学和社会心理参数方面是否存在差异。
连续招募了 255 名来我们诊所就诊的女性性功能障碍患者。根据《精神障碍诊断与统计手册》第四版修订版标准诊断 V。包括终身和获得性 V 病例。
患者接受了结构化访谈以及身体、妇科、实验室和阴蒂超声检查；他们完成了女性性功能指数（FSFI）、米德尔塞克斯医院问卷、女性性功能困扰量表修订版（FSDS）和身体不适测试。
V 被诊断为 20 名患者（7.8%）。V 组的女性明显比其他组的女性年轻（P<.05）。在性虐待史、关系参数或妇科疾病等传统危险因素或新调查的参数（即神经、激素和代谢改变）方面，没有发现差异。与其他性抱怨的受试者相比，V 组的患者表现出明显更高的戏剧-癔症症状和特征（通过 MHQ-H 评分检测；P<.05）。当所有 MHQ 子量表的分数同时引入逻辑模型时，V 与 MHQ-H 评分之间的关联得到确认（P=.013）。即使调整年龄因素，V 组的 FSFI 疼痛和 FSDS 总分也较高（P<.05）。在年龄调整模型中，V 的持续时间（P=.032）而不是严重程度（P=.032）会导致 FSDS 总分增加。在病例对照研究（比例= 1:3）中证实了所有观察结果。
我们的数据表明，应该研究一些阴道痉挛的新发病因，即戏剧-癔症特征。这种心理共病可以为干预和管理并发症提供有价值的见解。
这是第一项评估许多代谢和激素参数作为阴道痉挛潜在决定因素的研究。主要的限制是其探索性和横断面性质；我们的数据需要在更大、更系统的分析中得到证实。
E. Maseroli 等人，《阴道痉挛的心理生物学相关性：一项探索性分析》，《性医学杂志》2017 年；14:1392-1402。
