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Title: Thinking outside the box : using women’s contextualised accounts of vaginal trainer treatment of vaginismus to draft better practice guidelines
Author: Macey, Katherine
ISNI:       0000 0004 5362 612X
Awarding Body: University of Nottingham
Current Institution: University of Nottingham
Date of Award: 2014
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Introduction: This Portfolio contains a journal paper for submission to the British Journal of Obstetrics and Gynecology (BJOG), an Extended Paper describing background literature, further details concerning the methodology and an analysis of themes that could not be covered in the Journal paper, followed by appendices. The author reflects on how her experiences of treatment shaped this research. Objective: To explore women's experiences of vaginismus treatment with vaginal trainers and propose draft guidelines for improving treatment. Design: Qualitative study using semi-structured interviews Setting: Recruitment through a specialist clinic, 2 gynecologists, university campus adverts and two online forums. Sample: 13 women who had used vaginal trainers for vaginismus. Methods: Individual interviews (face-to-face/ telephone/ Skype) were audiorecorded, transcribed verbatim and analysed using Thematic Analysis. Main Outcome measures: Themes concerning treatment experience and possible avenues for improvement of future treatment and Draft Guidelines. Results: Four superordinate themes: (1) Lack of Knowledge, (2) Invalidation of suffering, (3) Difficult Journey, and (4) Making the Journey Easier. The BJOG Journal paper describes (3) and (4). Difficult Journey described the sometimes long and ardous 'Journey Into Treatment', including difficulties asking for help, undergoing physical investigations and negotiating 'the system' of medical referrals. It also described the sometimes demoralising process of 'Being in Treatment', which included emotional and practical demands of treatment. Making the Journey Easier described the importance of and limits to 'Partner Support'. 'Professional Support' comprised personal qualities of professionals/ therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. 'Peer Support! Helping each other' described the importance of supportive vaginimus networks and sharing tips with other women. The Extended Paper describes the remaining two superordinate themes (1) and (2). Lack of Knowledge comprised lack of Public Knowledge, including the women's enthusiasm for 'Breaking the Silence' surrounding vaginismus and a sense that 'Vaginismus is not a priority' for people who have not experienced it; Lack of Personal Knowledge, which included confusion about defining the symptoms as 'normal/abnormal' which impeded help-seeking, 'seeking/finding information', 'Difficulty communicating the problem' and describing symptoms and regrets about continuing with activities that caused a 'vicious cycle' of increasing symptoms; and Lack of Professional Knowledge, which resulted in professionals having difficulty 'recognising the problem' and over-estimations of vaginal trainers as a 'simple and effective treatment'. Invalidation of Suffering comprised of Judgemental and Dismissive Attitudes, which related to 'Pop-psychologising' by professionals and the 'importance of manner' when communicating about sensitive topics and women's experience of the Impact of Vaginismus on 'self', 'relationship' and 'fertility'. Conclusions: Women seek and access treatment within a context of general ignorance about vaginismus and its treatment and can experience unhelpful and abusive reactions from professionals. When the problem is recognised, treatment quality varies. Guidelines concern earlier detection and treatment, practical and emotional support during treatment, building therapeutic relationships, dissemination of specialist knowledge and further research.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available