CAPSTONE PROJECT 2
Dyspareunia Capstone Project
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Dyspareunia is a prevalent health condition that negatively impacts a couple's relationship, as it causes sexual pain. The DSM-5 criteria now refer to dyspareunia and vaginismus as a single condition known as genital pelvic pain/penetration disorder (GPPPD). The main contributor to female sexual dysfunction is a mental disease. The same is true for long-term illnesses that are known to affect the neurovascular underpinnings of sexual physiology. Therefore, depression rather than the physical toll of the disease or the severity of the comorbidity is the independent driver of sexual dysfunction among women who also have diabetes, multiple sclerosis, renal failure, and rheumatic disease. It is well knowledge that psychological factors have a role in the development and manifestation of chronic pain. Psychotherapy has also been demonstrated to lessen the suffering of those who experience chronic pain. Uncertainty surrounds several vulvar pain-related issues. The psychological flexibility model's applicability to vulvar pain warrants research given the relationship between ACT and psychological flexibility in chronic pain. According to new research on older women between the ages of 50 and 99, mental health and sexual health are more closely related than physical function, stress, or even age itself. A recent survey of 1,200 American women found that 43% of women, including those with mental health problems, agree that sexual health is an important aspect of their quality of life I understand (Trahan et al., 2019). Between 30 and 70 percent of endometriosis patients say that pain during sexual activity is one of the most painful sensations they feel (Trahan et al., 2019). This suggests that sexual experiences still matter, regardless of mental health. This study seeks to examine the effect of psychological intervention on the incidence of painful intercourse within 5 years.
PICOT Question
In women between 30 to 40 years suffering from stress-related Dyspareunia (P), does meditation (I), compared to no psychological intervention (C) affect the incidence of painful intercourse (O) in five months (T)?
Dyspareunia affects a lot of women around the world and in the country, and most the causes include certain illnesses and conditions such as hemorrhoids, endometriosis, uterine prolapse, irritable bowel syndrome, menopause, vaginal dryness, breastfeeding, childbirth, little before intercourse and some medications. Women between the age range of 30 to 40 years are prime candidates for this condition as they are in their sexual and childbearing stages. Among the treatments that the doctor recommend is meditation as a method of psychological intervention. This study seeks to examine the impact of mediation as a treatment method for women between the ages of 30-40.
Vulnerable Population
Dyspareunia is frequent sexually associated discomfort that is very stressful and generates interpersonal problems. About 10% to 20% of US women are affected by the condition. A woman's body image, connection with her partner, emotional and physical health, and attempts to get pregnant can all be significantly impacted by dyspareunia. Between 30 and 70 percent of endometriosis sufferers, painful sexual activity is one of the most prevalent pain sensations. According to new research on older women between the ages of 50 and 99, mental health and sexual health are more closely related than physical function, stress, or even age itself. A recent survey of 1,200 American women found that 43% of women, including those with mental health problems, agree that sexual health is an important aspect of their quality of life I understand. Depression, anxiety, and other chronic pain problems are substantially more prevalent in women with dyspareunia than in those without dyspareunia. Fibromyalgia, endometriosis, IBS, and painful bladder syndrome are a few of the primary consequence conditions.
Literature Review
Women who experience sexual pain are just as likely to avoid sexual engagement as women who don't experience it. The relationship between vulvar pain and sexual function—which commonly includes libido, arousal, orgasm, pain, and satisfaction—has been studied in several controlled research. After reviewing many articles, we found out that Basson & Gilks (2018) were in line with previous findings, women with dyspareunia exhibit much lower levels of sexual excitation, orgasm, and satisfaction than do those without this kind of pain. Dyspareunia patients claim that they are unable to engage in vaginal sex because it makes them feel unworthy as partners and as women (Basson & Gilks, 2018). She feels embarrassed by her struggles and worried about disappointing her boyfriend.
Clinical results for patients with diseases that cause chronic pain have been improved by therapies based on mindfulness. It consists of two-and-a-half-hour seminars, daily homework assignments of about 45 minutes, and a full-day meditation retreat at the end (Jaderek & Lew-Starowicz, 2019). Time and money were mentioned as obstacles, even though there is evidence to suggest that individuals with chronic pelvic pain may benefit from mindfulness-based stress reduction.
We also believe that incorporating basic mindfulness-based therapies into standard medical care would have a comparable positive impact on lowering pain perception just as per the finding of Jåfs (2021). This case series details the advantages of a straightforward mindfulness-based treatment for individuals with persistent pelvic discomfort. We also evaluate the intervention's ability to cause pain debilitation and its first effects on pain intensity.
For patients with chronic pain syndrome, another therapy option is a structured mindfulness-based intervention. A patient who practices mindfulness cultivates an internal state of openness, acceptance, and present-focused awareness. Exercises in mindfulness boost brain activity in the region of interoceptive perception, enabling the reassessment of sensory data and reducing pain perception (Tayyeb et al., 2022). Caregiving has been hindered by these programs' time-consuming nature.
According to other literature, women's sexual dysfunction, anxiety, and depression are related. Causal chains, however, have been hotly contested. Are mood problems like sadness and anxiety a prevalent cause of sexual dysfunction, or do they create it, and are they related to probable sexual dysfunction susceptibility? Recent research looking at this comorbidity over time has shown findings that are in line with the final explanation: a shared psychological vulnerability (Duma et al., 2020). This implies that the existence of any one of the three risk factors raises the possibility of current or future symptoms in one or both of her other two, hence daily monitoring for all comorbidities should be done (Majeed et al., 2019).
According to a recent study in the Journal of Sexual Medicine, the scientific community has spent more than 30 years researching how mindfulness therapy (MBT) affects numerous physical and mental conditions. The relationship between MBT and sexual dysfunction has only been covered in many articles throughout that time (Majeed et al., 2019). And only four of these studies were specifically concerned with treating painful sex. Although mindfulness-based therapy shows potential, it is not the same as sexual activity. These trials also included patient education regarding sexual pleasure and physical pain, pelvic floor therapy, and muscle relaxation therapy.
Proposal
There have been various studies have been done to examine the effect of meditation and other psychological treatment methods to treat dyspareunia. For women between the ages of 30-40 years, this condition is a critical condition that affects most of them. Following the study, we have come up with various recommendations for the treatment of dyspareunia together with what we have known about dyspareunia.
Treatment should include both medication and psychological treatment methods. Ospemifene is a drug that is approved by the Food and Drug Administration to treat moderate to severe dyspareunia as it acts as an estrogen on the vaginal lining (Trahan et al., 2019). Even though this is seen as safe, drugs have some drawbacks such as the risk of stroke, blood clots, and cancer. The use of medication and medication has seen some proof of faster and better results when treating dyspareunia.
The duration of mediation therapy should be increased from 5 hours weekly to 8 hours. This is because mindful therapy even though not showing great results has proved that an increase in the time gets to reflect on their issues through mediation reduces their painful feeling during intercourse.
Apart from medication, other psychological methods should be used alongside medication and meditation. This is because research has revealed that one of the causes of dyspareunia is mental health and it could be associated with post-traumatic stress disorder, schizophrenia, depression, and anxiety disorders. These conditions need to be treated and the ways include psychological methods.
Sexual education needs to be offered to patients who have dyspareunia as some of the causes might be there not being psychologically prepared. Communication and not rushing into intercourse are among the reasons for dyspareunia. Women need to be taught how to handle sexual encounters.
Conclusion
Meditation treatment has been proven to be effective on several occasions. From treating psychological disorders to being used as a relaxation technique, meditation is a significant way of treating dyspareunia. This study covered a vast area and showcased that even though meditation is not considered a major treatment method, it should be involved in the treatment strategy of these patients as it offers more psychological well-being than when meditation is used alone.
References
Basson, R., & Gilks, T. (2018). Women’s sexual dysfunction associated with psychiatric disorders and their treatment. Women's Health, 14, 174550651876266. https://doi.org/10.1177/1745506518762664
Duma, G., Ülbe, S., & Dirik, G. (2020). Mindfulness-based interventions in the treatment of female sexual dysfunction: A systematic review. Psikiyatride Guncel Yaklasimlar, 12(1), 72-90.
Jaderek, I., & Lew-Starowicz, M. (2019). A systematic review on mindfulness meditation–based interventions for sexual dysfunctions. The Journal of Sexual Medicine, 16(10), 1581-1596.
Jåfs, E. (2021). Mindfulness and cognitive behavioral therapy for managing vulvodynia: a literature review.
Majeed, M. H., Ali, A. A., & Sudak, D. M. (2019). Psychotherapeutic interventions for chronic pain: Evidence, rationale, and advantages. The International Journal of Psychiatry in Medicine, 54(2), 140-149.
Tayyeb, M., & Gupta, V. (2022). Dyspareunia. StatPearls [Internet].
Trahan, J., Leger, E., Allen, M., Koebele, R., Yoffe, M. B., Simon, C., … & Figuers, C. (2019). The efficacy of manual therapy for treatment of dyspareunia in females: a systematic review. Journal of women's health physical therapy, 43(1), 28.
