management of vaginismus
Last reviewed 01/2018
management
Often Specialist advice is required.
Treatment of vaginismus includes education, counselling, and behavioural exercises.
- treatment should be individualised according the needs of the patients or partner (if she is in a relationship) e.g - penetrative painless intercourse, tampon use, or painless vaginal examination.
- the patient should be educated about all the available treatment methods
- information about assisted conception should be provided if the patient desires to get pregnant
Aim of treatment should be to make the patient more comfortable with her genitals. A combination of relaxation techniques, self exploration of the genitals and insertion of “vaginal trainers” can be used achieve this object. Available treatment options include:
- progressive relaxation
- used manage anxiety, and consists of alternately tensing and relaxing groups of muscles in a prescribed sequence e.g - beginning from the feet and moving upwards
- benefits of this technique are thought to be due to increased sense of control and altered thinking
- should be used before self fingering or insertion of vaginal trainers
- desensitisation
- used to manage anxiety involved with phobias and other behavioural problems
- vaginal trainers are introduced to reduce the patients anxiety
- smallest vaginal trainers are used at the beginning The size is then increased gradually with time until the size of a penis can be inserted comfortably
- short term treatment (2-15 sessions) using insertion training seems
to be effective
- sensate focus
- a series of structured touching activities aimed at managing anxiety and increasing the comfort with physical intimacy
- intercourse is initially banned and couples use homework exercises to gradually move through stages of intimacy to penetration
- main focus is on touch rather than performance
- other clinical approaches include (based mainly on small observational studies, case reports, and anecdotal evidence):
- biofeedback
- uses electromyography to identify the time the pelvic floor muscles are active
- can be used together with pelvic floor exercises
- physiotherapy
- hypnotherapy
- topical lidocaine applied within the vagina
- antidepressants
- botulinum neurotoxin
- not licensed for this condition
- an open label study reported that botulinum toxins injected to 24 women with vaginismus who had not responded to other treatments resulted in 18 women achieving intercourse which was maintained over one year (1)
In patients with a history of sexual trauma, refer immediately for assessment of treatment
- psychologist referral is indicated in anxiety, phobic resistance to examination, or other mental health or relationship problems
- some patients may require referral to specialists such as gynaecologists, sexual therapists, psychiatrists, or psychotherapists (1)
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