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A Case Report-Primary Vaginismus: Predisposing Factors in Singapore
e332 THE FINDINGS GAINED FROM THE APPLICATION OF VERAPAMIL INTO THE PLAQUE OF PATIENTS SUFFERING FROM INDURATIO PENIS PLASTICA (IPP) e MORBUS PEYRONIE Marek BROUL Clinic of Urology and Robotic Surgery, Masaryk’s hospital in Usti nad Labem, Krajska zdravotni a.s. & Department of Sexual Medicine, Masaryk’s hospital in Usti nad Labem, Krajska zdravotni a.s., Czech Republic Jan SCHRAML1, Miroslav STRBAVY1, Petr SKALA1, Miroslav ZOUBEK2 1 Clinic of Urology and Robotic Surgery, Masaryk’s hospital in Usti nad Labem, Krajska zdravotni a.s., Czech Republic; 2Department of Sexual Medicine, Masaryk’s hospital in Usti nad Labem, Krajska zdravotni a.s., Czech Republic At the clinic of urology and robotic surgery, the original treatment of induratio penis plastica with the help of extracorporeal shock waves was in 2014 replaced by a treatment based on the direct injection application of verapamil into the plaque. The research evaluates the efficacy of treatment in 11 patients. At each session, 2 milliliters of verapamil were injected directly into the tunica albuguinea plaque. The treatment was started in the stabilized period of the illness. The patients were 61.2 years old on average. The plaques were found at the dorsum of the penis; the deviation of the penis when erected was 51 degrees on average and the size of the plaque was 8.3 millimetres on average. The erectile function was evaluated with the help of the IIEF-5 questionnaire. The average IIEF-5 score was 12.3. The research also evaluated the following points: the pain scale of the treatment, changes of deviation of erected penis in degrees, changes of plaques in size and the subjective quality of sexual health before and after the therapy. The application itself resulted as painless in all patients. Severe complications were not reported. The efficacy of the therapy was assessed two or three months after the last injection. Both objective and subjective improvement were found in 7 men (63.6 %). It is understood that our group is too small to evaluate the efficacy of the treatment properly. The long term experience at our workplace indicates that the treatment using the application of verapamil results in similar efficacy as the treatment using the method of extracorporeal shock waves. Our findings show that the application of verapamil is an efficient and safe method. A significant number of patients report an improvement of their sexual health. The method is thus rated as a routine method of conservative treatment IPP. Keywords: Morbus Peyronie, verapamil, conservative treatment Conflict of Interest and Disclosure Statement: None.
THE IMPOVERISHMENT OF YOUNG WOMEN’S DISCOURSE AFTER HAVING EXPERIENCED ABORTION Talita CASTELÃO FERNANDES Centro Universitário Adventista de São Paulo (UNASP), Brazil Eneida PENA TORRES Centro Universitário Adventista de São Paulo (UNASP), Brazil Introduction & purpose: In Brazil, one in every five women under the age of 40 has already undergone abortion. There are 4,7 million women going through this traumatic experience each year. This paper describes the impacts of abortion on the discourse of teenagers and young women. Population sample: The research counted on the participation of 6 single student women, aged between 17 and 30, in the years of 2015 and 2016. Method: This was a qualitative clinical case study. Ethical guidelines for research with human participation were followed. Findings & discussion: The results indicate that all women talk about the abortion as they were not involved in it, suggesting compromise in the expression of these feelings. The description of physical pain and a sense of isolation occurs, although there is no deepening in the description of the emotional pain, revealing an impoverishment of the discourse which renders the experience incommunicable. These women report is unfeasible as a mean of emotional support to other women which have also undergone abortion, because even when going through therapy they are already incapable of producing discourse on this topic. The experience is so impactful that it resembles the ones of soldiers returning from war, provoking a deep emotional dullness and distress for the soul. Recommendations: It is necessary to create opportunities for women who have undergone abortion and are experiencing an interior hardening so they can be sensitized in order to be psychologically reconstructed. Depression, feelings of guilt and
23rd Congress of the World Association for Sexual Medicine changes in personality are events that should be incorporated in specialized professional care. Keywords: abortion, impoverishment of discourse, young women Conflict of Interest and Disclosure Statement: None.
A CASE REPORT-PRIMARY VAGINISMUS: PREDISPOSING FACTORS IN SINGAPORE Xinyi CHEONG KK Women’s & Children’s Hospital, Singapore Tse YEUN TAN1, Caroline Shi Ling CHUA2, Jean-Jasmin Mi-Li LEE3, Seng Bin ANG3 1 Reproductive Medicine, KK Women’s & Children’s Hospital, Singapore; 2 Physiotherapy, KK Women’s & Children’s Hospital, Singapore; 3Family Medicine, KK Women’s & Children’s Hospital, Singapore This case report is representative of the typical vaginismus presentation to our multidisciplinary sexual health clinic with predisposing factors identified in the local context. A 36-year old Chinese lady with 6 month-history of unconsummated marriage due to 1 vaginimus presented with the aim of starting a family. The couple were both sexually naïve virgins. Long working hours were cited as a cause of reduced libido. We employed a multidisciplinary approach by clinician, psychologist and physiotherapist. Treatment addresses sexual knowledge deficiencies, lifestyle and communication issues; and utilises sensate focus, cognitive behavioural relaxation therapy, vaginal muscles training and trigger point release techniques. Vagina intercourse was achieved after 7-months therapy resulting in spontaneous conception. Singapore is a multi-ethnic, multi-religion Asian society. Sexual naivety in our married vaginismus patients can be a result of social norms, where pre-martial sex is not socially acceptable and is also due to sexual education programs promoting abstinence until marriage. With more couples getting married later in life due to education and work factors, we observed a trend of late 1 vaginimus presentations after marriage. Presentations are often prompted by desire for procreation rather than sexual fulfillment. Housing considerations also factor in their presentation. In land scarce Singapore, subsidized government housing is made available to newly married couples. However, the long waiting period for housing leads to the phenomenon of couples continuing to reside separately, or together in parental homes after marriage. This living arrangement affects opportunities for sexual intimacy. The Singapore workforce registers one of the highest work hours worldwide leading to poor work-life balance. Fatigue and long work hours impact sexual intimacy and delay couples from seeking earlier treatment. In face of these societal trends which are difficult to modify, educating medical professionals to recognise and treat the condition early as well premarital sexual education maybe a more realistic treatment approach. Keywords: primary vaginismus, cultural factors, Singapore Conflict of Interest and Disclosure Statement: None.
THE CLINICAL PRACTICE WITH TRANSSEXUALS IN THE SOUTH OF BRAZIL Cláudia CORRÊA GARCIA DE GARCIA Gender Identity Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil Marcia BRAMBILA, Dhiordan CARDOSO, César BRIDI, Karine SCHWARZ, Angelo Brandelli COSTA, Maria Inês Rodrigues LOBATO Gender Identity Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil Introduction & rationale: Within the transgender population there is a subgroup of patients with Gender Dysphoria (GD) who experience suffering and seek changes in their primary and secondary sexual characteristics, either through hormonal therapy or through sexual reassignment surgery. Such procedures aim at an improvement of the adaptation between the body and the mind of these patients. Action: The GD Program (PROTIG) of the Hospital de Clínicas of Porto Alegre (HCPA), for almost two decades, has tended for these patients with a multidisciplinary team for the GD in Brazil. The program meets National Health System (SUS) standards (free public service). (1) Outcome: Among the most common problems seen in clinical practice, aspects such as personal rights (social inclusion in the labor market, use of the social name), sex education (condom use and prevention of sexually transmitted diseases and sexual risk
J Sex Med 2017;14:e211ee350
THE IMPOVERISHMENT OF YOUNG WOMEN’S DISCOURSE AFTER HAVING EXPERIENCED ABORTION Talita CASTELÃO FERNANDES Centro Universitário Adventista de São Paulo (UNASP), Brazil Eneida PENA TORRES Centro Universitário Adventista de São Paulo (UNASP), Brazil Introduction & purpose: In Brazil, one in every five women under the age of 40 has already undergone abortion. There are 4,7 million women going through this traumatic experience each year. This paper describes the impacts of abortion on the discourse of teenagers and young women. Population sample: The research counted on the participation of 6 single student women, aged between 17 and 30, in the years of 2015 and 2016. Method: This was a qualitative clinical case study. Ethical guidelines for research with human participation were followed. Findings & discussion: The results indicate that all women talk about the abortion as they were not involved in it, suggesting compromise in the expression of these feelings. The description of physical pain and a sense of isolation occurs, although there is no deepening in the description of the emotional pain, revealing an impoverishment of the discourse which renders the experience incommunicable. These women report is unfeasible as a mean of emotional support to other women which have also undergone abortion, because even when going through therapy they are already incapable of producing discourse on this topic. The experience is so impactful that it resembles the ones of soldiers returning from war, provoking a deep emotional dullness and distress for the soul. Recommendations: It is necessary to create opportunities for women who have undergone abortion and are experiencing an interior hardening so they can be sensitized in order to be psychologically reconstructed. Depression, feelings of guilt and
23rd Congress of the World Association for Sexual Medicine changes in personality are events that should be incorporated in specialized professional care. Keywords: abortion, impoverishment of discourse, young women Conflict of Interest and Disclosure Statement: None.
A CASE REPORT-PRIMARY VAGINISMUS: PREDISPOSING FACTORS IN SINGAPORE Xinyi CHEONG KK Women’s & Children’s Hospital, Singapore Tse YEUN TAN1, Caroline Shi Ling CHUA2, Jean-Jasmin Mi-Li LEE3, Seng Bin ANG3 1 Reproductive Medicine, KK Women’s & Children’s Hospital, Singapore; 2 Physiotherapy, KK Women’s & Children’s Hospital, Singapore; 3Family Medicine, KK Women’s & Children’s Hospital, Singapore This case report is representative of the typical vaginismus presentation to our multidisciplinary sexual health clinic with predisposing factors identified in the local context. A 36-year old Chinese lady with 6 month-history of unconsummated marriage due to 1 vaginimus presented with the aim of starting a family. The couple were both sexually naïve virgins. Long working hours were cited as a cause of reduced libido. We employed a multidisciplinary approach by clinician, psychologist and physiotherapist. Treatment addresses sexual knowledge deficiencies, lifestyle and communication issues; and utilises sensate focus, cognitive behavioural relaxation therapy, vaginal muscles training and trigger point release techniques. Vagina intercourse was achieved after 7-months therapy resulting in spontaneous conception. Singapore is a multi-ethnic, multi-religion Asian society. Sexual naivety in our married vaginismus patients can be a result of social norms, where pre-martial sex is not socially acceptable and is also due to sexual education programs promoting abstinence until marriage. With more couples getting married later in life due to education and work factors, we observed a trend of late 1 vaginimus presentations after marriage. Presentations are often prompted by desire for procreation rather than sexual fulfillment. Housing considerations also factor in their presentation. In land scarce Singapore, subsidized government housing is made available to newly married couples. However, the long waiting period for housing leads to the phenomenon of couples continuing to reside separately, or together in parental homes after marriage. This living arrangement affects opportunities for sexual intimacy. The Singapore workforce registers one of the highest work hours worldwide leading to poor work-life balance. Fatigue and long work hours impact sexual intimacy and delay couples from seeking earlier treatment. In face of these societal trends which are difficult to modify, educating medical professionals to recognise and treat the condition early as well premarital sexual education maybe a more realistic treatment approach. Keywords: primary vaginismus, cultural factors, Singapore Conflict of Interest and Disclosure Statement: None.
THE CLINICAL PRACTICE WITH TRANSSEXUALS IN THE SOUTH OF BRAZIL Cláudia CORRÊA GARCIA DE GARCIA Gender Identity Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil Marcia BRAMBILA, Dhiordan CARDOSO, César BRIDI, Karine SCHWARZ, Angelo Brandelli COSTA, Maria Inês Rodrigues LOBATO Gender Identity Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil Introduction & rationale: Within the transgender population there is a subgroup of patients with Gender Dysphoria (GD) who experience suffering and seek changes in their primary and secondary sexual characteristics, either through hormonal therapy or through sexual reassignment surgery. Such procedures aim at an improvement of the adaptation between the body and the mind of these patients. Action: The GD Program (PROTIG) of the Hospital de Clínicas of Porto Alegre (HCPA), for almost two decades, has tended for these patients with a multidisciplinary team for the GD in Brazil. The program meets National Health System (SUS) standards (free public service). (1) Outcome: Among the most common problems seen in clinical practice, aspects such as personal rights (social inclusion in the labor market, use of the social name), sex education (condom use and prevention of sexually transmitted diseases and sexual risk
J Sex Med 2017;14:e211ee350