From the Guidelines
The management of vaginismus should start with the use of vaginal dilators, as they have been shown to be beneficial in the management of vaginismus and/or vaginal stenosis, particularly for women treated with pelvic radiation therapy 1. The approach to managing vaginismus involves a combination of physical and psychological therapies.
- Vaginal dilators can be offered to anyone having pain with examinations and/or sexual activity, and ideally, their benefit is greatest when started early 1.
- Pelvic floor physical therapy may be beneficial for patients experiencing symptoms of a potential pelvic floor dysfunction, including persistent pain and urinary and/or fecal leakage 1.
- Cognitive behavioral therapy and pelvic floor (Kegel) exercises may be useful to decrease anxiety and discomfort and can lower urinary tract symptoms 1.
- Topical vaginal therapies, such as low-dose vaginal estrogen, can be used for women who do not respond to conservative measures, although the risks and benefits should be thoroughly discussed, especially for women with hormone-positive breast cancer 1.
- Other options, such as ospemifene, DHEA, and topical anesthetics, may be considered based on individual patient needs and medical history, as outlined in recent guidelines 1. The most recent guidelines suggest a comprehensive approach to addressing sexual function concerns, including regular re-evaluation, discussion of available drugs and therapies, and referral to specialists as needed 1.
- A multimodal approach that addresses both physical and psychological aspects of vaginismus is likely to be the most effective, with most patients showing significant improvement when consistently following these therapies over 3-6 months. Key considerations in the management of vaginismus include the importance of early intervention, patient education, and a thorough discussion of the risks and benefits of various treatment options, as emphasized in the latest clinical practice guidelines 1.
From the Research
Management Options for Vaginismus
The management of vaginismus aims to help women regain voluntary control of their pelvic floor muscles. The treatment utilizes a behavioral method aimed at teaching relaxation of pelvic floor muscles together with a systematic desensitization of the fear of vaginal penetration 2.
Approaches to Vaginal Desensitization
There are two approaches to vaginal desensitization:
- Gradual desensitization using vaginal self-dilatation
- Rapid desensitization brought about by vaginal mould insertion 2 Other studies have also used a combination of different interventions, including:
- Providing sexual education
- Psychotherapy
- Serial dilation using graded plastic dilators
- Sensate-focused therapy
- Anti-anxiety medication 3
Treatment Methods
Various therapeutic approaches have been considered, including:
- Functional electrical stimulation (FES)-biofeedback with sexual cognitive-behavioral therapy (SCBT) 4
- Cognitive-behavioral therapy (CBT) 5
- Behavioral methods, such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear 5
- Surgery, although this is almost never required and may be detrimental to achieving success 2
Key Considerations in Therapy
The most important considerations in therapy seem to be: