The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review.

BACKGROUND: There is low social awareness of vaginismus despite it being a relatively common female sexual dysfunction that makes vaginal penetration painful, difficult, and/or impossible. While existing literature on vaginismus has had a clinical focus on the affected genitalia, there is a lack of research on women's help-seeking experiences of vaginismus from their perspective. OBJECTIVES: This integrative review's objective was to explore: women's help-seeking experiences of vaginismus, and how such help-seeking experiences impact their sense of self. DESIGN: Cooper's five-step integrative review approach was followed to develop a research question, a search strategy, selection criteria, and data evaluation, analysis, and presentation. DATA SOURCES AND METHODS: A systematic search of the literature was completed in the following seven databases in January 2023: PsycINFO, ProQuest Central, PubMed, Scopus, CINAHL, Cochrane, and Embase. Out of the 373 articles found through database searches and additional citation searching, 22 studies were included in this review for meeting the eligibility criteria of having an empirical design, being written in English, and examining women's help-seeking experiences for vaginismus and its impact on their sense of self. RESULTS: Thematic analysis was used to summarize the findings from the included studies which were informed by 1671 participants. Help-Seeking Process, Medical Management, Help-Seeking and Sense of Self, and Holistic Care Recommendations from the Findings emerged as four major themes with corresponding subthemes. CONCLUSION: This review indicates that women continue to face difficulties in seeking and receiving help for vaginismus even through the healthcare system. However, the studies did not explicitly discuss how women's help-seeking for vaginismus impacted their sense of self. This highlights an epistemological gap on how women's help-seeking for their vaginismus impacts their sense of self, which can affect their treatment responses. Recommendations are provided for future healthcare and research to improve health outcomes for women with vaginismus.

The effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment: a randomized controlled study.

INTRODUCTION AND HYPOTHESIS: The purpose of this study is to determine the effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment. METHODS: A total of 34 women at the vaginismus treatment stage, including 17 in the experiment group and 17 in the control group, were included in the study with a randomized controlled design. In addition to the routine treatment protocol, women in the experiment group were provided with pelvic relaxation and sexual counseling based on the Information, Motivation, Behavior (IMB) model consisting of four sessions. The control group received the routine treatment protocol. The assessments were made at the 3rd week and 2nd month after coitus. The women filled out an Information Form, the validated Female Sexual Function Index (FSFI), and the Vaginal Penetration Cognition Questionnaire (VPCQ). RESULTS: The mean age of the women was 27.59±5.32, and their mean duration of marriage/relationship was 33.44±12.11 months. After the treatment statistically significant increases were observed in the total FSFI scores and the desire, arousal, and pain dimension scores of the experiment group in comparison with the control group (p<0.05). In the VPCQ total scores, there was a significant reduction in the experiment group in comparison with the control group and after the treatment in comparison with before the treatment (p<0.01). CONCLUSIONS: The sexual counseling based on the IMB model and pelvic relaxation interventions provided to the women who were receiving vaginismus treatment affected their sexual function positively. It may be recommended to conduct comparative studies with a broader sample and different models.

Female sexual dysfunction: A potential minefield.

Female sexual dysfunction (FSD) is a much-neglected aspect of feminine health, especially in patriarchal cultures. We collated data from pertinent published literature on FSD to explore the types, associations, and best possible approach to FSD in the Indian context. We fed search words "female sexual dysfunction," "sexual health," "India," into medical search engines such as PubMed, Google Scholar, Clinical Key, ProQuest, SciVal for locating pertinent articles from which data was synthesized and extracted. Female sexual response is complex and is influenced by physiological, behavioral, social, and cultural factors. The latest Diagnostic and Statistical Manual of Mental Disorders-5 criteria classified FSD into female sexual interest/arousal disorder, female orgasmic disorder and genito-pelvic pain/penetration disorder, along with categories common to both genders like substance/drug induced and other unspecified subsets. Diagnosis requires detailed and specific history taking and clinical evaluation to rule out comorbidities. Treatment is multifaceted and prolonged, involving pharmacological, psychological, and behavioral therapy in both partners. Almost all Indian studies in this field have small sample sizes and none of the studies focused on FSD as the primary complaint. FSD is still an unexplored field of Indian medicine. Although newer treatment options and techniques are being explored, there is much to achieve. We need to develop culturally suitable questionnaires taking into account the Indian female psyche. Management should be holistic and involve focused liaison clinics, including dermatology, gynecology, psychiatry, clinical psychology, and urology specialties.

Determination of Dyadic Adjustment, Marriage and Sexual Satisfaction as Risk Factors for Women with Lifelong Vaginismus: A Case Control Study.

This study was conducted to assess dyadic adjustment, marriage, and sexual satisfaction as risk factors for women with lifelong vaginismus. This is a case-control study. A total of 142 women were included in the study: 71 women with a diagnosis of lifetime vaginismus constituted the study group and 71 women without a history of vaginismus/painful sexual activity constituted the control group. Data were collected using a questionnaire and the Revised Dyadic Adjustment Scale (RDAS), the Marriage Satisfaction Scale (MSS), and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Duration of marriage (OR = 1.344), frequency of sexual intercourse (OR = 0.059), marital satisfaction (OR = 1.450), sexual satisfaction (OR = 0.901), and consensus (OR = 1.749), which is a sub-dimension of RDAS, were found to be risk factors increasing likelihood of vaginismus by 83% (χ2 = 140.191, p < .001). In addition, those with low level of education, diagnosed with a psychological disorder (anxiety, depression, etc.), who found their spouse's body disgusting, who scored lower in MAS sub-dimensions, and who received lower total score in the RDAS and its satisfaction subdimension were more likely to have vaginismus (p < .05). Duration of marriage, sexual intercourse frequency, sexual satisfaction, marital satisfaction, and consensus are important risk factors for vaginismus. It may be incomplete to consider vaginismus only as a vaginal penetration problem. Women's demographic characteristics, dyadic adjustment, and marital and sexual satisfaction should be handled in a holistic manner.

A importância da intervenção fisioterapêutica no vaginismo: uma revisão sistemática / The importance of physiotherapeutic intervention in vaginism: a systematic review

Objetivo: Descrever a importância da intervenção fisioterapêutica para mulheres com vaginismo. Fonte de dados: Foram utilizadas as bases de dados SciELO, PubMed, Biblioteca Virtual de Saúde (BVS) e Literatura Cinza, incluindo artigos nacionais e internacionais, sem delimitação temporal. Foram propostas para as buscas as seguintes palavras-chave e operadores boleanos: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], sendo esses posteriormente adequados para as demais bases que foram utilizadas nesta revisão sistemática. Seleção dos estudos: A seleção dos estudos foi realizada por três examinadores independentes. Coleta de dados: Inicialmente foram excluídos estudos com base no título, em seguida os resumos foram analisados e, dos 353 artigos encontrados inicialmente, quatro foram elegíveis para esta revisão. Síntese dos dados: Os artigos incluídos descreveram que o tratamento fisioterapêutico é de extrema importância para as mulheres com vaginismo, pois aumenta a força e o controle sobre a musculatura do assoalho pélvico, diminuindo os sintomas do vaginismo e promovendo o incremento da satisfação sexual. Conclusão: A intervenção fisioterapêutica é imprescindível para mulheres que apresentam vaginismo, tendo em vista que suas técnicas têm efetividade na prevenção e tratamento do vaginismo, além de promover melhora importante na qualidade de vida e na satisfação sexual das mulheres.(AU)

Objective: To describe the importance of physical therapy intervention for women with vaginismus. Data source: The SciELO, PubMed, Virtual Health Library (BVS) and Gray Literature databases were used, including national and international articles, without temporal delimitation. The following keywords and Boolean operators were proposed for the searches: [("vaginismus") AND ("physiotherapy" OR "intervention" OR "efficiency")], which were later suitable for the other bases that were used in this systematic review. Study selection: Study selection was performed by three independent examiners. Data collection: Initially, studies were excluded based on the title, then the abstracts were analyzed and of the 353 articles found initially, 4 were eligible for this review. Data synthesis: The articles included described that physical therapy treatment is extremely important for women with vaginismus, as it increases strength and control over the pelvic floor muscles, decreasing the symptoms of vaginismus and promoting increased sexual satisfaction. Conclusion: Physical therapy intervention is essential for women who have vaginismus, considering that its techniques are effective in preventing and treating vaginismus, in addition to promoting an important improvement in women's quality of life and sexual satisfaction.(AU)

A cross-sectional study of traditional Chinese medicine practitioner's knowledge, treatment strategies and integration of practice of chronic pelvic pain in women.

BACKGROUND: Chronic pelvic pain (CPP) in women is persistent, intermittent cyclical and non-cyclical lower abdominal pain, lasting for more than 6 months. Traditional Chinese Medicine (TCM) is a popular treatment option for women's health conditions, but little is known about how treatment for CPP is delivered by TCM practitioners. The aim of this survey was to explore practitioners understanding and treatment of women with CPP, and how they integrate their management and care into the health care system. METHOD: An online cross-sectional survey of registered TCM practitioners in Australia and New Zealand between May and October 2018. Survey domains included treatment characteristics (e.g. frequency), evaluation of treatment efficacy, referral networks, and sources of information that informed clinical decision making. RESULTS: One hundred and twenty-two registered TCM practitioners responded to this survey, 91.7% reported regular treatment of women with CPP. Treatment decisions were most-often guided by a combination of biomedical and TCM diagnosis (77.6%), and once per week was the most common treatment frequency (66.7%) for acupuncture. Meditation (63.7%) and dietary changes (57.8%) were other commonly used approaches to management. The effectiveness of treatment was assessed using multiple approaches, most commonly pain scales, (such as the numeric rating scale) and any change in use of analgesic medications. Limitations to TCM treatment were reported by over three quarters (83.7%) of practitioners, most commonly due to cost (56.5%) and inconvenience (40.2%) rather than safety or lack of efficacy. Sources informing practice were most often Integration within the wider healthcare system was common with over two thirds (67.9%) receiving referrals from health care providers. CONCLUSION: TCM practitioners seeing women with various CPP symptoms, commonly incorporate both traditional and modern diagnostic methods to inform their treatment plan, monitor treatment progress using commonly accepted approaches and measures and often as a part of multidisciplinary healthcare for women with CPP.

Investigation of auditory P50 sensory gating with sexual visual stimuli in patients with vaginismus.

OBJECTIVES: The aim of the study was to investigate sensory information processing induced by visual sexual stimuli and to assess its relationship with sexual behaviors and symptoms in patients with vaginismus. METHODS: Twenty-one patients with vaginismus and 20 controls were included in the study. The sociodemographic information and sexual life history of the patients with vaginismus and controls were examined and electrophysiological measurements related to auditory P50 sensory gating were obtained using a double click paradigm during by sexual/horror visual stimulation, which was thought to be related to the pathophysiology of the disease. RESULTS: P50 suppression ratios during visual sexual stimuli were lower in vaginismus group compared to the control group. There was no difference in P50 suppression ratios during visual horror stimuli when the two groups were compared. The P50 suppression of the vaginismus group with visual sexual stimuli was found to be lower than P50 suppression with visual horror stimuli. A positive moderate correlation was found between the duration of foreplay and P50 suppression ratio during visual sexual stimuli in vaginismus group. CONCLUSION: Our study revealed that patients with vaginismus had sensory gating impairment during visual sexual stimuli. Increase in the duration of foreplay in vaginismus patients may improve sensory gating impairment by affecting sensory gating functions.

Myofascial Pelvic Pain: An Overlooked and Treatable Cause of Chronic Pelvic Pain.

Myofascial pelvic pain is a common, nonarticular musculoskeletal disorder characterized by the presence of myofascial trigger points in the lower abdominal wall and/or pelvic floor muscles. Myofascial pelvic pain is involved in an estimated 22% to 94% of cases of chronic pelvic pain, which is one of the most common gynecologic conditions in the United States. Myofascial pelvic pain may exist independently or in conjunction with disorders such as vaginismus, dysmenorrhea, and endometriosis and is frequently a causative factor in sexual pain or dyspareunia. This article reviews the pathophysiology, assessment, and treatment options for myofascial pelvic pain, with a particular focus on trigger point injections. Increased recognition and treatment of this commonly overlooked diagnosis has the potential to improve care and outcomes for many patients suffering from chronic pelvic pain.

The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients.

INTRODUCTION: The assessment of pelvic floor muscle (PFM) overactivity is part of a comprehensive evaluation including a detailed history (medical, gynecological history/antecedent), appraisal of the psychosocial contexts of the patient, as well as a musculoskeletal and a neurological examination. OBJECTIVES: The aims of this article are to review (i) the assessment modalities evaluating pelvic floor function in women and men with disorders associated with an overactive pelvic floor (OPF), and (ii) therapeutic approaches to address OPF, with particular emphases on sexual pain and function. METHODS: We outline assessment tools that evaluate psychological and cognitive states. We then review the assessment techniques to evaluate PFM involvement including digital palpation, electromyography, manometry, ultrasonography, and dynamometry, including an overview of the indications, efficacy, advantages, and limitations of each instrument. We consider each instrument's utility in research and in clinical settings. We next review the evidence for medical, physiotherapy, and psychological interventions for OPF-related conditions. RESULTS: Research using these assessment techniques consistently points to findings of high PFM tone among women and men reporting disorders associated with OPF. While higher levels of evidence are needed, options for medical treatment include diazepam suppositories, botulinum toxin A, and other muscle relaxants. Effective psychological therapies include cognitive behavioral therapy, couple therapy, mindfulness, and educational interventions. Effective physiotherapy approaches include PFM exercise with biofeedback, electrotherapy, manual therapy, and the use of dilators. Multimodal approaches have demonstrated efficacy in reducing pain, normalizing PFM tone, and improving sexual function. Multidisciplinary interventions and an integrative approach to the assessment and management of OPF using a biopsychosocial framework are discussed. CONCLUSION: Although the efficacy of various intervention approaches has been demonstrated, further studies are needed to personalize interventions according to a thorough assessment and determine the optimal combination of psychological, physical, and behavioral modalities. Padoa A, McLean, L, Morin M, et al. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients. Sex Med 2021;9:76-92.

Botulinum injections for myofascial pelvic pain.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to assess the impact of botulinum toxin injection in women with myofascial pelvic pain (MFPP) syndrome of the pelvic floor who had failed conservative treatment. METHODS: This was a retrospective descriptive observational study of 48 consecutive patients receiving botulinum toxin to the pelvic floor for MFPP syndrome in a tertiary teaching hospital over an 8-year period. Trigger points were identified, and botulinum toxin was injected into the pelvic floor at the trigger points in doses ranging from 50 to 200 units. The patient-reported global impression of improvement scale was used to evaluate the success at follow-up, and adverse effects were recorded. RESULTS: Forty-six women attended for follow-up at 3-6 months. Of these, 34 (74%) reported an improvement in their symptoms (slightly better, much better, very much better), 12 (26%) had no change, and no patients reported worsening of symptoms. One patient (2%) reported transient postoperative faecal incontinence, which resolved after 2 weeks. There appeared to be no difference in outcome between the doses. CONCLUSIONS: Botulinum toxin injection into the pelvic floor of women with MFPP appears to be beneficial in those who have failed conservative treatment. Prospective studies, including dose-finding studies, are now required.

Physiotherapeutic resources in vaginismus / Recursos fisioterapêuticos no vaginismo

Vaginismus consists of involuntary spasms in the external musculature of the vagina, the etiology of which is still unknown, but there are cases of biopsychosocial factors such as sexual abuse, strict sex, education, emotional trauma, religious beliefs, low-quality sexual relations, fear of sex, or even changes of ostemioarticular origin, can lead to this condition, making vaginal penetration impossible during sexual intercourse, gynecological exams or use of tampons. Objective: To highlight as physical therapy practices, their validation for the treatment of vaginismus and to verify the effectiveness of the analyzed practices. Methods: Systematic literature review carried out through digital bibliographic research on scientific articles published in electronic and electronic journals, randomized clinical trials, with no period between the years 2010 to 2020, in the electronic databases PubMed, Bireme and PEDro. Results: There was no great variability in the resources used and the studies showed positive and similar results. Conclusion: Physical therapy proved to be beneficial for cases of vaginismus, with the use of functional electrical stimulation (FES) in an analogue way, pelvic floor muscle relaxation exercises, local desensitization performed with vaginal dilator and massage. However, more research is needed, considering the moderate methodological scores found in the studies analyzed. (AU)

Vaginismo consiste em espasmos involuntários na musculatura do terço externo da vagina, com etiologia ainda desconhecida, mas há evidências de que fatores biopsicossociais como abuso sexual, sexo estrito, educação, trauma emocional, crenças religiosas, relações sexuais de baixa qualidade, medo do sexo, ou mesmo alterações de origem osteomioarticular, podem acarretar nesta condição, impossibilitando a penetração vaginal em relações sexuais, exames ginecológicos ou no uso de absorventes internos. Objetivo: Evidenciar as práticas fisioterapêuticas, sua validação para o tratamento do vaginismo e verificar a eficácia das práticas analisadas. Material e métodos: Revisão sistemática de literatura realizada através de busca bibliográfica digital em artigos científicos publicados em revistas impressas e eletrônicas, ensaios clínicos randomizados, no período compreendido entre os anos de 2010 a março de 2020, nas bases de dados eletrônicas Pubmed, Bireme e Pedro. Resultados: Não houve grande variabilidade dos recursos utilizados e os estudos apresentaram resultados positivos e semelhantes. Conclusão: A fisioterapia mostrou-se benéfica para os casos de vaginismo, com a utilização de estimulação elétrica funcional (FES) de forma analgésica, exercícios de relaxamento da musculatura do assoalho pélvico, dessensibilização local realizada com dilatador vaginal e massagem. No entanto, mais pesquisas são necessárias, tendo em vista os escores metodológicos moderados encontrados nos estudos analisados. (AU)

Comparing the effectiveness of functional electrical stimulation via sexual cognitive/behavioral therapy of pelvic floor muscles versus local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus: a randomized clinical trial.

INTRODUCTION AND HYPOTHESIS: Most patients suffering from vaginismus feel sinful, anxious, and incompetent, with reduced self-confidence. This study was aimed at comparing the effectiveness of the physiotherapy of pelvic floor muscles as a standard treatment and local injection of botulinum toxin on the sexual functioning of patients with primary vaginismus. METHODS: In this randomized clinical trial (RCT), the study population included women with primary vaginismus referred to the Sexual Health and Gynecologic Clinics of Imam Khomeini Hospital during 2013-2014. They were diagnosed according to DSM-5 criteria and underwent treatments with botulinum injection (intervention group) and physiotherapy as the current treatment (control group). The participants' primary and secondary outcomes were measured based on successful intercourse and sexual functioning of each group. RESULTS: The results indicated that the overall standard physiotherapy, along with other measurements, such as functional electrical stimulation and desensitization, could effectively improve the patients' Female Sexual Function Index compared with botulinum treatment. At the end of the study, it was found that 20 and 26 patients out of the 30 and 28 patients in the intervention and control groups managed to have successful intercourse respectively (P = 0.014). Also, sexual dysfunction frequencies were seen to be decreased by 26.6% and 50% in the mentioned groups respectively (p = 0.008 and p < 0.001). CONCLUSIONS: Considering the higher efficacy of physiotherapy procedures compared with those of the desensitization and electrical stimulation techniques, this therapeutic method should be considered the first-line treatment of vaginismus (IRCT2016061828486N1).

Atuação da fisioterapia nas disfunções sexuais / Performance of physiotherapy in sexual dysfunctions

As disfunções sexuais femininas (DSFs) são consideradas um problema de saúde pública pela Organização Mundial da Saúde (OMS). A disfunção sexual na mulher pode influenciar sua saúde física e mental. Dentre os transtornos sexuais femininos, os mais evidentes são vaginismo edispareunia. O vaginismo é a dificuldade de relaxamento da musculatura vaginal no momento da relação, e a dispareunia é definida como dor recorrente ou persistente associada à relação sexual. Assim, o objetivo desta revisão foi identificar as principais disfunções sexuais e verificar as intervenções da fisioterapia nas mesmas por meio de uma revisão da literatura. Foram encontrados artigos científicos nos idiomas inglês, português e espanhol, nas bases de dados Scielo e Pubmed. Os artigos analisados relatam o impacto negativo na vida das mulheres e mostram que a fisioterapia possui inúmeras técnicas para o tratamento dessas disfunções. Na busca inicial para a realização desta revisão integrativa, foram encontradas 28 publicações nas bases de dados Scielo e Pubmed. A maioria dos estudos analisados nesta revisão mostrou que a fisioterapia tem contribuído significantemente para a melhora da função sexual nas mulheres Os recursos utilizados pela Fisioterapia são: Cinesioterapia, Eletroestimulação, Ginástica Hipopressiva, Biofeedback, Cones Vaginais e Terapia Manual. A não padronização dos tratamentos dificulta concluir a melhor terapia, porém todos os estudos apresentaram melhora ou cura dos sintomas associados às disfunções sexuais, demonstrando os benefícios da fisioterapia.(AU)

Female sexual dysfunction (FSD) is considered a public health issue by the World Health Organization (WHO). Sexual dysfunction in women can influence their physical and mental health. Among the female sexual disorders, vaginismus and dyspareunia are the most evident. Vaginismus is the difficulty in relaxing the vaginal muscles during sexual relations and dyspareunia is defined as a persistent or recurrent pain associated with sexual intercourse. The purpose of this review was to verify the effectiveness of physical therapy treatments in female sexual dysfunction, through an literature review. The databases searched were PubMed and SciELO. 28 studies were found in English, Portuguese and Spanish. The analyzed articles report the negative impact of sexual dysfunction in women's lives and show that physical therapy has numerous techniques for treating such disorders. Most of the analyzed studies show a significant contribution of physical therapy to improve sexual function in women through resources such as kinesiotherapy, electrostimulation, hypopressive exercises, biofeedback, vaginal cones and manual therapy. The lack of standardization of treatments makes it difficult to conclude what the best therapy in the treatment of female sexual dysfunction is. However, all studies showed improvement or cure of the symptoms associated with sexual dysfunction, demonstrating the benefits of physical therapy in this condition.(AU)

Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve / Terapêutica multimodal do vaginismo: abordagem inovadora por meio de infiltração de pontos gatilho e radiofrequência pulsada do nervo pudendo

Abstract Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen.

Resumo O vaginismo é uma doença pouco compreendida que se caracteriza por uma contração muscular involuntária dos músculos do pavimento pélvico e do terço externo da vagina durante as tentativas de intercurso sexual, o que resulta em aversão à penetração. Estima-se que possa afetar entre 1%-7% da população feminina mundial. Com este relato os autores pretendem apresentar o caso de uma paciente jovem com vaginismo na qual foram usadas técnicas habitualmente do domínio da medicina da dor crônica como parte do seu esquema terapêutico multimodal.

Diagnosis and treatment of unconsummated marriage in an Iranian couple.

BACKGROUND: Unconsummated marriage is a problem among couples who would not be able to perform natural sexual intercourse and vaginal penetration. This disorder is more common in developing countries and sometimes couples would come up with non-technical and non-scientific methods to overcome their problem. Multi-dimensional approach and narrative exposure therapy used in this case. METHODS: This study would report a case of unconsummated marriage between a couple after 6 years. The main problem of this couple was vaginismus and post-traumatic stress. RESULTS: Treatment with multi-dimensional approach for this couple included methods like narrative exposure therapy, educating the anatomy of female and male reproductive system, correcting misconceptions, educating foreplay, educating body exploring and non-sexual and sexual massage and penetrating the vagina first by women finger and then men's after relaxation. The entire stages of the treatment lasted for four sessions and at the one-month follow-up couple's satisfaction was desirable. CONCLUSION: Unconsummated marriage is one of the main sexual problems; it is more common in developing countries than developed countries and cultural factors are effective on intensifying this disorder. The use of multi-dimensional approach in this study led to expedite diagnosis and treatment of vaginismus.

[Multimodal therapeutic approach of vaginismus: an innovative approach through trigger point infiltration and pulsed radiofrequency of the pudendal nerve]. / Terapêutica multimodal do vaginismo: abordagem inovadora por meio de infiltração de pontos gatilho e radiofrequência pulsada do nervo pudendo.

Vaginismus is a poorly understood disorder, characterized by an involuntary muscular spasm of the pelvic floor muscles and outer third of the vagina during intercourse attempt, which results in aversion to penetration. It is reported to affect 1-7% of women worldwide. With this report the authors aim to describe the case of a young patient with vaginismus in whom techniques usually from the chronic pain domain were used as part of her multimodal therapeutic regimen.

A fisioterapia pélvica no tratamento de mulheres portadoras de vaginismo / The pelvic-floor physical therapy for the treatment of woman suffering from vaginismus

O vaginismo é uma desordem sexual caracterizada por espasmos involuntários persistentes ou recorrentes da musculatura perineal e que interferem na relação sexual, levando ao comprometimento das relações interpessoais e conjugais da mulher. A fisioterapia é um recurso terapêutico recente na área da urologia e ginecologia e ainda são raros os estudos os quais abordam este tratamento para o vaginismo. Por causa disso, objetivou-se pesquisar a importância da fisioterapia pélvica e os recursos utilizados no tratamento de mulheres portadoras de vaginismo. Foi realizada uma revisão bibliográfica, tendo como base de dados Lilacs, PubMed e SciELO e incluindo teses, documentos legais e livros sobre o tema, entre os anos de 2001 e 2014. Quanto ao manejo da problemática, o fisioterapeuta se encontra preparado para abordar e tratar a queixa, pois é envolto de vários recursos e técnicas para compreender e abordar o vaginismo, ressaltando a importância do diagnóstico e de uma avaliação completa. Concluiu-se que a fisioterapia pélvica promove efeito significativo sobre a qualidade de vida e satisfação sexual de mulheres portadoras dessa desordem sexual.

Vaginismus is a sexual disorder characterized by persistent or recurrent involuntary spasms of the perineal muscles that interfere with sexual intercourse, leading to impairment of marital and interpersonal relationships of women. Physical therapy is a new therapeutic approach in the field of urology and gynecology and, as yet, there are relatively few studies addressing the treatment for this sexual dysfunction. As a result, the objective of this study was to discuss about the importance of physical therapy for pelvic floor disorders and also to examine the resources used in the treatment of women with vaginismus. It was held a review of articles in the databases Lilacs, PubMed and SciELO, published between 2001 and 2014; in addition to theses, legal documents and books that address the issue. The results show that concerning the management of this disturbance, the physiotherapist is prepared to address and treat this complaint. It was also found that the practitioner is surrounded by multiple resources and techniques to understand and address the vaginismus, to carry out the diagnosis as well as the assessment process. To sum up, it was concluded that the pelvic-floor physical therapy promotes significant effect on the quality of life and on the sexual satisfaction of women with this dysfunction.

Vaginismo / Vaginismus

Vaginismo é condição clínica rara em que a penetração vaginal, seja pelo ato sexual, espéculo ginecológico ou outro objeto, é impedida. Associa-se a multiplicidade de fatores que incluem condições sociais, psicológicas, psiquiátricas, ginecológicas, psicanalíticas e sexológicas. Sua etiologia está ligada, principalmente, a traumas sexuais e educação sexual rígida, embora nem sempre essas associações possam ser feitas. É assunto sobre o qual existe grande desconhecimento, inclusive pelos médicos, o que torna sua abordagem difícil, muitas vezes iatrogênica. O tratamento inclui técnicas de psicoterapia cognitiva e comportamental, tratamento médico com ansiolíticos e anestésicos tópicos, além de uso de vasodilatadores vaginais. Tratamentos com base em fisioterapia por eletroestimulação vaginal e injeções vaginais de neurotoxina botulínica têm sido propostos, ainda sem evidência científica que os autorize. Esta revisão discute conceitos e tratamentos do vaginismo.

Vaginismus is a rare clinical condition that prevents vaginal penetration, either during the sexual act, or by a gynecological speculum or any other object. It is associated to multiple factors including social, psychological, psychiatric, gynecological, psychoanalytical, and sexual conditions. Its etiology is mainly linked to sexual traumas and rigid sexual education,even though this kind of association is not always traceable. Knowledge about the subject is extremely limited, even among physicians. This is a difficult topic to approach, sometimes requiring iatrogenic approaches. Its treatment includes cognitive and behavioral psychotherapy, medical treatment with anxiolytics and topic anesthetics, as well as use of vaginal vasodilators. Treatment methods based on physical therapy by vaginal electrostimulation and vaginal injections of botulinum neurotoxin have been proposed, although no scientific evidence currently evidently supports their use. This review discusses concepts and treatment methods for vaginismus.