What is the best vaginismus treatment?

by | Jun 28, 2016 | vaginismus

5 vaginismus treatment options :

Vaginismus is a condition in which the vagina tightens or spasms in response to penetration or attempted penetration. This tightening causes discomfort, pain and often prevents sexual activity. A number of potential causes have been suggested . Vaginismus effects between 0.5-1% of women, (Simons, & Carey’s 2001) meaning 10’s of thousands of women in the UK are prevented from enjoying a full sex life. However, there are many highly effective ways to treat vaginismus, in this blog we examine 5 of the most popular.

1)    Couples therapy

One study of 56 couples achieved an 80.3% success rate as defined by achieving penetration. (Munasinghe, et al 2004) Another similar study achieved a remarkably similar outcome, which was sustained at a three month follow up.(Hawton & Catalan 1990). despite this high level of success, couple’s therapy has one substantial drawback, it requires both partners to cooperate and coordinate their time table, which can be a significant limitation.

2)    Pelvic floor exercises

Pelvic floor exercises are widely used exercises intended to strengthen and improve control over bladder, bowel, they may also help you to gain a greater control over your vagina. Research into pelvic floor exercises for vaginismus has found broadly positive out comes, with one recent study of 23 women find that 69% moved in to total remission and almost all improved (Kokate & Bulbuli,2025). Another study demonstrated an additive effect when pelvic floor exercies were combined with dilator therapy, a form of desensitization (see below) (Reissing et al 2013) .

3)    Systematic Desensitisation

This is graded exposure to vaginal penetration, often by the use of a series of different sized dilators (essentially dildos) or the insertion of fingers (1 finger, then 2 fingers etc). This is accompanied by relaxation exercises to counter the tensing which comes with vaginismus. In addition, often new thought patterns will be introduced. Most commonly the relaxation and new thoughts are taught in a session with a hypnotherapist or Cognitive behavioral therapist and then put into practice in private at home. Success rates are extremely high. With one study (Jeng et al 2006) finding that 83.3% of the participants were having regular intercourse with orgasm at one year follow up. Many studies of desensitization for vagnismus report 100% of participants achieve full intercourse at or before the completion of the study (Biswas & Ratnam 1995, ter Kuile et al 2007, Reamy 1982).

4)    Surgery

Hymenectomy, the surgical removal of tissue which partially or full obstructs the vagina, may at first appear to be a sensible treatment option for vaginismus. However, this is based on idea that penetration is likely to cause traumatic rupturing of the hymen, which is a common belief, but it may be that the belief is causing the symptom more frequently than the symptom causes the belief (Ward & Ogden 1994). Evidence suggests that for vaginismus hymenectomy is mostly ineffective (Katz & Tabisel 2001). Doubtless, for a small number of women surgery will be the right option, but for most there are easeir and safer options.

5)    Botox

Botox for vaginismus involves the injection of a controlled dose of botulinum toxin to freeze the pelvic floor muscles (Pacik 2011). Success rates vary from 75% (Ghazizadeh &, Nikzad  2004) up to 100% (El-Sibai 2000), at completion of therapy, with many studies showing a good retention of benefits at 1 to 2 year follow up (Pacik 2011, Bertolasi et al 2008). However, as with any intervention side effects have been reported including vaginal dryness and stress incontinence (Velayati,, Jahanian Sadatmahalleh,, Ziaei, & Kazemnejad,2019).

 

portraitThe Author

Matt Krouwel is a hypnotherapist in Birmingham who works with a variety of issues including specialisms in psycho-sexual disorders, including vaginismus and  Erectile dysfunction.

 

References

Bertolasi, L., Frasson, E., & Graziottin, A. (2008). Botulinum toxin treatment of pelvic floor disorders and genital pain in women. Current Women’s Health Reviews, 4(3), 180-187

Biswas, A., & Ratnam, S. S. (1995). Vaginismus and outcome of treatment. Annals of the Academy of Medicine, Singapore, 24(5), 755.

El-Sibai, A. S. O. (2000). Vaginismus: results of treatment with botulin toxin. Journal of Obstetrics & Gynecology, 20(3), 300-302.

Hawton, K., & Catalan, J. (1990). Sex therapy for vaginismus: characteristics of couples and treatment outcome. Sexual and marital therapy, 5(1), 39-48.

Ghazizadeh S, Nikzad M (2004) Botulinum toxin in the treatment of refractory vaginismus. Obstet Gynecol. 2004 Nov;104(5 Pt 1):922-5.

Jeng, C. J., Wang, L. R., Chou, C. S., Shen, J., & Tzeng, C. R. (2006). Management and outcome of primary vaginismus. Journal of sex & marital therapy, 32(5), 379-387.

Katz, D., & Tabisel, R. L. (2001). Is surgery the answer to vaginismus?. Obstetrics & Gynecology, 97(4), S27

Kokate, V. A., & Bulbuli, A. (2025). Effect of Pelvic Floor Rehabilitation in Women with Primary Vaginismus: A Clinical Trial. Journal of South Asian Federation of Obstetrics and Gynaecology, 17(4), 475-480.

Munasinghe, T., Goonaratna, C., & de Silva, P. (2004). Couple characteristics and outcome of therapy in vaginismus. Ceylon Medical Journal, 49(2), 54-57.

Pacik, P. T. (2011). Vaginismus: review of current concepts and treatment using botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia. Aesthetic plastic surgery, 35(6), 1160-1164.

Read, S., King, M., & Watson, J. (1997). Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner. Journal of Public Health, 19(4), 387-391.

REAMY, K. (1982). The treatment of vaginismus by the gynecologist: An eclectic approach. Obstetrics & Gynecology, 59(1), 58-62

Reissing, E. D., Armstrong, H. L., & Allen, C. (2013). Pelvic Floor Physical Therapy for Lifelong Vaginismus: A Retrospective Chart Review and Interview Study. Journal of sex & marital therapy, 39(4), 306-320.

Simons, J. S., & Carey, M. P. (2001). Prevalence of sexual dysfunctions: results from a decade of research. Archives of Sexual Behavior, 30(2), 177-219.

ter Kuile, M. M., van Lankveld, J. J., Groot, E. D., Melles, R., Neffs, J., & Zandbergen, M. (2007). Cognitive-behavioral therapy for women with lifelong vaginismus: Process and prognostic factors. Behaviour research and therapy, 45(2), 359-373.

Velayati, A., Jahanian Sadatmahalleh, S., Ziaei, S., & Kazemnejad, A. (2019). Can botox offer help women with vaginismus? A systematic review and meta-analysis. International Journal of Sexual Health, 31(3), 233-243.

Ward, E., & Ogden, J. (1994). Experiencing vaginismus–sufferers beliefs about causes and effects. Sexual and Marital Therapy, 9(1), 33–45. https://doi.org/10.1080/02674659408409565z