The first RCT of cognitive-behavioral treatment of lifelong vaginismus, testing the most often described intervention package, was only published in 2006. The rate of successful intercourse in this study was unexpectedly low (ITT: 14%), but the investigation yielded important suggestions for follow-up research, including a stronger emphasis in treatment on targeting fear of penetration and avoidance of penetration-related behavior.
A theoretical shift was made from viewing lifelong vaginismus as a sexual dysfunction to viewing it as a specific phobia for vaginal penetration. In subsequent research, this theoretical focus was investigated by limiting therapy to what was considered to be core elements of the maintenance of lifelong vaginismus: fear of penetration and behavioral avoidance of penetration. Therapist-assisted, massed exposure to penetration-related stimuli was chosen to target these etiological elements. This intervention was first evaluated in an uncontrolled study. Ten women with lifelong vaginismus were treated with therapist-assisted, massed exposure in a patient-as-own-control replicated n = 1 study. Subsequently an RCT was conducted among 70 women and their partners.
Participants were randomly allocated to exposure or a waiting-list control period of 12 weeks. The main outcome measure (intercourse ability) was assessed daily during 12 weeks. The exposure treatment consisted of a maximum of three 2-hour sessions during one week. Treatment was delivered at a university hospital outpatient clinic. The participant performed vaginal penetration exercises on herself, in the presence of her partner and a female therapist. Two follow-up sessions were scheduled over a 5-week period. Thirty-one out of 35 (89%) treated women had successfully had sexual intercourse at post treatment compared to 4 out of 35 (11%) of waiting-list control women. In 90% of the cases intercourse was achieved within the first two weeks of treatment. Next to successful vaginal penetration, treatment yielded clinical improvement in terms of lower dyspareunia complaints, decreased coital fear and lower sexual distress. Other aspects of sexual functioning in women or their partners were not affected.
