From the Guidelines
Vaginismus treatment should prioritize a multi-faceted approach including pelvic floor physical therapy, vaginal dilators, and psychological support, as this combination has been shown to be effective in reducing symptoms and improving quality of life 1.
Key Components of Treatment
- Pelvic floor physical therapy with a specialized therapist is highly effective in identifying and relaxing tense muscles, and can be used in conjunction with vaginal dilators to improve outcomes 1.
- Vaginal dilators can be used to help patients gradually become comfortable with penetration, and should be started with the smallest size and gradually increased over weeks to months 1.
- Psychological interventions such as cognitive behavioral therapy can address underlying anxiety or trauma, and can be used in conjunction with other treatments to improve outcomes 1.
Additional Treatment Options
- Topical lidocaine (2-5%) can be prescribed to reduce discomfort during initial attempts at penetration, or low-dose anxiolytics like diazepam (2-5mg) can be used for severe cases 1.
- Low-dose vaginal estrogen can be used to treat vaginal dryness and other symptoms, but should be used with caution in patients with a history of hormone-sensitive cancers 1.
- Ospemifene, a selective estrogen receptor modulator, can be considered for postmenopausal women without a history of breast cancer who are experiencing dyspareunia, vaginal atrophy, or other vaginal pain 1.
Importance of Patient Support
- Partners should be involved in the treatment process when appropriate, as their understanding and support can significantly improve outcomes 1.
- Patients should be encouraged to communicate openly with their healthcare providers about their symptoms and concerns, and should be offered referrals to specialized therapists or support groups as needed 1.
From the Research
Definition and Characteristics of Vaginismus
- Vaginismus is an involuntary spasm of the musculature of the outer third of the vagina that leads to impossible vaginal penetration, causing personal distress 2.
- It is a penetration disorder where any form of vaginal penetration such as tampons, finger, vaginal dilators, gynecological examinations, and intercourse is often painful or impossible 3.
- Vaginismus includes both physical as well as psychological aspects that make vaginal penetration extremely painful if not altogether impossible 4.
Diagnosis of Vaginismus
- Diagnosis rests on the physical examination, aside from history 4.
- The DSM 5 classification stresses that vaginismus is a penetration disorder 3.
- Stratifying the severity of vaginismus allows the clinician to choose among numerous treatment options and to better understand what the patient is experiencing 3.
Treatment Options for Vaginismus
- Various therapeutic approaches, both physiologic and psychological, have been considered 2.
- Treatment methods range from surgery to simple muscle-strengthening exercises to elaborate psychotherapeutic intervention 4.
- Behavioral methods have shown marked success 4.
- Functional electrical stimulation (FES)-biofeedback with sexual cognitive-behavioral therapy (SCBT) is an effective aid for patients with vaginismus to learn muscle control 2.
- Systematic desensitisation and other behavior therapies (e.g. cognitive behaviour therapy, sex therapy) may be effective, but more research is needed to confirm this 5.
- Botox can be used as part of a multimodal treatment program to treat vaginismus 3.
- Multidisciplinary care with multimodal therapy often results in positive patient outcomes 6.
Role of Healthcare Professionals in Managing Vaginismus
- 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 provide referrals to other relevant health professionals 6.
- Validating people's experiences and making an accurate diagnosis are important steps in helping people recover from vaginismus 6.