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Cultural aspects of vaginismus therapy: a case series of Arab-Muslim patients

Part of: Being an Anti-Racist CBT therapist

Published online by Cambridge University Press:  09 January 2019

Yosra Zgueb ,
Uta Ouali ,
Radhouane Achour ,
Rabaa Jomli  and
Fethi Nacef
Yosra Zgueb
Affiliation:
Department of Psychiatry A, Razi Hospital La Manouba, Tunisia Faculty of Medicine, University of Tunis El-Manar, Tunis, Tunisia
Uta Ouali*
Affiliation:
Department of Psychiatry A, Razi Hospital La Manouba, Tunisia Faculty of Medicine, University of Tunis El-Manar, Tunis, Tunisia
Radhouane Achour
Affiliation:
Faculty of Medicine, University of Tunis El-Manar, Tunis, Tunisia Emergency Department of Gynecology and Obstetrics, Centre of Maternity and Neonatology of Tunis, Tunisia
Rabaa Jomli
Affiliation:
Department of Psychiatry A, Razi Hospital La Manouba, Tunisia Faculty of Medicine, University of Tunis El-Manar, Tunis, Tunisia
Fethi Nacef
Affiliation:
Department of Psychiatry A, Razi Hospital La Manouba, Tunisia Faculty of Medicine, University of Tunis El-Manar, Tunis, Tunisia
*
*Author for correspondence: Uta Ouali, Department of Psychiatry A, Hôpital Razi, Cité des Orangers, 2010 La Manouba, Tunisia (email: uta.ouali@gmail.com).
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Abstract

Vaginismus in one of the most frequent causes of non-consummation of marriage, and of infertility, in Arab-Muslim societies. Cognitive behavioural therapy (CBT) proved to be effective, but it is important to consider the cultural context of the patient attending CBT for vaginismus. The aim of our study was therefore to draw attention to the belief systems and behaviours linked to female sexuality and couple relationship in the Arab-Muslim culture. We present a series of four patients representative of the local culture and show how treatment strategies were adapted to fit these behaviours and belief systems, as well as environmental factors. We found that excessive closeness of family members, allowing the family to be intrusive and exercising pressure on the couple, a strict education which highly values virginity, transmits fear of ‘the male’ and fear of sex, and which links sex with pain, were the common denominator of all patients of our case series. We adapted the classical CBT strategies for vaginismus to our cultural context. The educational component was enlarged. Cognitive techniques were used to modify specific traditional beliefs. The integration of the family, and not only of the partner, into the treatment process proved uniquely beneficial for the patients.

Keywords

cognitive behaviour therapyculturally sensitiveMuslimwomen's issuesfamilyanxiety

Information

Type
Special Issue: Cultural Adaptations of CBT
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e3
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Addar, MH (2004). The unconsummated marriage: causes and management. Clinical and Experimental Obstetrics and Gynecology 31, 279–281.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn.Google Scholar
Auwad, WA, Hagi, SK (2012). Female sexual dysfunction: what Arab gynecologists think and know. International Urogynecology Journal 23, 919–927.Google Scholar
Ben Dridi, I (2004). Le tasfih en Tunisie. Un rituel de protection de la virginité féminine. L'Harmattan: Paris.Google Scholar
Brin, MF, Vapnek, JM (1997). Treatment of vaginismus with botulinum toxin injections. Lancet 349, 252–253.Google Scholar
Ellison, C (1968). Psychosomatic factors in the unconsummated marriage. Journal of Psychosomatic Research 12, 61–65.Google Scholar
Flanagan, E, Herron, KA, O'Driscoll, C, Williams, AC (2015). Psychological treatment for vaginal pain: does etiology matter? A systematic review and meta-analysis. Journal of Sexual Medicine 12, 3–16.Google Scholar
Jeng, CJ, Wang, LR, Chou, CS, Shen, J, Tzeng, CR (2006). Management and outcome of primary vaginismus. Journal of Sex and Marital Therapy 32, 379–387.Google Scholar
Jindal, UN, Jindal, S (2010). Use by gynecologists of a modified sensate focus technique to treat vaginismus causing infertility. Fertility and Sterility 94, 2393–2395.Google Scholar
Kabakci, E, Batur, S (2003). Who benefits from cognitive behavioral therapy for vaginismus? Journal of Sex and Marital Therapy 29, 277–288.Google Scholar
Karrouri, R (2017). Mariage non consommé et vaginisme: à propos de trois cas Clinique. The Pan African Medical Journal 27, 60.Google Scholar
Klein, V, Koops, T, Lange, C, Briken, P (2015). Sexual history of male partners of women with the diagnosis vaginismus. Sexual and Relationship Therapy 30, 376–384.Google Scholar
Lahaie, MA, Boyer, SC, Amsel, R, Khalife, S, Binik, YM (2010). Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment. Women's Health (London) 6, 705–719.Google Scholar
Melzack, R (2005). Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004. Pain Practice 5, 85–94.Google Scholar
Mhiri, M, Smaoui, W, Bouassida, M, Chabchoub, K, Masmoudi, J, Bahloul, A (2013). Unconsummated marriage in the Arab Islamic world: Tunisian experience. Sexologies 22, 103–108.Google Scholar
Moller, L, Josefsson, A, Bladh, M, Lilliecreutz, C, Sydsjo, G (2015). Reproduction and mode of delivery in women with vaginismus or localised provoked vestibulodynia: a Swedish register-based study. BJOG: An International Journal of Obstetrics and Gynaecology 122, 329–334.Google Scholar
Mousavi Nasab, M, Farnoosh, Z (2003). Management of vaginismus with cognitive-behavioral therapy, self-finger approach: a study of 70 cases. Iranian Journal of Medical Sciences 28, 69–71.Google Scholar
Muammar, T, McWalter, P, Alkhenizan, A, Shoukri, M, Gabr, A, Bin, AA (2015). Management of vaginal penetration phobia in Arab women: a retrospective study. Annals of Saudi Medecine 35, 120–126.Google Scholar
Ö, Özdemir, F, Şimşek, Özkardeş, S, İncesu, C, Karakoç, B (2008). The unconsummated marriage: its frequency and clinical characteristics in a sexual dysfunction clinic. Journal of Sex and Marital Therapy 34, 268–279.Google Scholar
Plaut, SM, Rach Beisel, JA (1997). Use of anxiolytic medication in the treatment of vaginismus and severe aversion to penetration: case report. Journal of Sex Education and Therapy 22, 43–45.Google Scholar
Praharaj, SK, Verma, P, Arora, M (2006). Topical lignocaine for vaginismus: a case report. International Journal of Impotence Research 18, 568–569.Google Scholar
Ramli, M, Nora, MZ, Roszaman, R, Hatta, S (2012). Vaginismus and subfertility: case reports on the association observed in clinical practice. Malaysian Family Physician: the Official Journal of the Academy of Family Physicians of Malaysia 7, 24–27.Google Scholar
Rayan, A, Fawaz, M (2017). Cultural misconceptions and public stigma against mental illness among Lebanese university students. Perspective Psychiatric Care Journal 54, 258–265.Google Scholar
Reissing, ED, Binik, YM, Khalife, S (1999). Does vaginismus exist? A critical review of the literature. Journal of Nervous and Mental Disease 187, 261–274.Google Scholar
Reissing, ED, Binik, YM, Khalife, S, Cohen, D, Amsel, R (2004). Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus. Archives of Sexual Behavior 33, 5–17.Google Scholar
Safak Ozturk, C, Arkar, H (2017). Effect of cognitive behavioral therapy on sexual satisfaction, marital adjustment, and levels of depression and anxiety symptoms in couples with vaginismus. Turkish Journal of Psychiatry 28, 172–180.Google Scholar
Seo, JT, Choe, JH, Lee, WS, Kim, KH (2005). Efficacy of functional electrical stimulation-biofeedback with sexual cognitive-behavioral therapy as treatment of vaginismus. Urology Journal 66, 77–81.Google Scholar
van Lankveld JJ, Granot M, Weijmar Schultz, WC, Binik, YM, Wesselmann, U, Pukall, CF, Bohm-Starke, N, Achtrari, C (2010). Women's sexual pain disorders. Journal of Sexual Medicine 7, 615–31.Google Scholar
van Lankveld, JJ, ter Kuile, MM, de Groot, HE, Melles, R, Nefs, J, Zandbergen, M (2006). Cognitive-behavioral therapy for women with lifelong vaginismus: a randomized waiting-list controlled trial of efficacy. Journal of Consulting and Clinical Psychology 74, 168–178.Google Scholar
Weijmar Schultz, W, Basson, R, Binik, Y, Eschenbach, D, Wesselmann, U, Van Lankveld, J (2005). Women's sexual pain and its management. Journal of Sexual Medicine 2, 301–316.Google Scholar
Zargooshi, J (2000). Unconsummated marriage: clarification of aetiology; treatment with intracorporeal injection. British Journal of Urology International 86, 75–79.Google Scholar
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