Women's experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study.

BACKGROUND: Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes 'performance-based' sexuality which may be detrimental. Despite this, little has been done to seek women's views about their treatment. This study set out to explore women's experiences of vaginismus treatment with vaginal trainers, and to use their voices to propose guidelines for improving treatment. METHODS: 13 women who had used vaginal trainers for vaginal penetration difficulties diagnosed as vaginismus were recruited through a specialist clinic, university campuses, and online forums. The women took part in semi-structured individual interviews (face-to-face/telephone/Skype), which were audio-recorded, transcribed verbatim and analysed using Thematic Analysis. RESULTS: Four superordinate themes were elicited and used to draft 'better treatment' guidelines. Themes were: (1) Lack of knowledge, (2) Invalidation of suffering by professionals, (3) Difficult journey, and (4) Making the journey easier. This paper describes themes (3) and (4). Difficult Journey describes the long and arduous 'Journey into treatment', including difficulties asking for help, undergoing physical investigations and negotiating 'the system' of medical referrals. It also describes the sometimes demoralising process of 'being in treatment', which includes emotional and practical demands of treatment. Making the journey easier highlights the importance of and limits to 'partner support'. 'Professional support' comprises personal qualities of professionals/therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. 'Peer support/helping each other' describes the importance of supportive vaginimus networks and sharing tips with other women. CONCLUSIONS: Accessing effective treatment for vaginal penetration difficulties is difficult. The practical and emotional demands of using vaginal trainers may be underestimated by professionals, resulting in inadequate provision of support and information in practice. At times vaginal trainers may be prescribed to women who are unlikely to benefit from this treatment in isolation. Core communication skills like non-judgemental listening are important for supporting women through treatment. However professionals also need greater specialist knowledge, which in turn requires more detailed research. New ways to disseminate specialist knowledge and suggestions for further research are discussed.

Efetividade de intervenções fisioterapêuticas para o vaginismo: uma revisão de literatura / Effectiveness of physical therapy for vaginismus: a literature review

O vaginismo é uma persistente contração involuntária da musculatura da vagina que interfere na penetração, impedindo a relação sexual e podendo comprometer as relações interpessoais e conjugais, para o qual algumas estratégias de fisioterapia têm sido propostas. O objetivo desta revisão foi avaliar a efetividade de tratamentos fisioterapêuticos propostos para o vaginismo. Foram levantados estudos em que o diagnóstico clínico da amostra fosse vaginismo, nas bases de dados Pubmed e Scielo, entre 1998 e 2009. Foram excluídos artigos de revisão, estudos transversais, ou em que as participantes referiam sinais e sintomas de vaginismo decorrentes de outras doenças, ou ainda com intervenções não realizadas por fisioterapeutas. Foram identificados apenas três estudos que se adequaram a esses critérios, em que foram utilizadas as terapias: sexual cognitiva comportamental associada à estimulação elétrica funcional com biofeedback; de dessensibilização por dilatadores de silicone; e a proposta por Masters & Johnson. Os estudos foram avaliados como de baixa qualidade metodológica e não forneciam evidências consistentes para a intervenção fisioterapêutica no vaginismo. Não foi possível efetuar uma metanálise, mas uma revisão crítica, devido à escassez de trabalhos. Portanto, não foram encontradas evidências consistentes de intervenção clínica satisfatória para o vaginismo. Requerem-se estudos clínicos randomizados, de alta qualidade, para comprovar a efetividade dos tratamentos propostos...

Vaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible – hence interfering in personal and marital relationships – for which physical therapy strategies have been proposed. The aim of this review was to assess the effectiveness of physical therapy interventions for vaginismus. Clinical trials in which participants were diagnosed with vaginismus were searched for in Scielo and Pubmed databases between 1998 and 2009. Exclusion criteria were: review and transversal studies; studies where patients presented signs and symptoms of vaginismus resulting from other diseases; and studies in which the interventions proposed can’t be carried out by physical therapists. Only three studies were found, in which the following therapies were used: Master & Johnson’s; sexual cognitive-behavioural therapy plus functional electrical stimulation-biofeedback; and desensitization by silicone dilators. All three studies were evaluated as having poor methodological quality and did not provide consistent evidence for clinical interventions in vaginismus. Due to the scarcity of studies found, no metanalysis was done, only a critical review. No consistent evidence could thus be found on satisfactory clinical physical therapies for vaginismus. Further randomized clinical trials, of high quality, are needed to assess the effectiveness of the treatments proposed...

[The role of physical therapy in the treatment of female sexual dysfunction].

Healthy sexual function requires physical, mental, and emotional well-being. Physical presentations that may limit sexual activity include decreased mobility, alterations in sensation, decreased genital circulation and pain. Physical therapists play an important role in facilitating optimal sexual function by providing treatment to restore function, improve mobility and relieve pain. This article illustrates, through four case reports, the importance of physiotherapy in the multidisciplinary approach to the treatment of female sexual dysfunction.

[Treating vaginismus in Turkish women]. / Vaginismusbehandlung bei türkischen Frauen.

OBJECTIVES: Vaginismus is a sexual dysfunction involving various branches of medicine, including psychiatry and gynaecology. Psychiatric help is sought in only a small proportion of cases, although it is probable that the psychopathological aetiology is more frequent than generally recognized. This article deals with the causes and psychological circumstances in four Turkish couples who presented with unconsummated marriage for 3 to 7 years. Vaginismus F52.5 to the ICD-10 is a sexual dysfunction characterised as: deep anxiety about coitus leading to extreme spasm of musculature making coitus impossible or extremely unpleasant and painful. PATIENTS AND METHODS: Four Turkish couples with unconsummated marriage due to the female partners' penetration phobia were included to this study. A patient-oriented multidimensional individual treatment (combination therapy) is a cost effective, short-term (typically 10- to 12-week) treatment model for both partners. It includes some elements of cognitive behavioural therapy and systemic partner therapy which were considered not radically different from previous therapeutic strategies. RESULTS: Results were successful in all cases; the couples were extremely satisfied with having a normal sex life for the first time. This led to desired pregnancies and avoiding of possible breakdown of their families. DISCUSSION: The couples did well with combination behavioural therapy. This methodology is discussed in its various aspects and with a cultural background. We also emphasise the need for physicians to be mindful of cases of vaginismus requiring psychiatric intervention rather than gynaecological treatment.