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Cited by 8Sexual function and dysfunction studiesPsychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach

Open access
Merwin, Kathleen E., Brotto, Lori A.·2023·Archives of Sexual Behavior
DOI 10.1007/s10508-023-02617-3PMC PMC10228892
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Abstract

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD. © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Integrity signals

Registry

Crossref · 10.1007/s10508-023-02617-3

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

15 of 35 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Premisereasoning

    Clear evidence-based treatment recommendations for PGAD/GPD do not yet exist.

    “there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD”
    • Also stated in: § Introduction · plain
      “Overall, there is a dearth of research and literature about treatment approaches for PGAD/GPD.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Goldstein et al., 2021 source
    • cites Martín-Vivar et al., 2022 source

      The Conclusions call for standardized clinical guides and scientific consensus on PGAD treatment, supporting the claim that clear evidence-based recommendations are lacking. The Limitations state that the review covers women only and its results cannot be generalized to men, whereas the citing sentence refers to everyone with PGAD/GPD. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites Pukall et al., 2022 source
  • Premisecitation

    Most existing psychotherapy case studies for PGAD/GPD provide very limited information about the therapeutic techniques used.

    “Further, most of the existing psychotherapy case studies provide very limited information about the therapeutic techniques utilized”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Aswath et al., 2016 source

      The Management section describes two months of “supportive sessions” but gives no detail about the therapeutic techniques used. This supports the claim for this case study; the paper does not assess whether most existing psychotherapy case studies are similarly limited. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites Curran, 2019 source
    • cites Eibye & Jensen, 2014 source

      The Presentation of the Case and Treatment sections describe this patient's mindfulness, group, and individual therapy but give little detail about the techniques used. This supports the claim as an example, but the paper does not assess whether most existing PGAD/GPD psychotherapy case studies are similarly limited. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    PGAD/GPD likely arises from and is sustained by multiple biological, pharmacological, psychological, and systems-level factors.

    “Research to date indicates that PGAD/GPD is likely caused and maintained by a combination of biological (e.g., pudendal neuropathy, paracentral lobule hyperactivity), pharmacological (e.g., initiating/discontinuing SSRIs/SNRIs), psychological (e.g., depression, anxiety, catastrophizing), and systems-level (e.g., lack of awareness of PGAD/GPD by clinicians and the public) factors”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Goldstein et al., 2021 source
  • Premisecitation

    Evidence from chronic pain literature indicates mindfulness therapy leads to significantly greater reductions in pain catastrophizing and stress-related affect compared to CBT.

    “Additionally, there is evidence from the chronic pain literature that mindfulness therapy leads to significantly greater reductions in pain catastrophizing and stress-related affect, relative to CBT (Davis et al., 2015).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Davis et al., 2015 source

      The Discussion describes associations between self-efficacy and outcomes in women with provoked vestibulodynia, while Study limitations says this was not a CBT treatment trial (page numbers unavailable). Searches for mindfulness therapy and for a comparison with CBT found no passage reporting greater reductions in pain catastrophizing or stress-related affect. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Findingown data

    At assessment, the patient met DSM-5 criteria for generalized anxiety disorder with panic attacks.

    “At the time of presenting for treatment, she was assessed and met DSM-5 criteria for generalized anxiety disorder with panic attacks”
    Quote in the paperNot a substantial claim
  • May combine two claims. 29
  • Classified as probably not a substantial claim. 12
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    The cause and progression of PGAD/GPD remain relatively unknown.

    “The etiology and course of PGAD/GPD is still relatively unknown”
    • Also stated in: § Introduction · plain
      “Unfortunately, the etiology of PGAD/GPD is not yet well understood.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Goldstein et al., 2021 source

  • May combine two claims.

    Premisecitation

    Evidence to date indicates that psychological, pharmacological, and physiological treatments may be suitable and effective for PGAD/GPD.

    “current evidence suggests that psychological, pharmacological, and physiological treatment approaches may be appropriate and effective”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites Goldstein et al., 2021 source
    • cites Martín-Vivar et al., 2022 source
    • cites Pukall et al., 2022 source

  • May combine two claims.

    Premisecitation

    The Fear-Avoidance Model proposes that cognitive and behavioral strategies (cognitive restructuring, exposure, relaxation) could reduce fear and catastrophizing, increase adaptive coping and acceptance, leading to reduced symptoms and increased daily activities.

    “Further, the Fear-Avoidance Model proposes that cognitive and behavioral strategies (e.g., cognitive restructuring, exposure, and relaxation) could be used to reduce fear and catastrophizing, increase adaptive coping, and increase acceptance of PGAD/GPD symptoms, which would then lead to reduced symptoms and increased engagement in activities of daily living (i.e., recovery).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Jackowich & Pukall, 2020a source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The Fear-Avoidance Model of PGAD/GPD proposes that interpreting physical symptoms as threatening leads to catastrophizing and fear, then hypervigilance and avoidance, leading to negative psychosocial outcomes that maintain the cycle.

    “The Fear-Avoidance Model of PGAD/GPD suggests that if the physical symptoms of PGAD/GPD are interpreted as threatening, this will lead to catastrophizing about and fear of these sensations. Consequently, individuals become hypervigilant and engage in avoidance of behaviors/triggers related to sensations of arousal. Avoidance and hypervigilance then lead to negative psychosocial outcomes (e.g.,”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Jackowich & Pukall, 2020a source

  • May combine two claims.

    Premisecitation

    Only one of the existing psychological intervention case studies used validated measures to assess symptoms and treatment response, while most did not include formal assessment of symptoms over treatment.

    “Only one of these case studies used validated measures to assess symptoms and response to treatment (e.g., depression and anxiety, sleep quality, quality of life, intensity of symptoms, and marital interference; Elkins et al., 2014), while most did not include any formal assessment of symptoms over the course of treatment (Aswath et al., 2016; Curran, 2019; Eibye & Jensen, 2014; Hiller & Hekster,”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Elkins et al., 2014 source
    • cites Aswath et al., 2016 source
    • cites Curran, 2019 source

  • May combine two claims.

    Premisecitation

    The scoping review identified only seven studies examining psychological interventions for PGAD/GPD, all of which were case studies.

    “Notably, the scoping review only identified seven studies which examined psychological interventions, all of which were case studies.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Martín-Vivar et al., 2022 source

  • May combine two claims.

    Premisecitation

    Mindfulness-based therapy has been found effective for sexual arousal and sexual pain disorders in women, as well as anxiety and depression.

    “Mindfulness-based therapy has been found to be effective for sexual arousal (Brotto et al., 2008, 2022; Rashedi et al., 2022) and sexual pain disorders in women (Boerner & Rosen, 2015; Brotto et al., 2019; Dunkley & Brotto, 2016), as well as anxiety and depression (Hofmann et al., 2010; Khoury et al., 2013).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Brotto et al., 2008 source
    • cites Boerner & Rosen, 2015 source
    • cites Hofmann et al., 2010 source

  • May combine two claims.

    Premisecitation

    Some evidence indicates DBT skills training may effectively treat chronic pain, improving emotion regulation, pain intensity, catastrophizing, mood, coping, sleep, and general well-being.

    “Additionally, there is some evidence that DBT skills training can be an effective treatment for chronic pain, with improvements in emotion regulation, decreased pain intensity and catastrophizing, as well as with mood, coping behaviors, sleep, and general well-being (Linton & Fruzzetti, 2014; Norman-Nott et al., 2022).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Linton & Fruzzetti, 2014 source
    • cites Norman-Nott et al., 2022 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Following onset of PGAD/GPD, the patient experienced intense shame, social isolation, a major depressive episode with frequent suicidal ideation lasting eight months, and elevated anxiety lasting three months.

    “Following the onset of PGAD/GPD symptoms, the patient experienced intense feelings of shame, felt socially isolated, had a major depressive episode with frequent suicidal ideation (lasting eight months), and elevated anxiety (lasting three months).”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The patient was a 58-year-old White heterosexual woman with acquired PGAD/GPD that began in March 2020.

    “We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020”
    • Also stated in: § Case Report · plain
      “The patient is a 58-year-old, White, heterosexual woman who described herself as an Atheist.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient believed her PGAD/GPD developed because of significant distress and anxiety related to the COVID-19 pandemic.

    “she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic.”
    • Also stated in: § Assessment · plain
      “she attributed the onset of PGAD/GPD to stress related to the COVID-19 pandemic.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The patient was unable to wear pants for 18 months and unable to sit for long durations because these worsened her PGAD/GPD symptoms.

    “She was unable to wear pants for 18 months and unable to sit down for long durations as these would worsen her PGAD/GPD symptoms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient reported that her PGAD/GPD symptoms were frequently triggered by high levels of anxiety.

    “The patient reported her PGAD/GPD symptoms were frequently triggered by high levels of anxiety”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The patient did not meet DSM-5 criteria for a major depressive episode at assessment but reported ongoing depressive symptoms.

    “She did not meet DSM-5 criteria for a major depressive episode at the time of assessment but still reported ongoing depressive symptoms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient had to retire from her profession in 2020 due to PGAD/GPD, anxiety, and depressive symptoms.

    “The patient was employed as a childbirth educator, doula, and doula educator, but had to retire from her profession in 2020 due to her PGAD/GPD, anxiety, and depressive symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No notable changes in sexual functioning occurred by the end of treatment, including no change in sexual desire, and she had not resumed solo or partnered sexual activity.

    “There were no notable changes in sexual functioning by the end of treatment (e.g., no changes in sexual desire) and she had not resumed solo or partnered sexual activity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient had taken a consistent medication regimen for 1 year 2 months but experienced only marginal benefit.

    “the patient had been on a consistent medication regime for 1 year 2 months yet only experienced marginal benefit.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The patient developed and held an alternative balanced core belief ('I am enough'), which she said increased her self-worth and reduced distress and shame.

    “She was able to develop and hold an alternative, balanced core-belief (“I am enough”), which she reported led to feelings of increased self-worth and reduced distress and shame.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The patient seemed to respond particularly well to DBT therapeutic communication styles, and a strong therapeutic alliance appeared to develop in part due to these communication styles.

    “The patient seemed to respond particularly well to the DBT therapeutic communication styles, and a strong therapeutic alliance appeared to develop in part due to these communication styles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient used mindfulness of breathing daily, which she said reduced her stress and enabled her to stop amitriptyline.

    “The patient used mindfulness of breathing daily, which she reported reduced her stress and allowed her to stop taking the amitriptyline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient reported that TIPP skills reduced her PGAD/GPD symptoms quickly and effectively.

    “The patient was encouraged to use TIPP when experiencing either high levels of emotional distress or high levels of physical distress associated with PGAD/GPD, which she reported reduced her symptoms and quickly and effectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient began prioritizing herself and her well-being, which led to better relationships with her family, especially her husband.

    “Further, she began prioritizing herself and her own well-being, which was leading to improved relationships with her family, especially her husband.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient verbally reported fewer and less severe PGAD/GPD flare-ups, greater confidence in coping with flare-ups, and more acceptance of her condition.

    “She reported some decrease in the frequency and severity of PGAD/GPD flare-ups, and—more importantly—she felt more confident in her ability to cope with flare-ups and had more acceptance towards her condition”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The patient showed increases in several quality-of-life domains, including intermediate activities of daily living, work performance, mental health, and social interaction quality.

    “and increases in several aspects of her quality of life, including intermediate activities of daily living (e.g., walking, doing light housework, grocery shopping, driving a car, engaging in vigorous exercise), work performance, mental health, and quality of social interactions (Fig. 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At the end of treatment, the client said she felt heard for the first time in her life and had developed new ways of thinking about and relating to her PGAD/GPD and anxiety, plus better coping skills.

    “Overall, at the end of treatment, the client stated that this was the first time in her life that someone was listening to/hearing her, and that she had developed a new way of thinking and relating to her PGAD/GPD and anxiety, as well as improved coping skills.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Over the course of therapy, the patient showed less overall catastrophizing about PGAD/GPD, with decreases in rumination, magnification, and helplessness.

    “Over the course of therapy, the patient experienced a reduction in overall catastrophizing about PGAD/GPD symptoms, and reductions in rumination, magnification, and feelings of helplessness about PGAD/GPD (Fig. 2).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The patient was no longer experiencing frequent suicidal ideation and desire when she presented for treatment.

    “Additionally, it is important to note that the patient was no longer experiencing frequent suicidal ideation and desire by the time she presented for treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The patient may have met criteria for persistent depressive disorder, but this was not formally assessed.

    “She may have met criteria for persistent depressive disorder; however, this was not formally assessed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    DBT is a gold-standard treatment for borderline personality disorder, which involves struggles with emotion dysregulation and distress tolerance.

    “DBT is a gold-standard treatment for those with borderline personality disorder, who struggle with emotion dysregulation and distress tolerance (Linehan, 2015; Linehan et al., 1991, 2015).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Linehan, 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Linehan et al., 1991 source
    • cites Linehan et al., 2015 source

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationown data

    The success of the presented integrative approach suggests that psychological treatments should be considered first-line, or at least in parallel with first-line pharmacological treatments, for PGAD/GPD.

    “However, the success of the presented integrative therapeutic approach suggests that psychological treatments should be considered as a first-line treatment (or at the very least in parallel with first-line pharmacological treatments).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: People with PGAD/GPD typically present to gynaecology, and medical approaches are usually considered first-line treatment.
    • Rests on an assumption: Psychological treatment is a cost-effective, accessible, and minimally invasive treatment option for PGAD/GPD.

  • May combine two claims.

    Premisecitation

    A literature review found only one case report of CBT couples therapy for PGAD/GPD and one of MBCT for PGAD/GPD, with no other reports of an integrative psychotherapeutic approach.

    “A review of the literature revealed only one case report of using CBT couples therapy for PGAD/GPD (Hiller & Hekster, 2007) and one case report using MBCT for PGAD/GPD (Bilal & Cerniglia, 2020); however, there were no other reports of an integrative psychotherapeutic approach such as this.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Hiller & Hekster, 2007 source
    • cites Bilal & Cerniglia, 2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    DBT has recently been suggested as a treatment approach for sexual dysfunctions in those with a history of childhood sexual abuse, although it has not yet been evaluated as such.

    “Further, DBT has recently been suggested as a treatment approach for sexual dysfunctions in those with a history of childhood sexual abuse (Wohl & Kirschen, 2018), although has not yet been evaluated as such.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wohl & Kirschen, 2018 source

  • May combine two claims.

    Interpretationreasoning

    The authors cannot completely dismiss the marginal benefits from medications or the fact that pharmacotherapy and psychological therapy were provided in parallel.

    “However, it is important to note that we cannot completely dismiss the marginal benefits she received from this combination of medications—which provided enough relief that she was able to do some activities of daily living and engage in psychological treatment—nor that she was receiving pharmacotherapy and psychological therapy in parallel.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The presented integrative approach targets aspects of the Fear-Avoidance Model of PGAD/GPD, including catastrophizing, avoidance, and psychosocial distress/impairment, which appear to maintain the disorder.

    “Overall, we present a novel treatment approach for PGAD/GPD, which targets different aspects of the Fear-Avoidance Model of PGAD/GPD (e.g., catastrophizing, avoidance, psychosocial distress/impairment), which seem to maintain the disorder.”
    Quote in the paperSubstantial claim
34 of 34

  • The paper relies on this without support.

    CBT is an effective treatment for mood and anxiety disorders.

    “Further, CBT is an effective treatment for mood and anxiety disorders, suggesting it could also be used to help address some of this patient’s comorbidities.”

  • The paper relies on this without support.

    People with PGAD/GPD typically present to gynaecology, and medical approaches are usually considered first-line treatment.

    “People with PGAD/GPD typically present to gynaecology and medical approaches are usually considered first-line treatment.”

  • The paper relies on this without support.

    Psychological treatment is a cost-effective, accessible, and minimally invasive treatment option for PGAD/GPD.

    “Psychological treatment provides a cost-effective, accessible, and minimally invasive treatment option for PGAD/GPD.”
3 of 3

Cites

Flagged first, then by citations

3 of the 48 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Anderson, F. G., Sweezy, M., & Schwartz, R. C. (2017). Internal Family System: Skills training manual trauma-informed treatment for anxiety, depression, PTSD, & substance abuse. PESI Publishing & Media.
  2. Beck, A. T., & Steer, R. A. (1993). Beck Anxiety Inventory Manual. New York: Psychological Corporation.
  3. Kamatchi, R., & Ashley-Smith, A. (2013). Persistent genital arousal disorder in a male: A case report and analysis of the cause. British Journal of Medical Practitioners, 6(1), a605.

Cited by

Sorted by citations

Related

Authors
Merwin, K. E., & Brotto, L. A.
Affiliations
  • Dalhousie University (CA)
  • University of British Columbia (CA)
Corresponding author
Brotto, Lori A.
ORCID
Venue
Archives of Sexual Behavior
Publisher
Springer Science and Business Media LLC
Published
2023-05-30
Volume
52
Issue
5
Pages
2249-2260
ISSN
  • 0004-0002 (ISSN-L)
  • 1573-2800
DOI
10.1007/s10508-023-02617-3
PMC
PMC10228892
OpenAlex
W4378783621
Cited by
8
References
48
Citations by year
2026: 1 · 2025: 3 · 2024: 4
FWCI
1.62
Type
journal article
Language
en
Open access
Licence
Locations
  • Archives of Sexual Behavior (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
persistent genital arousal disorder, psychological intervention, integrative therapy, cognitive behavioral therapy, dialectical behavior therapy, distress tolerance, emotion regulation, mindfulness, COVID-19 pandemic, anxiety, depression, catastrophizing, quality of life, self-compassion, psychoeducation
MeSH terms
COVID-19, Arousal, Female, Genitalia, Humans, Middle Aged, Paresthesia, Quality of Life, Sexual Dysfunctions, Psychological, Pandemics

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