What is the diagnosis and treatment for vaginismus?

From the Guidelines

Vaginismus is a condition that can be effectively managed with a multi-faceted approach, including pelvic floor physical therapy, vaginal dilators, and psychological support, as recommended by the most recent guidelines 1. The treatment plan should be tailored to the individual patient's needs and may involve a combination of these approaches.

• Pelvic floor physical therapy can help to improve vaginal elasticity and reduce pain during intercourse.
• Vaginal dilators can be used to gradually increase vaginal depth and accommodation, and can be particularly beneficial for patients with vaginal stenosis or vaginismus.
• Psychological support, such as cognitive behavioral therapy, can help to address anxiety and fear associated with penetration, and can be beneficial for patients with a history of trauma or sexual dysfunction.

The use of vaginal dilators is a key component of the treatment plan, and patients should start with the smallest dilator and gradually progress to larger sizes over weeks to months, using them for 5-10 minutes daily with lubricant, as recommended by the guidelines 1. Relaxation techniques, such as deep breathing and mindfulness, can also help to reduce anxiety and improve treatment outcomes. For severe cases, healthcare providers may prescribe muscle relaxants or recommend botulinum toxin injections into the pelvic floor muscles. Psychological therapy, particularly cognitive behavioral therapy, can help to address underlying anxiety and fear associated with penetration, and can be beneficial for patients with a history of trauma or sexual dysfunction.

It is essential to note that the treatment of vaginismus should be guided by the most recent and highest-quality evidence, and healthcare providers should prioritize a patient-centered approach that takes into account the individual patient's needs and preferences 1. By working together with a healthcare provider, patients with vaginismus can develop a comprehensive treatment plan that addresses their physical and emotional needs, and can improve their overall quality of life. Some of the key points to consider when developing a treatment plan for vaginismus include:

• The use of vaginal dilators to gradually increase vaginal depth and accommodation
• The importance of relaxation techniques, such as deep breathing and mindfulness, in reducing anxiety and improving treatment outcomes
• The potential benefits of psychological therapy, particularly cognitive behavioral therapy, in addressing underlying anxiety and fear associated with penetration
• The need for a patient-centered approach that takes into account the individual patient's needs and preferences.

From the Research

Definition and Symptoms 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.
• The DSM 5 classification stresses that vaginismus is a penetration disorder in that any form of vaginal penetration such as tampons, finger, vaginal dilators, gynecological examinations, and intercourse is often painful or impossible 3.
• Women with vaginismus may experience symptoms such as pain, anxiety, and fear, and may feel sinful, anxious, and incompetent, with reduced self-confidence 4.

Treatment Options for Vaginismus

• Functional electrical stimulation (FES)-biofeedback with sexual cognitive-behavioral therapy (SCBT) has been shown to be an effective treatment for vaginismus 2.
• Physiotherapy of pelvic floor muscles, including internal manual techniques, patient education, dilatation exercises, and home exercises, may be a promising treatment option for women with lifelong vaginismus 5.
• Local injection of botulinum toxin has also been used as a treatment for vaginismus, but its effectiveness compared to physiotherapy is still being studied 4.
• A multimodal approach, including medical and psychosexual interventions, may be the most effective way to treat vaginismus 3, 6.

Effectiveness of Treatment Options

• Studies have shown that treating vaginismus is associated with the completion of sexual penetrative intercourse in 79% of cases, independently of the therapy used 6.
• The combination of physiotherapy and psychological interventions may be more effective than waiting list control or botulinum toxin injection alone 4, 6.
• However, the success rate of treatment may vary depending on the definition of vaginismus, the origin of vaginismus, and the involvement of the partner in the intervention 6.