The joint work of the gynecologist and psychologist to treat disorder of sexual pain and vulval vestibulitis and the use of visnadina (refeel)
Creators: name: Basile, Valeria
name: Iannace, Maria Giulia
name: Quartuccio, Antonio
Publisher: name: F1000Research
Year: 2016

description: When a couple decides to have sexual intercourse, the male partner may have a problem, that is the man is un-able to enter the woman’s vagina.<br>The woman, presumably for fear of pain contracts her vaginal muscles so that any foreign body (whether it is the partner’s penis or the speculum of the gynecologist) is unable to enter. Even just the idea is perceived as painful and the penis is rejected. Whether penetration takes place or not, it was once referred to as dyspareunia or vaginismus; nowadays in the DSM-5, this distinction no longer exists and both disorders come under the heading of Pain Disorder and Pelvic genital penetration. Actually, sexual pain disorders could be interpreted in a much broader sense to include also non-coital sex disorders (for example clitoris pain or vulvar vestibulis pain during petting).<br><br>The Vulvar Vestibulitis(VV) sums up the complexity of interacting values in the genesis of pain. The VV is a clinical disorder characterised by three symptoms for excellence: Acute vestibule pain at any attempt of penetration; Tenderness caused by pressure in the vaginal vestibule; if we consider the entrance to the vaginal orifice as a clock face, the pain is at its greatest in the 5 and 7 areas; Erythe-ma of various degrees in the vaginal vestibule. Vulvar vestibulitis as a multi system disorder involves the mucosa of the vaginal vesti-bule and can become home to an intense inflammatory response; it also involves the immune system with the proliferation of painful nerve endings, the nervous system, the muscular and vascular system. Symptoms associated with VV can be of a urinary nature, with an urgent need to urinate after intercourse , or chronic cystitis or the onset of pain with the same charac-teristics as dyspareunia during a gynecological examination and so on.<br><br>In an outpatients setting which differs from the usual psychological/ gynecological one, the presence of two specialists, that is a psychologist and a gynecologist at the gynecological examination may help. During the check up when the speculum is inserted into the vagina to get a direct observation of the structure of the vagi-na, any lesions caused by chronic inflammation of the vaginal vestibule can be highlighted. The psychologist on the other side of the bed keeping direct eye contact with the patient can help her to manage the anxiety or pain linked to the moment of finger penetration or with the use of diagnostic instruments, as well as breathing management through autogenic training which will lower any anxiety-related situations. Eye contact can also keep the patient anchored to the real situation and keep her in touch with reality which can easily be distorted in a panic situation. In these conditions the gynecologist can carry out his examination, with penetration for ex-ample giving the patient a direct experience of it which in turn can act as a positive feedback for future experi-ence.<br><br>The use of VisnadinaVisnadinaVisnadina (Refeel SprayRefeel Spray) is particularly useful for patients who suffer generally from painful sex and sexual arousal disorders. Refeel SprayRefeel Spray was the product used as the reference sample in these cases. Refeel SpraySpraySpray is a Visnadina – based formula that helps to promote a proper physiological re-sponse of the genitals during sexual stimulation thus improving the lubrication and firmness. Triggering off the physiological sexual response in this way, typical of the excitement phase , makes penetration easier and promotes a positive feedback in the resolution phase that will accordingly influence the desire phase.