Die Vulvodynie aus somatischer, psychosomatischer und sexualmedizinischer Sicht
DOI: 10.61387/S.2022.12.5
Autoren
Dietmar Richter
Abstract
Problem cases in gynecological practice include patients with complaints in the vulva area – especially if the diagnosis has shown that there is no clear organic cause. These patients offer a physical sympton on which they are fixated on. The mostly chronic existing complaints lead to psychological, sexual, social and almost always to partnership problems. Comprehensive psy- chosomatic anamnesis includes a wide variety of controversial affects, such as deeply repressed anger, identity and role con- flicts, repression and denial of pleasurable sexuality. One finds anxiety disorders, depression and post-traumatic stress disorder. In the sense of a somatization disorder, the patients show a physical symptom and are convinced that an organic cause is the basis. The way of dealing with these patients is to „decipher“ this symptom of vulvodynia and to put it into the context of the patient‘s personality and her bio-psycho-social situation. Only gynecological, psychosomatic and sexual medicine diag- nostics, beginning as early as possible, ideally with the initial gynecological examination, enables an immediate holistic view of the patient and her suffering. Already during the first gynecological examination, the doctor should make clear to the patient during careful rectovaginal palpation that the significantly increased muscle tone of the pelvic floor muscles is most probably the main cause of the chronic pain. After the gynecological examination, this finding is visually enhanced with image material from the anatomy atlas. In this way, a common disease model, the so-called “Passung” can be established. This is important for the devel- opment of the doctor-patient relationship, during which the manifold possible causes for the patient‘s vulvodynia can be derived from her biography, “deciphered” as a somatization disorder and gradually resolved. A high-dose magnesium therapy and a pharmacotherapy with selective serotonin reuptake inhibitors (SSRI) that changes the “pain memory” leads to a significant reduction in pain and changes the frequently encountered – often compulsive – search for a somatic cause of the patient’s pain. A therapeutic manner radiating patience, calmness and optimism can pro- mote this process. In addition, targeted physiotherapy in the pelvic floor-vulva perineal area by specially trained therapists is supportive and helpful. A too rapid psychologization or even referral to the psychotherapist is to be avoided, as this can lead to the termination of the doctor-patient relationship. In the field of sexuality, the involvement of the partner in a couple‘s therapeutic setting with instructions for body exercis- es – as they are known from vaginismus therapy – allows pain to gradually become pleasure. Surgical intervention should be avoided because it irreversibly destroys anatomical structures that are important for the sexual experience of the woman.
Keywords
Vulvodynia, Somatiziation disorder, Pelvic floor tension, Bio, psycho, social diagnosis, Sexual medicine therapy concept
Metadaten
Veröffentlicht in: Sexuologie. Zeitschrift für Sexualmedizin, Sexualtherapie und Sexualwissenschaft. Band 29 • Jahr 2022 • Heft 1-2, Seiten 33-46