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Objective: 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). The Vulvar Vestibulitis (VV) sums up the complexity of interacting values in the genesis of pain. The VV is a clinical disorder characterized by three symptoms for excellence: 1) Acute vestibule pain at any attempt of penetration; 2) 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; 3) Erythema of various degrees in the vaginal vestibule. Design and Method: Vulvar vestibulitis as a multi system disorder involves the mucosa of the vaginal vestibule 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 characteristics as dyspareunia during a gynecological examination and so on. Results: 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 checkup when the speculum is inserted into the vagina to get a direct observation of the structure of the vagina, 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. Conclusions: In these conditions the gynecologist can carry out his examination, with penetration for example giving the patient a direct experience of it which in turn can act as a positive feedback for future experience. The use of Visnadina (Refeel Spray) is particularly useful for patients who suffer generally from painful sex and sexual arousal disorders. Refeel Spray was the product used as the reference sample in these cases.

The Joint Work of Gynecologist and Psychologist in the Treatment of Sexual Pain Disorders and Vulvar Vestibulitis and the Use of Visnadina