From the Guidelines
Vaginismus treatment should start with pelvic floor physical therapy, combined with the use of vaginal dilators and psychological therapy, such as cognitive behavioral therapy (CBT), to address both physical and psychological components of the condition, as recommended by the most recent and highest quality study 1.
Treatment Approach
The treatment of vaginismus involves a multifaceted approach that includes:
- Pelvic floor physical therapy to identify and relax tense pelvic floor muscles through specialized exercises and biofeedback
- Vaginal dilators used progressively to gradually accustom the vaginal muscles to insertion and reduce fear responses, starting with the smallest size dilator for 5-10 minutes daily and gradually increasing to larger sizes over weeks or months
- Psychological therapy, particularly CBT, to address anxiety and fear associated with penetration
Additional Interventions
Additional interventions that may be considered include:
- Topical lidocaine (2-5%) applied to the vaginal entrance 10-20 minutes before attempted penetration to reduce pain
- Low-dose anxiolytics to manage anxiety temporarily
- Mindfulness techniques and relaxation exercises as complementary approaches
Importance of Consistency and Patience
Treatment success depends on consistency, patience, and addressing both physical and psychological components, as vaginismus involves a protective muscle response triggered by anticipated pain. Partners should be involved in the treatment process when appropriate, and progress typically occurs gradually over several months of dedicated practice, as supported by the study 1.
Consideration of Recent Evidence
The most recent study 1 provides the highest quality evidence for the treatment of vaginismus, and its recommendations should be prioritized in clinical practice. This study highlights the importance of a comprehensive approach to treating vaginismus, including physical and psychological therapies, and provides guidance on the use of vaginal dilators and other interventions.
From the Research
Vaginismus Treatment Options
- Vaginismus is a condition that can be treated with various therapeutic strategies, including sex therapy and desensitization 2.
- General practitioners play a vital role in diagnosing and treating vaginismus, as well as coordinating a multidisciplinary team to support people with vaginismus 3.
- Treatment options for vaginismus include:
- Pelvic floor relaxation and sexual counseling based on the Information, Motivation, Behavior (IMB) model 4.
- Functional electrical stimulation via sexual cognitive/behavioral therapy of pelvic floor muscles 5.
- Systematic desensitization, which has been shown to be effective in some studies, but the evidence is limited 2.
- Medical interventions, such as botulinum toxin injections, which have been compared to physiotherapy in some studies 5.
Effectiveness of Treatment Options
- A systematic review and meta-analysis found that treating vaginismus is associated with the completion of sexual penetrative intercourse in 79% of cases, independently of the therapy used 6.
- Another study found that sexual counseling and pelvic floor relaxation interventions provided to women receiving vaginismus treatment affected their sexual function positively 4.
- A randomized clinical trial found that physiotherapy procedures were more effective than botulinum toxin injections in improving sexual functioning in women with primary vaginismus 5.
- However, the evidence is limited, and further well-designed trials are required to determine the most effective treatment options for vaginismus 2, 6.
Considerations for Treatment
- The origin of vaginismus (primary, secondary, or both), its duration, the mean age of the participants, the involvement of the partner in the intervention, or the geographic setting did not exert a significant effect on the outcome 6.
- Studies enrolling women with unconsummated marriage showed a significantly worse success rate 6.
- A multidisciplinary approach, including medical and psychosexual interventions, may be beneficial for women with vaginismus 3, 6.