IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 4, Issue 2 Ver. I (Mar.-Apr. 2015), PP 81-91 www.iosrjournals.org DOI: 10.9790/0837-04218191 www.iosrjournals.org 81 | Page Effect of Cognitive Behavioral Therapy on Women with Dyspareunia : A Nursing Intervention Nabila El-sayed Saboula 1 and Marwa Ahmed Shahin 2 1 Assis Prof .Community Health Nursing, Faculty of Nursing, Menoufia University, Egypt 2 Lecturer Maternal and Newborn Health Nursing, Faculty of Nursing, Menoufia University, Egypt Abstract: Background: Female dyspareunia is a sexual dysfunction manifested as pain in reproductive organs combined with sexual intercourse. It can alter a woman’s sense of sexual competency and identity. The aim of the study was to identify risk factors of dyspareunia and evaluates the effect of cognitive behavioral therapy (CBT) on women with dyspareunia including (sexual pain severity, sexual performance, marital and psychosocial adjustment). Subjects and Methods: A quasi experimental design (A pre-post-test) was used. The study was conducted at two Maternal and Child health centers (MCH) and family planning out-patient clinic (FPOC) at Shebin -El-Kom Teaching Hospital- Egypt. A purposive sample of 200 women (100 women with dyspareunia and 100 free of dyspareunia) were included to detect the risk factors. The 100 women who diagnosed with dyspreunia received CBT intervention. These women were followed up for 12 weeks. Five tools were used to collect pertinent data. Results: the study revealed that, the mean score of maternal age of the women with dyspareunia were 24.74±4.01. Most of them were had intermediate level of education (60%), were lived in rural community (78%) and not had enough income (56%). The common risk factors for dyspareunia were related to demographic data (age, residence, and income), reproductive factors (vaginal dryness, itching, abnormal vaginal discharge and cervical ulcer, erosion) and obstetric factors (episiotomy, laceration during delivery and breast feeding). A significant improvement was found between women before and after receiving CBT intervention regarding severity of sexual pain, sexual performance, marital-relationship, social & psychological status. Conclusion: CBT as an important nursing intervention is an effective therapy in managing dyspareunia for decreasing sexual pain severity, improving sexual performance, marital adjustment, psychosocial state. Key words: CBT, Dyspareunia, Sexual dysfunction, Pain , Risk factors. I. Introduction Sexual dysfunction is highly prevalent disorder among women in today's society. Dyspareunia (painful sexual intercourse) is a recurrent or persistent acute pain associated with attempted or complete vaginal entry and/or penile vaginal intercourse (1) . The clinical importance of pain during intercourse is increasingly recognized, lack of consensus still prevails concerning the etiology of this distressing female sexual health problem (2) . There is almost no controversy today concerning the classification of dyspareunia as a sexual dysfunction. Both the Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Association, (2013) and the International Classification of Disease include dyspareunia in their sections on sexual dysfunction (3) . A worldwide prevalence of chronic pelvic pain in systematic review is reported that, the rate of dyspareunia ranges between 8% and 21.8% (4) . On the other hand, twenty-six percent of female patients at sexology outpatient clinics in the Netherlands received treatment for dyspareunia, which makes it the most prevalent problem at Dutch sexology outpatient clinics (5) . In Egypt 31.5% of women were suffered from dyspareunia (6) . A recent study conducted at Mansoura city that studied the effect of sexual counseling program on pain level and sexual function among women with dyspareunia revealed that 27.3% of the study sample complained with dyspareunia and their age was ranged between 20- 45 years (7) . Two types of dyspareunia are distinguished; pain felt deep inside the pelvis during penile thrusting (deep dyspareunia), and pain experienced at the vaginal introitus (i.e superficial dyspareunia). The vast majority of symptomatic women reports superficial dyspareunia (8) . The causes of dyspareunia may be mixed between physiological and psychological, interpersonal and socio-cultural causes: The common physical causes of dyspareunia include interstitial cystitis, irritable bowel syndrome, pelvic inflammatory disease, chronic pelvic pain, and endometriosis. Also, diseases as diabetes, thyroid disease, diseases of heart, liver, and /or kidney disease, pelvic surgery, pelvic injury or trauma, neurological disorders, medication side effects, alcohol or drug abuse and fatigue (9) . Psychological causes could result from fear of pain, interpersonal disturbance, sexual abuse, stress or anxiety from work or family responsibilities, concern about sexual performance, conflicts in the relationship with partner, depression/anxiety, unresolved sexual orientation issues, previous traumatic sexual or physical experience, body image and self-esteem problems (10) .