Perfiles e indicadores psicológicos relacionados con la dispareunia y el vaginismo. Estudio cuantitativo. Primera parte / Profiles and pshychological indicators related to dyspareunia and vaginismus: Quantitative study

ABSTRACT

Background At the Department of Psychology of the National Institute of Perinatology Isidro Espinosa de los Reyes (INPerIER) -a medical unit specialized in reproductive problems-, a line of investigation on human sexuality was opened due to the high numbers of patients with some kind of problem in their sexual lives. We have been performing exploratory studies where we have found a high prevalence of sexual disorders, i.e. 52% in women and 38.8% in men, in addition to other comparative studies. These studies revealed that people with disturbances in their sexual life were in a disadvantageous position when considering factors such as self-concept, assertivity, levels of anxiety, marital satisfaction, style of communication and marital communication, when compared to population not showing sexual problems. This brought us to the conclusion that the presentation of one or more sexual disorders is a risk factor that deserves exhaustive studies from the psychological point of view. Our studies, made in groups of men and women showing sexual disorders, lead to the need of studying risk factors related with every sexual disorder. We have a hypothesis that not all disorders show in a similar manner and that it is in the different combination of factors where the specificity to provide elements that can help improve intervention plans lies. Objective The general objective of this work was to identify the frequency, differences, relationships and combinations between the feminine sexual dysfunctions known as sexual pain disorders dyspareunia and vaginismus, and some intervening variables. These were gender role and self-esteem (psychological factors) and background (child sexual traumatic experience, sexual information, sexual fears, masturbation and conjugal problems), in order to create a profile of each one of these sexual disorders so that it provides elements for intervention plans. Material and methods This was a non-experimental, transversal, retrospective field study with a correlational-multivariate design and an independent sample divided into three groups with individuals selected by intentional sampling according to pre-established quotas. This work belongs to a wider research study of some risk factors found in male and female sexual dysfunctions, whose original sample consisted of 400 participants; out of this group we selected only participants with dyspareunia and vaginismus and they were compared with the same number of participants who showed no sexual disorder. So, the sample classification remained as follows Group 1, no sexual dysfunctions; group 2, with dyspareunia, and group 3 with vaginismus. Women participating are frequent attendees of the National Institute of Perinatology (INPerIER) and had to meet all the inclusion criteria. For the allocation into groups and the collection of sexual background data we used the codified clinical history for female sexuality (CCHFS). Measurement of personality factors was performed with the Masculinity and Femininity Inventory (MFI) and with Coppersmith's self-esteem inventory. A questionnaire on sexuality and the other instruments was provided and filled in one single session at the outpatient room. For the analysis of results, we used central tendency measurements to describe controlled socio-demographic factors such as age, civil status and schooling. The statistical analysis consisted on determining the frequency of the presence of sexual dysfunctions within the group of women with sexual dysfunctions, out of which we got the patients presenting dyspareunia and vaginismus for group allocation. Then we made an analysis to compare the groups. The first group was set to be the one with no dysfunctions, the second one with dyspareunia and the third one with vaginismus, in order to get the significative differences and the relationship between groups and personality factors under study (gender role and self-esteem); for these we used the t-Student test and ETA coefficient. For the analysis of sexual background (child sexual traumatic experience, sexual information, sexual fears, masturbation and conjugal problems) and their relationship with dysfunctions, we used X² and Cramer's V. Factors resulting related were used to perform a discriminant analysis so as to propose explanational profiles; all variables found to be related, psychological factors and sexual background were included in the analysis. Statistical data analysis was made with the software SPSS version 11. Results The description of the samples shows a normal distribution with an average for groups of age and schooling as follows for group 1, age 31.9±5.32, years in school 10.9±3.17; for group 2, age 32.7±5.54, years in school 10.2±2.8; and for group 3, age 33.7±3.1, years in school, 9.9±2.5. From every statistical analysis variables were isolated and personality factors studied, indicating women with dyspareunia showed a decrease in masculinity features and in their levels of self-esteem, and an increase in submissive features, when compared to women with no sexual dysfunctions. As to the analysis of the results of sexual background, in the dyspaurenia group we found a relationship with conjugal problems, suggesting these variables have a significant intervention in the presence of dyspaurenia during women's adult life. The discriminant analysis launched a factor out of four variables, with 75.9% of the cases correctly classified, demonstrating that women with dyspaurenia within this percentage have related indicators, discriminating variables constituting an explanational approximation. Results of the group of women with vaginismus indicate a decrease in the self-esteem feature and an increase in the submissive features. Analysis of sexual background showed a relation between women with vaginismus and sexual fears, a decrease in sexual information and presence of conjugal problems. Described background data have a significant intervention in these women's adult life. The discriminant analysis launched a factor out of five variables, with 84.1% of the cases correctly classified, demonstrating that women with vaginismus within this percentage have these related indicators, discriminating variables constituting an explanational approximation. Conclusion The isolation of variables with the purpose of detecting the factors related to the presence of the two sexual disorders, dyspareunia and vaginismus, has as its main target to provide indicators of risk that facilitate the creation of intervention plans, in order to avoid making generalizations for the handling of sexual disorders.

RESUMEN

Antecedentes En el Departamento de Psicología del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes (INPerIER), se encontró una alta prevalencia de disfunciones sexuales 52% en las mujeres y 38.8% en los hombres, además de que otros estudios comparativos indican que la población que presentó alteraciones en la vida sexual mostró siempre desventaja en factores como el autoconcepto, la asertividad, la satisfacción marital, el estilo de comunicación y la comunicación marital, en comparación con la población que no presenta problemas sexuales. Por esto es necesario estudiar factores de riesgo relacionados con cada una de las disfunciones sexuales, bajo la hipótesis de que no todas se comportan igual y es en la diferencia de la combinación de factores donde se encuentra la especificidad que puede aportar elementos que mejoren los planes de intervención. Objetivo Identificar la frecuencia, la diferencia, la relación y la combinación entre las disfunciones sexuales femeninas (dispareunia y vaginismo) el papel de género y la autoestima (factores psicológicos), y algunos antecedentes sexuales (experiencia sexual infantil traumática, información sexual, temores a la sexualidad, masturbación y problemas conyugales) para generar un perfil de cada una de estas disfunciones sexuales que aporten elementos para los planes de intervención. Material y método Estudio no experimental, de campo, retrospectivo, transversal, con un diseño correlacional-multivariado de una muestra independiente dividida en tres grupos, seleccionados mediante un muestreo intencional por cuota. Este trabajo forma parte de una investigación más amplia sobre el estudio de algunos factores de riesgo en las disfunciones sexuales femeninas y masculinas, cuya muestra original constó de 400 participantes. De éstos sólo se tomaron las participantes con dispareunia y vaginismo las que se compararon con el mismo número de participantes que no presentaron ninguna disfunción sexual. Las muestras quedaron clasificadas de la siguiente manera Grupo 1 sin disfunciones sexuales, grupo 2 con dispareunia y grupo 3 con vaginismo. Las participantes asisten al INPerIER y debieron cubrir todos los criterios de inclusión. Para la clasificación de los grupos y de los antecedentes sexuales se utilizó la Historia Clínica Codificada de la Sexualidad Femenina (HCCSF). Se utilizó el Inventario de Masculinidad y Feminidad (IMAFE), y el Inventario de Autoestima de Coopersmith. Él análisis estadístico se realizó con la prueba t de Student, el coeficiente ETA, la X² y una V de Cramer. Finalmente se aplicó un análisis discriminante para proponer los perfiles explicativos. Se trabajó con el paquete estadístico SPSS versión 11. Resultados Se encontró una distribución normal. Los resultados indican que las mujeres con diapareunia presentan una disminución en las características de masculinidad y los niveles de autoestima y un incremento en las características de sumisión, así como relación con problemas conyugales. En el grupo de mujeres con vaginismo hay disminución en la autoestima, incremento en las características de sumisión, relación con temores a la sexualidad, con una pobre información sexual y problemas conyugales. En los demás factores no se encontró relación. Conclusiones El aislar variables para detectar factores relacionados con la presencia de estas dos disfunciones sexuales, tiene como objetivo final descubrir indicadores de riesgo que puedan facilitar los planes de intervención con una mayor especificidad y no hacer generalizaciones de manejo para todas las disfunciones.