From the Guidelines
The first line of treatment for vaginismus after endometriosis surgery is vaginal dilators, as recommended by the NCCN Survivorship Panel, despite limited evidence for their effectiveness 1. When considering treatment options, it's essential to address the specific type of problem, in this case, vaginismus, which can be associated with pelvic surgery.
- Vaginal dilators are specifically recommended for vaginismus, sexual aversion disorder, vaginal scarring, or vaginal stenosis from pelvic surgery 1.
- While pelvic floor muscle training may improve sexual pain, arousal, lubrication, orgasm, and satisfaction, the evidence is based on a small study of survivors of gynecologic cancers, and its effectiveness for vaginismus after endometriosis surgery is not explicitly stated 1.
- Other treatment options, such as water-, oil-, or silicone-based lubricants and moisturizers, vaginal estrogen, and psychotherapy, may be helpful for female sexual dysfunction, but they are not specifically recommended as the first line of treatment for vaginismus after endometriosis surgery 1.
- It's crucial to note that the evidence base for interventions to treat female sexual dysfunction in survivors is weak, and high-quality studies are needed to support treatment recommendations 1.
- A multi-modal approach, including psychological support and pain management, may be beneficial in addressing the physical and psychological components of vaginismus, but the primary recommendation is to use vaginal dilators 1.
From the Research
Vaginismus after Endometriosis Surgery
- Vaginismus is a condition characterized by involuntary contraction of the pelvic floor muscles, making vaginal penetration difficult or impossible 2.
- It can be a complication after endometriosis surgery, and its treatment is crucial for improving the patient's quality of life.
First Line of Treatment
- The first line of treatment for vaginismus after endometriosis surgery is not explicitly stated in the provided studies.
- However, cognitive-behavioral therapy (CBT) has been shown to be effective in treating vaginismus 3.
- Functional electrical stimulation-biofeedback with sexual cognitive-behavioral therapy (SCBT) is also a promising treatment approach for vaginismus 4.
- Pelvic floor physical therapy and psychosocial interventions, such as CBT, may be beneficial in treating vaginismus and other pelvic floor disorders 2.
Treatment Approaches
- A multimodal treatment protocol, including ultrasound-guided trigger point injections, peripheral nerve blocks, and pelvic floor physical therapy, has been shown to be effective in decreasing pain and improving function in endometriosis patients post-surgical excision 5.
- Cognitive behavioral therapy (CBT) is also an essential component of this treatment protocol, aiming to address the psychological aspects of vaginismus and pelvic pain 5.
- Hormonal therapies, such as combined oral contraceptives and progestin-only options, are first-line treatments for endometriosis, but their effectiveness in treating vaginismus is not explicitly stated in the provided studies 6.