Perfiles e indicadores psicológicos relacionados con la dispareunia y el vaginismo: Estudio cualitativo. Segunda parte / Profiles and psychological indicators related to dyspareunia and vaginismus: Qualitative study. Part two

ABSTRACT

One target of psychology of health is the quest for specificity when detecting factors related to psychological disorders, among which there are female sexual dysfunctions showing associated pain dyspareunia and vaginismus (not caused by medical disease). Dyspareunia is the presence of genital pain during sexual intercourse and is related to psychological or relational factors. Vaginismus is characterized by spasms in the muscles of the vaginal entrance, making it difficult or impossible to perform coitus; the woman can be sexually aroused, responsive and enjoying sexual games, she can even reach her orgasm, as long as there is no penetration. Of all the causes mentioned, the following are recognized incapacity to let go to the erotic experience, fear to failure, cultural influence predisposing sexual conflict, anxiety and shame, as well as couple problems. However, specificity is lacking in the factors related to each one of these sexual dysfunctions in order to provide elements generating intervention strategies. Objective The objective is to detect new indicators with the purpose of having a better understanding of why an individual exercises sexuality in such a way that it makes her have a proper sexual response and why, in other situations, the sexual response shows alterations leading to dyspareunia or vaginismus. Four are the specific objectives: 1. Identification of current indicators that have an influence in sexual dysfunctions of the participants. 2. Identification of indicators that have had an influence in the unsatisfactory development of sexuality of the participants. 3. Identification of elements of perception of the participants in the couple life of their parents that may have had an impact on their sexuality. 4. Identification of indicators that, within the sexual management provided by the family, had an impact in the sexual life of the participants. Material and methods The qualitative-interpretative method was used, in the form of an exploratory case-study. The institution where the study took place was the Department of Psychology of the National Institute of Perinatology (INPerlER). The sample was constituted by three participants, all of them patients from the institution; they had to comply with certain inclusion criteria of the study. Any physical problem that could have caused the sexual dysfunction was discarded. The first participant did not show any sexual dysfunction (NSD), the second one showed dyspareunia (D) and the third one showed vaginismus (V). We used a semi-structured, focalized, in-depth interview. Interviews took place after having signed a letter of informed consent, accordingly to the ethical institutional requirements, and we also got an approval of recording the interview. We used the analysis of content with an empiric, exploratory orientation. Categories were organized accordingly with the specific objectives. Results The three participants were NSD 32 years old, five years of marriage. No sexual dysfunction. V 36 years old, six years of marriage. Diagnosis vaginismus. D 33 years old, one year in free union. Diagnosis dyspareunia. Data systematization was performed dividing the units of analysis by every participant and the parts of the most significative stories of every specific objective within its respective categories. In the analysis of categories we detected two conditions internal and relational, as well as two types of indicators risk indicators and protective indicators. What marked the difference was the dominium of the protective indicators overthe risk indicators in the NSD participant. Among the more important risk indicators, we found feelings of disadvantage, uselessness and devaluating feelings, linked to a tendency to submissive behavior, as a consequence of remote causes such as having faced a double moral in the family on the one hand erotized family bonds during infancy and, on the other hand, prohibitions and stiffness towards any sexual curiosity or manifestation, apart from a poor socialization. The conflict between desire and sexual prohibition generates confusion in the identification of sensations, setting a painful, fearful association to sexuality, even moreso if this landscape is complicated with other elements such as violence and carelessness. Other elements found as a consequence of the aforementioned include self-inflicted violence, annulment of desire, lack of self-care and interacting problems with the opposite sex in everyday life. All of this leads to an incapacity of exerting a satisfactory sexual life, drifting towards secondary fears when feeling disadvantageous while interacting with the couple; this, in great extent, determines the conflicts, which maybe either a cause or a consequence of the sexual problem. Confusion also arises when trying to identify whether problems are internal or external, thence conductual responses tend to complicate the relationship. In both sexual dysfunctions we find a specific type of frustration, since desire, excitement and orgasm are present, but coitus cannot be performed in a satisfactory way. The following are the more important protective indicators conductual assertive responses, clarity in the affections, situation of the problems, search for sexual information, openness to family communication and with the couple, a couple's differential place, plus the search of satisfaction of sexuality and self care. Among the indicators shared we found limited or null sexual education, poor communication in the family nucleus, and gender stereotypes highly polarized between parents, among others. Conclusions We corroborate in this study that it is the combination of specific elements which contributes to the presence of these two sexual dysfunctions, since the psychological world has many intertwined streams, intervention models cannot be centered only in sexual techniques, but they should also consider the indicators related to such alterations. Finally, it must be pointed out that the results of this phase are the product of an exploratory study, opening the gates to new lines of research.

RESUMEN

Una de las metas de la psicología de la salud es la búsqueda de especificidad en la detección de factores relacionados con los trastornos psicológicos, entre los que se encuentran las disfunciones sexuales femeninas por dolor la dispareunia y el vaginismo (no debidas a enfermedad médica). La dispareunia es la presencia de dolor genital en la relación sexual. El vaginismo se caracteriza por espasmos de la musculatura de la entrada vaginal que dificultan o hacen imposible la realización del coito. Entre las causas se mencionan la incapacidad de abandonarse a la experiencia erótica, temor al fracaso, etc. Sin embargo, hace falta especificar los factores relacionados con éstas disfunciones sexuales para obtener elementos generadores de estrategias de intervención. Objetivo de la segunda fase Detectar indicadores para tener una mayor comprensión de por qué una mujer tiene un ejercicio de la sexualidad que la lleva a tener una respuesta sexual adecuada y por qué en otra la respuesta sexual presenta alteraciones que dan como resultado la presencia de dispareunia o vaginismo. Los objetivos específicos son cuatro 1. Identificar indicadores actuales que influyen en la presencia de disfunciones sexuales de las participantes. 2. Identificar indicadores que hayan influido en el desarrollo insatisfactorio de la sexualidad de las participantes. 3. Identificar elementos de la percepción que tienen las participantes de la vida en pareja de sus padres, que pudieron impactar en su sexualidad. 4. Identificar procesos que dentro de la dinámica familiar impactaron la vida sexual de las participantes. Material y método Se utilizó el método cualitativo-interpretativo, estudio de casos y exploratorio. El escenario fue el Departamento de Psicología del Instituto Nacional de Perinatología (INPerlER), se entrevistó a tres participantes pacientes de éste. La primera sin disfunción sexual (SDS), la segunda con dispareunia (D) y, la tercera con vaginismo (V). Se utilizó la entrevista en profundidad semi-estructurada y se trabajó con análisis de contenido. Las categorías se organizaron de acuerdo a los objetivos específicos. Resultados La sistematización de los datos se realizó dividiendo las unidades de análisis por cada participante de cada objetivo específico. Se detectaron dos condiciones las internas y las relaciónales, así como dos tipos de indicadores los de riesgo y los protectores. Lo que marcó la diferencia fue el predominio de los indicadores protectores sobre los de riesgo en la participante SDS. Entre los indicadores de riesgo se encuentran sentimientos de desventaja, de inutilidad y devaluatorios, ligados a una tendencia a la sumisión; ello como consecuencia de causas remotas, como haber enfrentado una doble moral familiar. El conflicto entre deseo y prohibición sexual genera confusión, estableciéndose una asociación doloroso y llena de temores hacia la sexualidad. Otro elemento encontrado, consecuencia de lo anterior, es la violencia al propio cuerpo, la anulación del deseo, falta de autocuidado y problemas en la interacción con el sexo opuesto en su vida actual. De los indicadores protectores están las respuestas conductuales asertivas, la claridad de sus afectos, ubicación de los problemas, búsqueda de información sexual, apertura en la comunicación familiar y con la pareja, búsqueda de satisfacción de su sexualidad y autocuidado. Entre los indicadores que comparten se encuentra una limitada educación sexual, pobre comunicación en el núcleo familiar y estereotipos de género muy polarizados de los padres. Conclusiones Es la combinación de elementos específicos que se presentan de manera cotidiana los que implican un mayor riesgo para desarrollar estas disfunciones sexuales, los modelos de intervención no pueden únicamente centrarse en las técnicas sexuales y deben contemplar los indicadores relacionados con estas alteraciones. Cabe señalar que los resultados son producto de un estudio exploratorio que abre las puertas para nuevas líneas de investigación y de los cuales no se pueden hacer generalizaciones.