Over the past 15 years, there has been ongoing debate about whether vaginismus can be differentiated from dyspareunia categorically, dimensionally, or not at all (Reissing, Binik, & Khalifé, 1999). Despite the fact that the debate on diagnostic distinction continues, a significant change was made in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). The diagnosis of Genito-Pelvic Pain/Penetration Disorder (GPPPD) was introduced to replace the hitherto separate diagnosesofDyspareuniaandVaginismus,previouslyunder thesubcategory of sexual pain disorders (DSM-IV-TR; American Psychiatric Association, 2000). Binik (2005a) argued that the sexual pain disorders were the onlypainconditionsthatwereclassifiedaccordingtotheactivity they interfered with and argued for their removal from the classification of sexual dysfunctions. This was received with broad skepticism from clinicians and researchers alike (Binik, 2005b). The introduction of GPPPD may represent an apparent compromise. The diagnostic criteria for this new category have focused on symptomatology related to pain during sexual activity and/or pain with (anticipated) vaginal penetration. The multidimensional diagnosis of GPPPD is clearly more in line with the outcomes of scientific research and clinical practice than the original categorical classification in DSM-IV-TR as outlined elegantly by Binik’s (2010a, 2010b) summary of the literature. However, GPPPD fails to capture the complexity of sexual difficulties in women who have never been able to experience intercourse (for the purpose of this commentary referred tobythepreviousdiagnostic labelof lifelongvaginismus). Inour opinion, we run the risk that the baby (lifelong vaginismus) is thrown out with the bathwater (sexual pain disorders). By summarizing different aspects of lifelong vaginismus based on the results of recent studies, we will underscore this and offer a temporary solution to assist clinicians and researchers to mediate the omission of lifelong vaginismus from the DSM-5. Vaginismus was first mentioned as a sexual/reproductive problem by the Italian physician Trotula of Salerno in the eleventh century:‘‘On the tightening of the vulva so that even a woman who has been seduced may appear a virgin’’(1940; p. 37). The diagnostic term ‘‘vaginismus’’was coined by the English gynecologist, J. Marion Sims, in 1861. Even in the first description of vaginismus, the confusion between pelvic Charmaine Borg and Symon K. Spoelstra are both second authors.

“Throwing the Baby Out with the Bathwater”: The Demise of Vaginismus in Favor of Genito-Pelvic Pain/Penetration Disorder

Treatment of erectile dysfunction.

Resume Objectif Evaluer a long terme dans une population adulte, la continence, les reprises chirurgicales et la satisfaction des patients porteurs d’une derivation urinaire cutanee continente fonctionnelle de type Mitrofanoff. Materiel et methodes Etude retrospective de revue des dossiers menee de 1997 a 2015. Les donnees pre-, per- et postoperatoire ont ete colligees. Tous les patients ont ete contactes au terme de l’etude, un questionnaire leur a ete soumis. Resultats Soixante-sept patients ont ete operes d’une cystostomie continente de type Mitrofanoff. Quarante-cinq patients repondaient aux criteres d’inclusions suivants : âge du patient superieur a 18 ans, pas d’antecedent de derivation urinaire cutanee anterieure, suivi superieur a 6 mois. La cohorte etait composee majoritairement par des patients porteurs de vessies neurologiques (84 %) representes par des blesses medullaires (54 %) et des patients spina-bifida (15 %). L’âge median etait de 35 ans [22–49]. Le suivi median etait de 64 mois [39–90]. Le montage chirurgical utilisait un conduit appendiculaire chez 30 patients (67 %) et un conduit ileal remodele chez 15 patients (33 %). Au terme du suivi 88 % des patients ont une continence urinaire stomiale totale, 89 % ont une continence uretrale. Vingt-neuf patients ont necessite une (41 %) ou plusieurs re-interventions. Les indications des 58 reprises chirurgicales etaient les suivantes : stenose de l’orifice stomial (31 %), fuites urinaires uretrales (29 %), fuites urinaires stomiales (15 %), lithiases (9 %). Ces complications etaient majoritairement traitees par abord local (31 %) ou abord endoscopique (35 %). Aucune difference statistiquement significative en matiere de complications chirurgicales immediates ou tardives (p = 0,93) n’a ete mise en evidence entre les deux types montages ; trans-appendiculaire et conduit ileal remodele. Quatre-vingt-quatorze pour cent des patients decrivaient un confort urinaire satisfaisant. L’orifice stomial etait juge esthetique par 71 %, sa realisation a permis une amelioration de la qualite de vie pour 89 % d’entre eux. Conclusion La derivation urinaire cutanee selon Mitrofanoff reste une alternative chirurgicale fiable sur le long terme, mais necessitant des interventions iteratives pour maintenir un conduit fonctionnel continent et catheterisable. En depit du nombre de re-interventions les patients restent satisfaits de ce mode mictionnel. Niveau de preuve 4.

Évaluation à long terme des cystostomies continentes de type Mitrofanoff chez l’adulte : résultats à 5 ans

/pdf/short-term-intracavernous-self-injection-treatment-of-1qrbvcs97m.pdf

Short-term intracavernous self-injection treatment of psychogenic erectile dysfunction secondary to sexual performance anxiety in unconsummated marriages.

http://jarums.arums.ac.ir/article-1-1721-en.pdf

مرور نظام مند مطالعات گزارش شیوع واژینیسموس

Unconsummated marriage in the Arab Islamic world: Tunisian experience

Le mariage non consommé dans le monde arabo-islamique : l’expérience tunisienne

Resume But L’objectif de notre travail a ete d’evaluer l’influence de la derivation urinaire externe continente de type Mitrofanoff (DUECM) sur la sexualite masculine. Materiel et methodes Il s’agit d’un questionnaire portant sur l’evaluation de la sexualite masculine apres realisation d’une DUECM dans un service d’urologie d’un centre hospitalo-universitaire. Durant la periode de 20 ans entre 1992 et 2011, 140 patients ont eu ce type de derivation pour des etiologies diverses. Sur 76 hommes, 46 ont repondu a notre questionnaire. Cette etude a ete effectuee a l’aide d’un ensemble de 3 questionnaires valides (IIEF, DAN PSS et Urolife), regroupes selon le modele de representation de la sexualite de l’homme publie par le CTMH. Les patients etaient repartis en fonction de leur statut matrimonial : groupe 1 : 15 patients maries avant l’intervention, groupe 2 : 7 patients maries apres l’intervention et groupe 3 : 24 celibataires. Resultats Dans le premier groupe, la dimension fonctionnelle etait positive avec un score global de 81 %, le score de gene sexuelle etait evalue a 26 % et le score de satisfaction sexuelle etait de 77 %. Chez les nouveaux maries, la fonction sexuelle etait jugee conservee dans tous les cas avec un score de satisfaction estime a 98 %. Ces patients avaient signale un sentiment de bien-etre suite a la disparition de l’incontinence urinaire avec integrite de leurs images corporelles. En revanche, chez les celibataires, une alteration relative de la fonction sexuelle etait notee (65 %) avec un score de satisfaction estime a 59 %. Ces troubles etaient de causes multifactorielles en rapport surtout avec la pathologie neurologique. Conclusion A notre connaissance, notre etude est la premiere etudiant la sexualite masculine chez des patients presentant une derivation urinaire continente de type Mitrofanoff. Le statut matrimonial joue un role preponderant dans la sexualite de ces patients. Une etude prospective avec evaluation pre- et postoperatoire permettra de mieux preciser les facteurs influencant la sexualite chez ces patients. Niveau de preuve 5.

Étude de la sexualité masculine après dérivation urinaire externe continente de type Mitrofanoff

Perception de l’image du corps et sexualité féminine : enquête auprès de 100 femmes tunisiennes

Tobacco, Anxiety and Depression Among Medical Students

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