Abstract/Text: INTRODUCTION: Approximately 15% of women have chronic dyspareunia that is poorly understood, infrequently cured, often highly problematic, and distressing. Chronic dyspareunia is an urgent health issue.
AIM: To provide recommendations/guidelines concerning state-of-the-art knowledge for the assessment and management of women's sexual pain disorders.
METHODS: An international consultation, in collaboration with the major sexual medicine associations, assembled over 200 multidisciplinary experts from 60 countries into 17 committees. One six-member committee focused on women's sexual pain disorders, developing recommendations over a 2-year period.
MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.
RESULTS: There is increasing evidence for the role of neuropathic pain mechanisms in the pathophysiology of sexual pain disorders. Empirical literature has demonstrated the comorbid presence of clinical psychopathology. With regard to the pathophysiologic role of the pelvic floor and sexual pain disorders, studies reveal that (i) differentiation between vaginismus and dyspareunia using clinical tools is difficult; (ii) vaginal spasms have not been identified; (iii) physical therapists can differentiate vaginismic women from matched controls based on muscle tone/strength differences; (iv) the traditional treatment of vaginismus with vaginal "dilatation" plus psycho-education, desensitization, and so forth is not evidence-based; (v) pelvic floor muscle tone/strength measures for women suffering from vulvar vestibulitis syndrome are intermediate between those of women with vaginismus and no-pain controls; and (vi) the pelvic floor musculature is indirectly innervated by the limbic system and highly reactive to emotional stimuli and states. Pelvic floor therapies for dyspareunia may be effective.
CONCLUSION: Recommendations include (i) revising the definitions of vaginismus and dyspareunia; (ii) integration of treatment approaches; (iii) validation of nonspecific treatment effects; (iv) controlled studies to test interventions; and (v) sexuality education to help prevent sexual pain.

Abstract/Text: INTRODUCTION: Approximately 15% of women have chronic dyspareunia that is poorly understood, infrequently cured, often highly problematic, and distressing. Chronic dyspareunia is an urgent health issue.
AIM: To provide recommendations/guidelines concerning state-of-the-art knowledge for the assessment and management of women's sexual pain disorders.
METHODS: An international consultation, in collaboration with the major sexual medicine associations, assembled over 200 multidisciplinary experts from 60 countries into 17 committees. One six-member committee focused on women's sexual pain disorders, developing recommendations over a 2-year period.
MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.
RESULTS: There is increasing evidence for the role of neuropathic pain mechanisms in the pathophysiology of sexual pain disorders. Empirical literature has demonstrated the comorbid presence of clinical psychopathology. With regard to the pathophysiologic role of the pelvic floor and sexual pain disorders, studies reveal that (i) differentiation between vaginismus and dyspareunia using clinical tools is difficult; (ii) vaginal spasms have not been identified; (iii) physical therapists can differentiate vaginismic women from matched controls based on muscle tone/strength differences; (iv) the traditional treatment of vaginismus with vaginal "dilatation" plus psycho-education, desensitization, and so forth is not evidence-based; (v) pelvic floor muscle tone/strength measures for women suffering from vulvar vestibulitis syndrome are intermediate between those of women with vaginismus and no-pain controls; and (vi) the pelvic floor musculature is indirectly innervated by the limbic system and highly reactive to emotional stimuli and states. Pelvic floor therapies for dyspareunia may be effective.
CONCLUSION: Recommendations include (i) revising the definitions of vaginismus and dyspareunia; (ii) integration of treatment approaches; (iii) validation of nonspecific treatment effects; (iv) controlled studies to test interventions; and (v) sexuality education to help prevent sexual pain.

Abstract/Text: Posterior deeply infiltrating endometriosis (PDIE) is an invalidating disorder that may involve the rectosigmoid colon. MRI with gel opacification after rectosigmoid colon cleansing improves visualization of rectosigmoid endometriosis. Nonetheless, the depth of bowel wall infiltration is still difficult to assess. In this regard, the use of high-frequency echoendoscope may be needed. Recognition of rectosigmoid endometriosis is important to establish a correct diagnosis and provide counseling and appropriate therapy.

Copyright © 2012 Elsevier Inc. All rights reserved.

Abstract/Text: The concept of vaginitis is widely accepted. Most physicians assume that vaginitis represents an infection, with nearly all vaginal complaints diagnosed as Candidiasis, bacterial vaginosis, or trichomonas. However, like the mouth, the vagina is covered with squamous epithelium, and therefore affected by various dermatoses. Some dermatoses prominently affect mucous membranes, such as lichen planus, pemphigus vulgaris, cicatricial pemphigoid, and blistering forms of erythema multiforme. In addition, some dermatoses affect only the vagina, including desquamative inflammatory vaginitis and atrophic vaginitis. The diagnosis and management of these diseases are hampered by the difficulty of visualizing the vagina, and the lack of medications other than antimicrobials available for use in the vagina.

Copyright © 2010. Published by Elsevier Inc.