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  1. Banaei M, Kariman N, Ozgoli G, Nasiri M, Ghasemi V, Khiabani A, et al.
    Int J Gynaecol Obstet, 2021 Apr;153(1):14-24.
    PMID: 33300122 DOI: 10.1002/ijgo.13523
    BACKGROUND: Dyspareunia is one of the most common postpartum sexual dysfunctions.

    OBJECTIVE: To estimate the prevalence of postpartum dyspareunia.

    SEARCH STRATEGY: Web of Science, Scopus, PubMed, and Embase databases were searched to July 2019 using keywords including 'perineal pain,' 'dyspareunia,' and 'sexual pain'.

    SELECTION CRITERIA: Observational studies on the prevalence of postpartum dyspareunia were included.

    DATA COLLECTION AND ANALYSIS: Two authors independently reviewed articles and extracted data. Study heterogeneity was evaluated by I2 index; publication bias by Egger and Begg tests.

    MAIN RESULTS: Twenty-two studies enrolling 11 457 women were included. Based on meta-analysis, the overall estimated prevalence of dyspareunia was 35% (95% confidence interval [CI], 29%-41%). The prevalence was 42% (95% CI, 26%-60%) at 2 months, 43% (95% CI, 36%-50%) at 2-6 months, and 22% (95% CI, 15%-29%) at 6-12 months postpartum. Begg test showed no significant bias in data related to the prevalence of postpartum dyspareunia (p = 0.466).

    CONCLUSION: The prevalence of postpartum dyspareunia was 35% and decreased with increasing postpartum duration. Given the high prevalence and its impact on a woman's quality of life, special attention should be paid to this common complaint during the postpartum period.

    Matched MeSH terms: Dyspareunia/epidemiology*
  2. Sidi H, Asmidar D, Seng LH, Jaafar NR, Midi M, Guan NC
    Psychopharmacol Bull, 2016 Mar 1;46(1):24-35.
    PMID: 27738371
    OBJECTIVES: The current study compares the risk of sexual pain in depressed female patients in remission between those who were treated with Escitalopram and Fluoxetine. The associated factors were also examined.
    METHODS: This is a cross-sectional study involved 112 depressed female patients (56 treated with Escitalopram and 56 treated with Fluoxetine) who were in remission (as defined by Diagnostic and Statistical Manual-IV (DSM-IV) in the past 2 months and Montgomery-Asberg Depression Rating Scale (MADRS) score of ≤ 10) from the psychiatric clinic, University Kebangsaan Malaysia Medical Centre (UKMMC). They were interviewed using Structured Clinical Interview for DSM-IV (SCID). Hypoactive sexual desire was assessed using the Pain subscale of Malay Version of the Female Sexual Function Index (MVFSFI).
    RESULTS: The results show that risk of sexual pain was relatively low (16.07% for all patients), with no statistical significant between the two groups (17.86% for fluoxetine group, 14.29% for escitalopram group). Older age (adjusted odds ratio = 1.524, 95% CI = 1.199, 1.938) was the only factor significantly associated with sexual pain disorder.
    CONCLUSIONS: There should not be any barrier when continuing the use of escitalopram or fluoxetine as antidepressants amongst the female patients.
    KEYWORDS: depression; escitalopram; female; fluoxetine; sexual pain

    Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
    Matched MeSH terms: Dyspareunia*
  3. Lo TS, Tan YL, Cortes EF, Wu PY, Pue LB, Al-Kharabsheh A
    Aust N Z J Obstet Gynaecol, 2015 Jun;55(3):284-90.
    PMID: 26044791 DOI: 10.1111/ajo.12340
    The Food and Drug Administration has recently highlighted an increase in reported complications associated with the use of transvaginal mesh.
    Matched MeSH terms: Dyspareunia/etiology*; Dyspareunia/therapy
  4. Kadir ZS, Sidi H, Kumar J, Das S, Midin M, Baharuddin N
    Curr Drug Targets, 2018;19(8):916-926.
    PMID: 28228081 DOI: 10.2174/1389450118666170222153908
    Vaginismus is an involuntary muscle contraction of the outer third of vaginal barrel causing sexual penetration almost impossible. It is generally classified under sexual pain disorder (SPD). In Diagnostic and Statistical Manual, 5th edition (DSM-5), it is classified under the new rubric of Genito-Pelvic Pain/Sexual Penetration Disorder. This fear-avoidance condition poses an ongoing significant challenge to the medical and health professionals due to the very demanding needs in health care despite its unpredictable prognosis. The etiology of vaginismus is complex: through multiple biopsycho- social processes, involving bidirectional connections between pelvic-genital (local) and higher mental function (central regulation). It has robust neural and psychological-cognitive loop feedback involvement. The internal neural circuit involves an inter-play of at least two-pathway systems, i.e. both "quick threat assessment" of occipital-limbic-occipital-prefrontal-pelvic-genital; and the chronic pain pathways through the genito-spinothalamic-parietal-pre-frontal system, respectively. In this review, a neurobiology root of vaginismus is deliberated with the central role of an emotional-regulating amygdala, and other neural loop, i.e. hippocampus and neo-cortex in the core psychopathology of fear, disgust, and sexual avoidance. Many therapists view vaginismus as a neglected art-and-science which demands a better and deeper understanding on the clinico-pathological correlation to enhance an effective model for the bio-psycho-social treatment. As vaginismus has a strong presentation in psychopathology, i.e. fear of penetration, phobic avoidance, disgust, and anticipatory anxiety, we highlighted a practical psychiatric approach to the clinical management of vaginismus, based on the current core knowledge in the perspective of neuroscience.
    Matched MeSH terms: Dyspareunia/physiopathology*; Dyspareunia/psychology
  5. Ramli M, Nora M, Roszaman R, Hatta S
    Malays Fam Physician, 2012;7(1):24-7.
    PMID: 25606241 MyJurnal
    OBJECTIVE: To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman's wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms.

    METHOD: We report a series of cases of Malaysian women who had been suffering from vaginismus and 'infertility'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety.

    CONCLUSION: The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.
    Matched MeSH terms: Dyspareunia
  6. M F A, Narwani H, Shuhaila A
    J Obstet Gynaecol, 2017 Oct;37(7):906-911.
    PMID: 28617056 DOI: 10.1080/01443615.2017.1312302
    Endometriosis is a complex disease primarily affecting women of reproductive age worldwide. The management goals are to improve the quality of life (QoL), alleviate the symptoms and prevent severe disease. This prospective cohort study was to assess the QoL in women with endometriosis that underwent primary surgery. A pre- and post-operative questionnaire via ED-5Q and general VAS score used for the evaluation for endometrial-like pain such as dysmenorrhoea and dyspareunia. A total of 280 patients underwent intervention; 224 laparoscopically and 56 via laparotomy mostly with stage II disease with ovarian endometriomas. Improvements in dysmenorrhoea pain scores from 5.7 to 4.15 and dyspareunia from 4.05 to 2.17 (p 
    Matched MeSH terms: Dyspareunia/etiology; Dyspareunia/psychology; Dyspareunia/surgery
  7. Ismael NN
    Maturitas, 1994 Oct;19(3):205-9.
    PMID: 7799827
    In an attempt to gather data on the menopause in Malaysia, 400 women (13% Chinese, 70% Malays and 16% Indians), representing the three major ethnic groups in Malaysia, were interviewed. The majority (76%) of these women were still married and living with their husbands and 63% of them were working. Most of them (90%) had attained menarche by the age of 15 years and 50% of them had married before the age of 20. Their reproductive record was good, since 76% of them had 3 or more children who were still alive. The mean age at menopause in the Malaysian women studied was 50.7 years. Analysis of the climacteric symptoms reported showed significant differences in the vasomotor and nervosity indices in the perimenopausal and postmenopausal groups. Eighty percent (80%) of the women saw no need to consult a doctor about their climacteric symptoms. When they did, most of them (84%) received medication, but 43% of them did not comply with the prescribed treatment. Dyspareunia and urinary incontinence were evidently regarded as embarrassing complaints in all three groups, since around 80% of the women did not seek medical advice. This is not surprising in view of the fact that 89% of them rated their health as good.
    Matched MeSH terms: Dyspareunia/epidemiology
  8. Narkunam R, Raman S, Kulenthran A, Sinnathuray TA
    Med J Malaysia, 1984 Mar;39(1):78-81.
    PMID: 6513845
    This study reviews experiences in the management of three cases of lacerations of the vagina following coitus. A brief review of the recent literature is made. Although the extent of injuries can be very variable, the principles of management consist of prompt
    resuscitation and arrest of haemorrhage, appropriate surgical repair under general anaesthesia, and systemic or local antibiotic therapy to combat infection. Avoidance of vigorous or abnormal coital practices, especially in single women, in the immediate postpartum period, and in postmenopausal women, can help to reduce the frequency and severity of such injuries.
    Matched MeSH terms: Dyspareunia/complications
  9. Zahran MH, Fahmy O, El-Hefnawy AS, Ali-El-Dein B
    Climacteric, 2016 Dec;19(6):546-550.
    PMID: 27649461
    OBJECTIVES: To evaluate the impact of radical cystectomy and urinary diversion on female sexual function.

    MATERIALS AND METHODS: A Medline search was conducted according to the PRISMA statement for all English full-text articles published between 1980 and 2016 and assessing female sexual function post radical cystectomy and urinary diversion. Eligible studies were subjected to critical analysis and revision. The primary outcomes were the reporting methods for female sexual dysfunction (FSD), manifestations of FSD, and factors associated with FSD, postoperative recoverability of FSD, and awareness level regarding FSD.

    RESULTS: From the resulting 117 articles, 11 studies were finally included in our systematic review, with a total of 361 women. Loss of sexual desire and orgasm disorders were the most frequently reported (49% and 39%). Dyspareunia and vaginal lubrication disorders were reported in 25% and 9.5%, respectively. The incidence of sexual dysfunction was 10% in 30 patients receiving genital- or nerve-sparing cystectomy vs. 59% receiving conventional cystectomy.

    CONCLUSION: Although female sexual function is an important predictor of health-related quality of life post radical cystectomy and urinary diversion, the available literature is not enough to provide proper information for surgeons and patients.

    Matched MeSH terms: Dyspareunia/epidemiology
  10. Jiang H, Qian X, Carroli G, Garner P
    Cochrane Database Syst Rev, 2017 Feb 08;2(2):CD000081.
    PMID: 28176333 DOI: 10.1002/14651858.CD000081.pub3
    BACKGROUND: Some clinicians believe that routine episiotomy, a surgical cut of the vagina and perineum, will prevent serious tears during childbirth. On the other hand, an episiotomy guarantees perineal trauma and sutures.

    OBJECTIVES: To assess the effects on mother and baby of a policy of selective episiotomy ('only if needed') compared with a policy of routine episiotomy ('part of routine management') for vaginal births.

    SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (14 September 2016) and reference lists of retrieved studies.

    SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing selective versus routine use of episiotomy, irrespective of parity, setting or surgical type of episiotomy. We included trials where either unassisted or assisted vaginal births were intended. Quasi-RCTs, trials using a cross-over design or those published in abstract form only were not eligible for inclusion in this review.

    DATA COLLECTION AND ANALYSIS: Two authors independently screened studies, extracted data, and assessed risk of bias. A third author mediated where there was no clear consensus. We observed good practice for data analysis and interpretation where trialists were review authors. We used fixed-effect models unless heterogeneity precluded this, expressed results as risk ratios (RR) and 95% confidence intervals (CI), and assessed the certainty of the evidence using GRADE.

    MAIN RESULTS: This updated review includes 12 studies (6177 women), 11 in women in labour for whom a vaginal birth was intended, and one in women where an assisted birth was anticipated. Two were trials each with more than 1000 women (Argentina and the UK), and the rest were smaller (from Canada, Germany, Spain, Ireland, Malaysia, Pakistan, Columbia and Saudi Arabia). Eight trials included primiparous women only, and four trials were in both primiparous and multiparous women. For risk of bias, allocation was adequately concealed and reported in nine trials; sequence generation random and adequately reported in three trials; blinding of outcomes adequate and reported in one trial, blinding of participants and personnel reported in one trial.For women where an unassisted vaginal birth was anticipated, a policy of selective episiotomy may result in 30% fewer women experiencing severe perineal/vaginal trauma (RR 0.70, 95% CI 0.52 to 0.94; 5375 women; eight RCTs; low-certainty evidence). We do not know if there is a difference for blood loss at delivery (an average of 27 mL less with selective episiotomy, 95% CI from 75 mL less to 20 mL more; two trials, 336 women, very low-certainty evidence). Both selective and routine episiotomy have little or no effect on infants with Apgar score less than seven at five minutes (four trials, no events; 3908 women, moderate-certainty evidence); and there may be little or no difference in perineal infection (RR 0.90, 95% CI 0.45 to 1.82, three trials, 1467 participants, low-certainty evidence).For pain, we do not know if selective episiotomy compared with routine results in fewer women with moderate or severe perineal pain (measured on a visual analogue scale) at three days postpartum (RR 0.71, 95% CI 0.48 to 1.05, one trial, 165 participants, very low-certainty evidence). There is probably little or no difference for long-term (six months or more) dyspareunia (RR1.14, 95% CI 0.84 to 1.53, three trials, 1107 participants, moderate-certainty evidence); and there may be little or no difference for long-term (six months or more) urinary incontinence (average RR 0.98, 95% CI 0.67 to 1.44, three trials, 1107 participants, low-certainty evidence). One trial reported genital prolapse at three years postpartum. There was no clear difference between the two groups (RR 0.30, 95% CI 0.06 to 1.41; 365 women; one trial, low certainty evidence). Other outcomes relating to long-term effects were not reported (urinary fistula, rectal fistula, and faecal incontinence). Subgroup analyses by parity (primiparae versus multiparae) and by surgical method (midline versus mediolateral episiotomy) did not identify any modifying effects. Pain was not well assessed, and women's preferences were not reported.One trial examined selective episiotomy compared with routine episiotomy in women where an operative vaginal delivery was intended in 175 women, and did not show clear difference on severe perineal trauma between the restrictive and routine use of episiotomy, but the analysis was underpowered.

    AUTHORS' CONCLUSIONS: In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma. Other findings, both in the short or long term, provide no clear evidence that selective episiotomy policies results in harm to mother or baby.The review thus demonstrates that believing that routine episiotomy reduces perineal/vaginal trauma is not justified by current evidence. Further research in women where instrumental delivery is intended may help clarify if routine episiotomy is useful in this particular group. These trials should use better, standardised outcome assessment methods.

    Matched MeSH terms: Dyspareunia/epidemiology
  11. Boulet MJ, Oddens BJ, Lehert P, Vemer HM, Visser A
    Maturitas, 1994 Oct;19(3):157-76.
    PMID: 7799822
    The menopause is universal, but what about the climacteric? In an attempt to answer this question, a study was conducted in seven south-east Asian countries, namely, Hong Kong, Indonesia, Korea, Malaysia, the Philippines, Singapore and Taiwan. Samples of approximately 400 women in each country were questioned about a number of climacteric complaints, incontinence and dyspareunia, consultation of a physician, menopausal status and several background characteristics. Special care was taken to overcome linguistic and cultural problems, and the data collected were kept as objective as possible. From the results obtained we were able to show that the climacteric was indeed experienced in south-east Asian countries, although in a mild form. The prevalence of hot flushes and of sweating was lower than in western countries, but was nevertheless not negligible. The percentages of women who reported the more psychological types of complaint were similar to those in western countries. The occurrence of climacteric complaints affected perceived health status. A physician was consulted for climacteric complaints by 20% of the respondents, although this was most frequently associated with the occurrence of psychological complaints and less so with that of hot flushes and sweating. The median age at menopause (51.09) appeared to be within the ranges observed in western countries. Ethnic background and age at menarche were found to have a significant influence on age at menopause. The study clearly demonstrated that climacteric complaints occur in south-east Asia. The findings suggest, however, that vasomotor-complaint-related distress might be 'translated' into psychological complaints, which are more frequently considered to warrant consulting a physician.
    Matched MeSH terms: Dyspareunia/epidemiology
  12. Dizavandi FR, Ghazanfarpour M, Roozbeh N, Kargarfard L, Khadivzadeh T, Dashti S
    Post Reprod Health, 2019 Mar;25(1):11-20.
    PMID: 30786797 DOI: 10.1177/2053369118823365
    OBJECTIVE: The aim of this overview was to evaluate the effectiveness of phytoestrogens on vaginal health and dyspareunia in peri- and post-menopausal women.

    MATERIAL AND METHODS: Three databases including MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials were from inception to August 2017.

    RESULT: Two systematic reviews and 11 RCTs were included in the overview. According to the findings, isoflavones increased the maturation value and attenuated the vaginal atrophy in the post-menopausal women. Topical isoflavones had beneficial effects on the vaginal atrophy. Similar efficacy was found in Pueraria mirifica and conjugated estrogen cream on dryness ( p = 0.277), soreness ( p = 0.124) and irritation ( p = 0.469), as well as discharge ( p = 0.225) and dyspareunia ( p = 0.089). However, the conjugated estrogen cream was more effective compared to Pueraria mirifica ( p > 0.005) regarding maturation index improvement. Comparison of fennel 5% vaginal cream and placebo gel showed significant difference in superficial cells ( p dyspareunia decreased by 27%.

    CONCLUSION: Phytoestrogens have various effects based on administration route and type on the vaginal atrophy.

    Matched MeSH terms: Dyspareunia/drug therapy*
  13. Sidi H, Puteh SE, Abdullah N, Midin M
    J Sex Med, 2007 Mar;4(2):311-21.
    PMID: 17040486
    Female sexual dysfunction (FSD) is a prevalent sexual health problem that does not spare the women in Malaysia, a nation with a conservative multiethnic society.
    Matched MeSH terms: Dyspareunia/epidemiology
  14. Chua Y, Limpaphayom KK, Cheng B, Ho CM, Sumapradja K, Altomare C, et al.
    Climacteric, 2017 Aug;20(4):367-373.
    PMID: 28453308 DOI: 10.1080/13697137.2017.1315091
    OBJECTIVES: The Pan-Asian REVIVE survey aimed to examine women's experiences with genitourinary syndrome of menopause (GSM) and their interactions with health-care professionals (HCPs).

    METHODS: Self-completed surveys were administered face-to-face to 5992 women (aged 45-75 years) in Indonesia, Malaysia, Singapore, Taiwan, and Thailand.

    RESULTS: Of 638 postmenopausal women with GSM symptoms, only 35% were aware of the GSM condition, most of whom first heard of GSM through their physician (32%). The most common symptoms were vaginal dryness (57%) and irritation (43%). GSM had the greatest impact on sexual enjoyment (65%) and intimacy (61%). Only 25% had discussed their GSM symptoms with a HCP, and such discussions were mostly patient-initiated (64%) rather than HCP-initiated (24%). Only 21% had been clinically diagnosed with GSM and only 24% had ever used treatment for their symptoms. Three-quarters of those who had used treatment for GSM had discussed their symptoms with a HCP compared to only 9% of those who were treatment-naïve.

    CONCLUSION: GSM is underdiagnosed and undertreated in Asia. As discussion of GSM with HCPs appears to be a factor influencing women's awareness and treatment status, a more active role by HCPs to facilitate early discussions on GSM and its treatment options is needed.

    Matched MeSH terms: Dyspareunia/epidemiology
  15. Yeoh CA, Chan CL, Chin CC, Tan WC
    Med J Malaysia, 2020 03;75(2):103-109.
    PMID: 32281589
    INTRODUCTION: Chlamydia trachomatis is one of the most common sexually transmitted diseases (STDs) globally. However, data on its prevalence and risk factors in Malaysia is still scarce.

    OBJECTIVE: We aimed to identify the prevalence and risk factors of genitourinary C.trachomatis infection among patients attending STD clinics in northern Peninsular Malaysia.

    METHODS: A hospital-based cross-sectional study was conducted in STD clinics of Hospital Pulau Pinang and Hospital Sultanah Bahiyah, Kedah from January to November 2014. Participants were individually interviewed using a structured data collection form followed by a physical examination and laboratory tests. Nucleic Acid Amplification Test (NAAT) was used to detect C.trachomatis infection. Analysis was carried out using SPSS Version 15.

    RESULTS: Eighty-three sexually active patients were enrolled, consisting of 51 males and 32 females. The median age was 28.0 years. In general, 32.5% patients were asymptomatic, the remaining presented with genital discharge (41.0%), genital warty lesion (25.3%), genital ulcer (13.3%), dysuria (13.3%), dyspareunia (2.4%), urine hesistancy (1.2%) and genital swelling (1.2%). The prevalence of genitourinary C.trachomatis infection was 21.7% in the study population; 17.6% in males and 28.1% in females. Among the infected females, 44.4% were pregnant. Of those infected 56.6% did not show any symptoms of genital infection, and 77.8% were aged between 18 and 30 years, of which most were females. Among newly diagnosed HIV patients, the prevalence was 14.3%. From multivariable logistic regression analysis, age under 28 years, being married and engagement in oral sex had significantly increased odds of C.trachomatis infection.

    CONCLUSIONS: C.trachomatis infection was common among patients attending STD clinics in northern Penisular Malaysia especially in the younger age groups. Majority of the infected patients were asymptomatic.

    Matched MeSH terms: Dyspareunia
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