The Impact of the COVID-19 Pandemic and Social Isolation on the Sexual Functioning of Women Who Have Been Treated for Vaginismus

A group of women who had been treated for vaginismus prior to the pandemic engaged in this observational research conducted in Eva Women’s Health Clinic, Ankara, Turkey. A total of 204 subjects were included in the current study who did not meet the exclusion criteria that included: women who 1) were pregnant at the time of the research, 2) had vulvar vestibulitis syndrome, 3) had a history of tubo-ovarian abscess and pelvic inflammatory disease, 4) had diseases transferred by sexual contact, and/or 5) were hesitant to complete the questionnaires during a telephone interview. On the basis of the DSM-5 and the Structured Clinical Interview for DSM-5 Disorders (SCID-5) [7], a clinical psychologist made each and every diagnosis. In our study, which we published before COVID-19, all patients met the DSM-5 diagnostic criteria for vaginismus [9]. We were already asking these survey questions to all of our patients in order to assess the success of our therapy, and we were getting written agreement from them to participate in this survey. Also, since this research was conducted in accordance with the Helsinki Declaration, informed consent was obtained from all participants at the time of enrollment. When the COVID-19 pandemic started, the same questions were posed to the previously polled patients. Ethics committee permission was not required since it was a retrospective and observational research. The same professional gynecologist interviewed each participant individually.

Before COVID-19 broke out, we used sexual function questionnaires [9,10] to test a group of 512 patients with vaginismus. During the pandemic, we decided to recall and reexamine the same treated group. A reevaluation happened between March and April of 2022.The overall response rate was 39.8% (N = 204). During the pandemic, clinical factors investigated in the pre-COVID-19 research were re-evaluated, including Arizona Sexual Experiences Scale (ASEX), the female version of the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) and Hamilton Depression Rating Scale (HDRS) that were previously administered. A total of 204 patients with vaginismus who had been asked to take part in the study did so. People filled out the questionnaires and took part in the study online, over the phone, or in person. From the women’s medical records, demographic information and the assessment of female sexual function before to the pandemic were gathered. Three months following their first sexual encounter, each woman had got a standard gynecologic checkup. The frequency of sexual activity was recorded, and a visual analog scale was used to assess pain. The ASEX and the female version of the GRISS were used to assess sexual function, while the HDRS was used to assess depression. They reported having successful sexual encounters following therapy and during the three-month follow-up. No feedback was received indicating the recurrence of the problem.

The ASEX, developed by McGahuey et al. [11], was applied to evaluate the sexual activity of the couples. The Turkish version, of which validity and reliability studies were conducted by Soykan [12], was used. The score ranged between 5 and 30, and a higher total score indicated sexual dysfunction. In this study, scores ≥11 were considered the cut-off, as suggested by Soykan. The female version of the GRISS is a 28-item questionnaire used to measure heterosexual couples’ sexual dysfunction [13]. It includes subscales for anorgasmia, vaginismus, non-communication, infrequency, female avoidance, female non-sensuality, and female unhappiness. The higher the score, the worse the sexual function, and subscale values 5 suggest sexual dysfunction. GRISS has been certified in Turkish [14]. The HDRS is a 17-item self-report rating inventory that examines severity of depression attitudes and symptoms [15]. The range for the total score is 0 to 53. Between 0 and 7 there is no depression, 8 to 13 there is mild depression, 14 to 18 there is moderate depression, and 19 to 22 there is severe depression. The HDRS has been recognized in Turkish [16]. The ladies were given a specific space for completing the ASEX, GRISS, and HDRS using traditional pen and paper. All ladies independently completed the surveys. During the pandemic, telephone interviews were conducted to determine the existence and frequency of sexual activity, obstetric history, and preferred method of contraception, as well as to administer the ASEX, GRISS, and HDRS. The severity of dyspareunia was measured using a visual analog scale.

The most important results of the study were how the pandemic affected the ASEX, GRISS, and HDRS scores. At the time of the COVID-19 pandemic, the secondary effects were a change in how often people were sexually active and a change in how painful sexual activity was on a visual analogue scale.

For statistical analysis, IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States) was used. The data was presented using the mean standard deviation format. In addition, the homogeneity of variances, which is one of the prerequisites of parametric tests, was checked with the Levene test. Normality assumption was analyzed using the Shapiro-Wilk test. p0.05 was considered to be statistically significant.