Objective: Many patients with female sexual dysfunction (FSD), receive sex therapy wishing to become pregnant through the natural sexual process. However, as many Japanese women in the recent times, tend to postpone their marriage to later years, the potential for FSD subjects to get pregnant through effective sex therapy faces numerous challenges. The author considered the ways in which they may decide on the therapy under these circumstances.
Methods: The author:
1. reviewed recent official documents related to sexuality and reproduction in Japan and
2. evaluated her record of vaginismus patients who received sex therapy from 1987 to 2013, since vaginismus is a typical form of FSD affecting consummation and pregnancy.
Results: The mean age at which the Japanese women had their first child rose to 30.1 years in 2011. About 2.7% of babies were born by the IVF-ET in 2010. Among 241 vaginismus patients who completed sex therapy, 172 had a desire for babies while 69 did not. The success rate of the sex therapy was 47% for the group with a desire to bear babies, and was 26% for the other group. In these two groups, the patients who dropped out from the therapy were 42% and 48% respectively. Among the main reason to quit therapy was the “switch to infertility treatment” in 26%.
Conclusions: While sex therapy in this setting is challenging, the satisfaction is remarkable if the patients succeed in sexual intercourse; additionally, the inherent desire for a baby was shown to support a successful outcome of sex therapy. Sex therapists should encourage the patients to continue with their efforts to overcome their problems. However, the therapist should also find out whether the patients gave priority to the pregnancy, and should support their decision if they opted for infertility treatment. The cooperation between experts of sex therapy and infertility treatment is necessary so that the patients can choose both sex therapy and sterility treatment to optimise the management outcome.
This research aims to explore the interplay between distress and treatment seeking for women with genital pain. It is estimated that 15% of women experience dyspareunia. A compounding factor in the detection and management of dyspareunia is distress. Higher levels of distress are associated with the desire to seek treatment however there is little research exploring the interplay between distress and treatment seeking behaviours. Eleven women with genital pain completed the Female Sexual Distress Scale and two semi-structured, in-depth interviews. Data is also being collected through a qualitative on-line questionnaire. Charmazian Grounded Theory methodology is being used to analyse the data in order to develop a substantive grounded theory.
Treatment of vaginismus is typically systematic desensitization using graduated vaginal dilators, a form of behaviour therapy. Less often, procedures such as examination under anaesthesia and Fenton's operations are performed to stretch or cut the "spastic" vaginal muscles. The problem is understood as muscular in origin and the goal of treatment is to make penetrative sex possible.
The so-called “sexual pain” disorders, vaginismus and dyspareunia, have been treated quite differently in the past. Women suffering from vaginismus were typically treated via a Masters & Johnson progressive dilatation method. Until recently, this type of treatment was considered a sex therapy success story. On the other hand, women suffering from dyspareunia, were rarely treated via sex therapy but were typically either referred for medical intervention or for treatment of a presumed underlying psychosocial cause for their pain (e.g. abuse, couple dysfunction, depression etc).