AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2578-8965/236
1Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA.
2The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA.
*Corresponding Author: Katherine Wolfrum, Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA.
Citation: Allyson Shrikhande, Lolasri Rampally, Katherine Wolfrum, Rachael Haverland, Kimberlee Leishear., et al. (2024), Vaginismus: Results from Treatment with the PRM Protocol™, J. Obstetrics Gynecology and Reproductive Sciences, 8(7) DOI:10.31579/2578-8965/236
Copyright: © 2024, Katherine Wolfrum. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 28 August 2024 | Accepted: 04 September 2024 | Published: 10 September 2024
Keywords: pelvic medicine; vaginismus; pelvic floor therapy; patient reported outcomes; pain management interventions
Background/Aim: Vaginismus, a condition characterized by involuntary pelvic floor muscle spasms, presents considerable challenges in diagnosis and treatment, impacting sexual health and quality of life. This study evaluates the efficacy of a novel pelvic peripheral nerve block and trigger point injection protocol (the PRM Protocol™) in addressing vaginismus.
Materials/Methods: A retrospective chart review of 961 patients diagnosed with vaginismus, aged 18-76, was conducted. Participants underwent a 6-week treatment protocol involving neuromuscular treatment and physical therapy.
Results: Outcome measures included the Visual Analog Scale (VAS) pain scale, the Functional Pelvic Pain Scale (FPPS), and the modified Sexual Function Profile (SFP). Post-treatment, there were notable decreases in VAS by 46%, FPPS by 51% and a 25% improvement in SFP. Additionally, opioid use decreased by 22%, ER visits decreased by 18%, and absenteeism and presenteeism decreased by 56% and 68%, respectively. No adverse events were reported.
Conclusion: The study highlights the comprehensive efficacy of the PRM Protocol™ in alleviating vaginismus symptoms and improving patient outcomes. Implementation of this protocol offers a transformative opportunity to enhance patient care and optimize resource allocation in managing vaginismus, warranting further research and clinical application.
Vaginismus is a sexual health condition characterized by involuntary muscle spasms or contractions of the pelvic floor muscles surrounding the vagina1. These spasms can make any form of vaginal penetration, including sexual intercourse, gynecological examinations, or tampon insertion, painful or even impossible [1]. It is important to note that vaginismus is not a conscious choice or a result of psychological resistance; instead, it is an involuntary physiological response. Although a long-standing condition, first defined in 1862, research on the topic continues to be very limited[2]. Currently, vaginismus continues to affect somewhere between 5-17% of women, with reports on the prevalence varying[2].
The severity of vaginismus can vary, ranging from mild discomfort to extreme pain. The condition can have a significant impact on sexual relationships, causing emotional distress and anxiety for individuals experiencing it and their partners[1]. Vaginismus can be classified into primary or secondary categories. Primary vaginismus occurs when the condition has been present from the beginning of a person's attempts at vaginal penetration, while secondary vaginismus develops after a period of normal sexual function[2]. The causes of vaginismus are complex and may include psychological factors, past traumatic experiences, relationship issues, or medical conditions. Treatment approaches often involve a combination of physical therapy, counseling, and, in some cases, medical interventions2. Successful treatment typically requires a comprehensive and individualized approach addressing both the physical and psychological aspects of the condition[3]. If someone is experiencing symptoms of vaginismus, seeking the guidance of multiple healthcare professionals, such as gynecologists or sex therapists, is crucial for accurate diagnosis and tailored treatment plans[2].
The traditional indicator of vaginismus has been involuntary muscle spasms leading to sexual dysfunction[4]. However, both the American College of Obstetrics and Gynecology (ACOG) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) V-Text Revision (TR) have defined vaginismus as a part of genito–pelvic pain/penetration disorder. ACOG defines genito-pelvic pain/penetration disorder as a combination of dyspareunia and vaginismus5. In the most recent DSM-V-TR, vaginismus is listed as a symptom within the category of “genito-pelvic pain/penetration disorder, “which is difficulty in one of the following: (a) vaginal intercourse/penetration, (b) genito-pelvic pain, (c) fear of vaginal intercourse/penetration/pain, or (d) heightened pelvic floor muscle tension during attempted penetration5. This is an update from the prior definitions of vaginismus used by DSM, which was defined as an involuntary contraction of muscles, making penetration painful or impossible [5,6]. The International Classification of Diseases (ICD)-11 classifies vaginismus as a sexual pain-penetration disorder [7].
Due to the lack of a clear definition for vaginismus, despite its long history, the etiology and treatment for vaginismus are varied. Currently, several treatment modalities are employed to address vaginismus, reflecting the complex nature of the disorder. Pelvic floor physical therapy is a common approach, focusing on the relaxation and strengthening of the pelvic floor muscles through targeted exercises and interventions [2]. General psychotherapy aims to address any underlying psychological issues or trauma that may contribute to vaginismus, fostering a holistic approach to treatment [2]. Additionally, pharmacological therapies, such as muscle relaxants or anesthetics, may be considered in some instances to alleviate symptoms[2]. Sex/cognitive behavioral therapy (CBT) plays a pivotal role in modifying negative thought patterns and behaviors associated with vaginal penetration, providing a structured and goal-oriented therapeutic approach2.
The available treatment options for vaginismus are diverse. However, the research literature frequently encounters methodological difficulties, such as small sample sizes and the necessity for long-term follow-up data. This study sought to address these concerns by conducting a comprehensive investigation into the efficacy of an outpatient neuromuscular treatment protocol. Notably, the research utilized a large-scale approach to enhance the study's statistical power, providing more reliable insights into the effectiveness of the novel treatment protocol. The focus of the study was explicitly directed toward treating myofascial pain and dysfunction commonly observed in vaginismus patients, offering a nuanced and targeted intervention for this intricate condition. The substantial sample size contributes to the validity and generalizability of the study's findings, shedding light on potential advancements in the treatment landscape for vaginismus.
The study included 961 participants aged 18 to 76 years old diagnosed with vaginismus who sought treatment at an outpatient pelvic rehabilitation practice between April 2021 and December 2022. The demographic and clinical characteristics of the patients are depicted in Figure 1 and Figure 2. The inclusion criteria for the retrospective chart review included the completion of the PRM Protocol™, which consists of a series of pelvic peripheral nerve blocks and trigger point injections; an internal examination with necessary workup; and specific findings such as trigger points, pelvic floor hypertonia, tenderness upon palpation of the levator ani sling during an internal examination; and tenderness along the pudendal nerve and posterior femoral cutaneous nerve at Alcock's canal and obturator canal bilaterally internally.
Exclusion criteria for the retrospective chart review included active infection, malignancy, pregnancy, pudendal nerve entrapment syndrome, and incomplete patient-reported outcome measures.
The Institutional Review Board (IRB) approved the six-week neuromuscular office-based treatment called the PRM Protocol™ (IRB# 17‐0761) designed for patients diagnosed with vaginismus. The treatment involved pre-medication with diclofenac 75 mg PO, pre-treatment with atopical anesthetic spray, and weekly external ultrasound-guided trigger point injections of Lidocaine 1% into the pelvic musculature. A global injection targeted specific muscles of the levator ani sling using a flexible, 6‐inch, 27‐gauge needle injected from the subgluteal posterior approach under ultrasound guidance.
Simultaneous ultrasound‐guided peripheral nerve blocks of the pudendal nerve at Alcock’s canal and the posterior femoral cutaneous nerve were administered. The initial treatment included dexamethasone with Lidocaine 1%, followed by subsequent appointments with normal saline and Lidocaine 1% for nerve blocks. Patients resumed normal activities immediately after treatment.
During the PRM Protocol™, patients did pelvic floor physical therapy either at a local clinic or at home virtually, with the goal of downtraining the pelvic floor musculature and the peripheral and central nervous systems. Patients also simultaneously participated in mindfulness, meditation, and deep breathing exercises at home alone or through PRM’s mindfulness meditation course, “Retrain Your Pelvic Pain.”
Six weeks after the final treatment, participant response to the PRM Protocol™ was measured. Primary outcome measures included Visual Analog Scale (VAS) scores for pelvic pain concentration and Functional Pelvic Pain Scale (FPPS) scores to assess pelvic functionality. Patients provided their average pain intensity ratings on a scale of 1 to 10 for the Visual Analog Scale (VAS) based on the preceding 24 hours. The overall Functional Performance Pain Scale (FPPS) score is derived by summing sub-scores across distinct categories, including working, intercourse, sleeping, walking, running, lifting, bladder, and bowel. Within each category, scores range from 0 to 4, where 0 signifies normal performance and 4 indicates substantial debilitation, yielding a cumulative FPPS score ranging from 0 to 32.
Secondary outcome measures encompass a modified version of the National Institutes of Health Sexual Function Profile (SFP), featuring three questions focused on sexual well-being that are totaled to derive an overall Modified SFP score. Additional perspectives on a patient's well-being are captured through Absenteeism and Presenteeism questionnaires, along with patient-reported data on the frequency of opioid use and Emergency Room (ER) visits. A retrospective review of medical records was conducted to analyze the outcome measures. The Wilcoxon signed-rank test, suitable for non-normally distributed paired samples, was employed to analyze VAS, FPPS, and SFP scores. Differences in Absenteeism and Presenteeism were assessed using a Chi-squared test, while changes in opioid use and ER visits were examined using a McNemar test for paired proportions.
Figure 1: Age Distribution of Patients
Figure 2: Previous Diagnostic Procedures
Significant statistical findings were observed across various outcome variables. No adverse events were reported from the PRM Protocol™. The 1-10 Visual Analog Scale (VAS), Functional Pelvic Pain Scale (FPPS), a modified version of the Sexual Function Profile (SFP), as well as measures of opioid use, Emergency Room visits, Absenteeism, and Presenteeism (Figures 4-9). Measures were assessed during participants' New Patient (NP) and their six-week follow-up (6-WK FU) appointments after completing the initial protocol series. SPSS v.29 was used for analysis, with α = 0.05 as the cutoff for all analyses.
VAS pain levels decreased by 46% from 7.2 (SD 2.46, CI = 6.93 – 7.28) to 3.9 (SD 2.49, CI = 3.61 – 3.92) (p < .001). FPPS total scores decreased by 51% from an average of 9.6 (SD 5.23, CI = 9.52 – 9.68) to an average of 4.7 (SD 5.82; CI = 4.58 – 4.79) (p < .001). Improvements in all FPPS categories were statistically significant (p < .001), with the largest decreases in intercourse (47%), bowel function (45%), bladder function (44%), and sleep (42%).
Our modified SFP asked the following three questions: “In the past 30 days, how would you describe the comfort of your vagina during sexual activity?” “In the past 30 days, how often have you had difficulty with sexual activity because of discomfort/ pain in your vagina?” and “In the past 30 days, how often have you stopped sexual activity because of discomfort/ pain in your vagina?” Responses were scored 0-5 and summed for an average improvement of 25% (p = <0.01).
For those who underwent the PRM Protocol™, 38% of patients reported using opioids for their vaginismus-related pain at their first appointment. 29% of patients reported having gone to an Emergency Room for their vaginismus-related pain at their first appointment. These proportions reduced to 16% and 11%, respectively, at their six-week follow-up appointment after undergoing the PRM Protocol™. This is a 22% decrease in opioid use and 18% decrease in patients visiting the ERER (both p< 0.01) for the treatment group. Absenteeism, defined by at least one day of work missed in the past three months due to pelvic pain, decreased by 56%. Presenteeism, defined by at least 1 hour of work productivity being disturbed by pelvic pain in the past three months, decreased by 68%.
Figure 3: VAS and FPPS Scores Measured for Pelvic Pain Concentration in New patients (NP) and patients after 6 Week-follow (6WK-FU).
Figure 4: Significant improvements in FPPS Categories in New patients (NP) and patients after 6 Week-follow (6WK-FU).
Figure 5: SFP measured for patients at NP and 6 WK-FU
Figure 6: Opioid Use and ER Visits
Vaginismus, a condition often characterized by complexity and misunderstanding, presents considerable challenges in both diagnosis and treatment. Determining the accurate prevalence of vaginismus is difficult due to underreporting and the private nature of sexual health concerns. Despite these obstacles, vaginismus is not uncommon, and its impact on individuals and their relationships can be profound, leading to emotional distress, strained relationships, and avoidance of sexual activities, thereby negatively affecting overall quality of life. The primary objective of this study was to evaluate the impact of the pelvic peripheral nerve block and trigger point injection protocol (the PRM Protocol™) on a wide range of outcome parameters, including pain, functionality, work productivity, quality of life, mental health, sexual health, and healthcare system utilization. It is noteworthy that the participants in this study reported an average pain duration of 9.5 years, underscoring the chronic and debilitating nature of vaginismus.
Significant improvements in Visual Analog Scale (VAS) pain levels were observed among patients, underscoring the efficacy of this approach in addressing the fundamental causes of nerve and muscle dysfunction. Myofascial dysfunction in the pelvic region is intricately linked to issues such as bowel, bladder, and sexual dysfunction, contributing to pelvic pain through the presence of myofascial trigger points[8]. The PRM Protocol™ employs ultrasound-guided trigger point injections in each muscle of the levator ani-sling to address the underlying myofascial pain and pelvic floor dysfunction. This intervention alleviates ongoing nociception, creating space for enhanced flow of pelvic peripheral nerves with reduced constriction and improved blood circulation[13].
Additionally, the PRM Protocol™ targets both peripheral and central sensitization, aiming to mitigate neurogenic inflammation, inhibit feedback loops from the peripheral to central nervous systems, and prevent cross-sensitization between the pudendal and posterior femoral cutaneous nerves9. Peripheral sensitization is managed through consecutive peripheral nerve blocks targeting the pudendal and posterior femoral cutaneous nerves9. The PRM Protocol™ employs two primary mechanisms for this purpose: 1) the reduction of neurogenic inflammation by locally administering dexamethasone to deplete substance P8 and utilizing repeated exposure to lidocaine 1%, which diminishes histamine release from mast cells, and 2) the desensitization of hyperactive peripheral nociceptors through repeated exposure to lidocaine 1%[10]. In addition to addressing peripheral sensitization, the PRM Protocol™ also focuses on central sensitization by treating associated pelvic neurogenic inflammation, effectively interrupting the feedback loop from the peripheral nervous system to the central nervous system [11]. It is crucial to note that the overlap in pain patterns and innervation between the pudendal and posterior femoral cutaneous nerves may lead to cross-sensitization, a phenomenon observed in the pelvic region where a sensitized structure can influence an adjacent, otherwise normal structure [12,13]. The PRM Protocol's™ multi-faceted approach, addressing myofascial dysfunction, pelvic floor dysfunction, and peripheral and central sensitization, demonstrates a comprehensive strategy for managing the intricate facets of vaginismus.
This study focused on assessing patients with vaginismus, aiming to establish a method for evaluating the severity of the condition and exploring effective treatment strategies for this specific group. A substantial cohort of patients with vaginismus actively participated in the study, providing a robust foundation for the research findings. The multimodal treatment approach, addressing both the physical and psychological dimensions of vaginismus, demonstrated a notable degree of success and safety, accompanied by a low recurrence rate. Significantly, the outcomes revealed that this comprehensive approach achieved pain-free intercourse successfully, even for patients with a history of long-term failures with alternative vaginismus treatments. The most notable enhancements were observed in symptoms related to intercourse, sleeping, and bladder function. The PRM Protocol™ specifically targets pelvic nerve inflammation and the pelvic muscles associated with both intercourse and vaginismus, leading to a reversal of pelvic neurogenic inflammation and a reduction in hypertonic pelvic floor conditions. This, in turn, results in decreased vulvar pain and improved functionality during intercourse.
A limitation of the study is its retrospective nature, preventing the use of randomized control groups and limiting the ability to evaluate the protocol's effectiveness compared to placebos. Consequently, individuals diagnosed with vaginismus often navigate a complex medical journey, seeking relief in the emergency room during severe pain episodes and undergoing unnecessary diagnostic procedures in addition to a series of unsuccessful surgical and non-surgical therapeutic interventions. It is crucial for the medical community to collaboratively establish a streamlined diagnostic and treatment protocol for vaginismus patients, benefiting both the individuals suffering from the condition and the healthcare system. Future research in a university context may address these limitations and contribute to a more comprehensive understanding of the studied phenomenon. Nevertheless, the findings from this study contribute valuable insights into the potential effectiveness and safety of the PRM Protocol™ in managing vaginismus, presenting a promising avenue for future research and clinical applications. As a complex and multifaceted condition, vaginismus necessitates a comprehensive and compassionate approach for successful diagnosis and treatment. Increased awareness among healthcare providers, coupled with open communication and support, can contribute to improved outcomes for individuals affected by vaginismus. Ongoing research and advocacy efforts are essential to destigmatize the condition, facilitate early intervention, and enhance the overall well-being of those living with vaginismus.
In conclusion, this research underscores the remarkable efficacy and safety of the PRM Protocol™ in alleviating distress among individuals aged 18-76 diagnosed with vaginismus. The substantial reductions observed in surgical interventions, medical treatments, diagnostic procedures, pain management interventions, opioid utilization, and emergency room visits bear significant clinical and economic implications. Integrating this protocol into healthcare practices presents a transformative prospect to enhance patient care, optimize resource allocation, and provide effective treatments for vaginismus. This study contributes valuable insights that advocate adopting the PRM protocol as a promising and impactful approach to addressing the challenges posed by vaginismus across diverse demographic groups.
The authors report no conflicts of interest in this work.
All authors contributed to the design and implementation of the research, to the analysis of the
Results, and to the writing of the manuscript.
Ethics approval and consent to participate
The protocol for this research project has been approved by an institution's suitably constituted Ethics Committee, and it conforms to the provisions of the Declaration of Helsinki. Committee of The Feinstein Institutes for Medical Research, Approval No. IRB# 17-0761. Our study does not have a clinical trial number, and consent forms were waived due to the study design.
The study was performed at Pelvic Rehabilitation Medicine, Atlanta, Chicago, Dallas, Houston, Miami, New York City, New Jersey, Michigan, and Washington DC. Patient data were gathered from these clinics.
This research received no external funding.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
