From the Guidelines
Management of vaginismus involves a multidisciplinary approach combining psychological and physical therapies, with vaginal dilators and pelvic floor muscle exercises being cornerstone treatments, as recommended by the most recent guidelines 1. Treatment typically begins with education about the condition and reassurance that it can be successfully treated.
- Psychotherapy, particularly cognitive behavioral therapy (CBT), helps address anxiety, fear, and negative beliefs about penetration.
- Physical therapy focuses on pelvic floor muscle exercises to reduce involuntary contractions, including progressive muscle relaxation techniques.
- Vaginal dilators are used, starting with the smallest size and gradually progressing to larger ones as comfort allows, typically used for 5-15 minutes daily.
- Sexual counseling for both partners can improve communication and reduce performance anxiety. In some cases, medications may be prescribed, including:
- Topical lidocaine (2-5%) to reduce pain during initial penetration attempts
- Anxiolytics like diazepam (2-5mg) for severe anxiety, though these should be used cautiously and temporarily
- Botulinum toxin injections into the pelvic floor muscles may be considered in refractory cases, as suggested by recent studies 1. Treatment success depends on consistent practice, patience, and addressing both physical and psychological components.
- Most patients see improvement within 2-6 months of dedicated therapy, though complete resolution may take longer depending on severity and underlying causes. It is essential to consider the patient's overall health and medical history when selecting treatment options, as certain medications or therapies may be contraindicated in specific cases, as noted in the guidelines 1.
From the Research
Treatment Options for Vaginismus
The treatment options for vaginismus, also known as genito-pelvic pain penetration disorder, include a range of approaches, both physiologic and psychological. Some of the treatment options are:
- Functional electrical stimulation (FES)-biofeedback with sexual cognitive-behavioral therapy (SCBT) 2
- Behavioral methods, such as gradual desensitization and exposure therapy 3, 4
- Cognitive-behavioral therapy (CBT), which may include group therapy or bibliotherapy 4
- Pelvic floor muscle relaxation using FES-biofeedback 2
- Paula Garburg's sphincter muscle exercises, combined with the use of vaginal dilators 5
- Multidisciplinary care with multimodal therapy, which may include a range of healthcare professionals and treatment approaches 6
Effectiveness of Treatment Options
The effectiveness of these treatment options has been demonstrated in various studies. For example:
- A study found that FES-biofeedback with SCBT was an effective aid for patients with vaginismus to learn muscle control and increase the success rate of treatment 2
- A randomized controlled trial found that cognitive-behavioral group therapy and bibliotherapy were efficacious in treating lifelong vaginismus, with 14% of treated participants reporting successful intercourse at posttreatment 4
- A study found that Paula Garburg's sphincter muscle exercises, combined with the use of vaginal dilators, was a simple, easy, and effective treatment for vaginismus, with a shorter mean number of treatment sessions required for successful outcome compared to traditional behavioral approaches 5
Role of Healthcare Professionals
General practitioners (GPs) play a vital role in diagnosing and treating vaginismus, as well as coordinating a multidisciplinary team to support people with vaginismus 6. GPs can offer a range of treatment options for people with vaginismus and can refer patients to other relevant health professionals as needed.