From the Guidelines
Vaginismus treatment should prioritize a combination of pelvic floor physical therapy, psychological approaches, and gradual desensitization, with vaginal dilators and topical therapies considered as adjunctive treatments, as recommended by the most recent guidelines 1.
Treatment Overview
Vaginismus is a condition characterized by involuntary tightening of the vaginal muscles during attempted penetration, leading to pain and difficulty with intercourse, tampon insertion, or gynecological exams. The treatment approach should focus on addressing both physical and psychological aspects of the condition.
Physical Therapy
Pelvic floor physical therapy is a crucial component of vaginismus treatment, where specialists teach relaxation techniques and provide exercises to help patients gain control over their vaginal muscles. This approach has been shown to improve sexual pain, arousal, lubrication, orgasm, and satisfaction 1.
Psychological Interventions
Psychological interventions, such as cognitive behavioral therapy, can help address anxiety and fear associated with penetration, which are common underlying factors contributing to vaginismus.
Adjunctive Treatments
Vaginal dilators can be used as an adjunctive treatment, starting with the smallest size and gradually progressing to larger ones as comfort allows. Topical therapies, such as vaginal moisturizers and lubricants, can also help alleviate symptoms like vaginal dryness and pain.
Medications and Other Options
In some cases, medications like muscle relaxants or topical lidocaine may be prescribed to reduce pain and muscle tension. Other options, such as botulinum toxin injections into the pelvic floor muscles, may be considered for severe cases.
Key Considerations
When treating vaginismus, it is essential to prioritize a comprehensive approach that addresses both physical and psychological aspects of the condition. The most recent guidelines recommend a combination of pelvic floor physical therapy, psychological approaches, and gradual desensitization, with adjunctive treatments considered as needed 1.
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.
- It 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.
Treatment Options for Vaginismus
- Functional electrical stimulation (FES)-biofeedback with sexual cognitive-behavioral therapy (SCBT) is an effective aid for patients with vaginismus to learn muscle control 2.
- Cognitive-behavioral therapy (CBT) seems an effective treatment of lifelong vaginismus, and techniques such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear, constitute an important avenue of change in the treatment of lifelong vaginismus 4.
- Physiotherapy for the treatment of vaginismus should address the components of anxiety and pain, in addition to normalizing muscle tone of the pelvic floor 5.
- A multimodal approach to treating vaginismus, including stratifying the severity of the condition and choosing among numerous treatment options, can lead to a high rate of success 3.
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 multidisciplinary care with multimodal therapy often results in positive patient outcomes 6.