An internet-based guided self-help intervention for vaginismus. Results of a randomised controlled proof-of-concept trial

Abstract

Background: Difficulties with desired vaginal penetration during intercourse pose a huge burden for women with vaginismus. Vaginismus is associated with low sexual functioning, reduced sexual behaviours, low sexual satisfaction, a negative self-image and relationship to partners. To date, only few treatments addressing this issue have been evaluated. The aim was to assess the effectiveness of a guided self-help Internet-intervention for vaginismus compared to a waitlist control condition in a randomised controlled superiority trial. Methods: 77 women with severe vaginismus were randomly allocated to the intervention or waiting condition. The intervention comprised 10 modules based on psychoeducation, relaxation exercises, self-exploration, sensate focus and gradual exposure. Guidance consisted of feedback on completed modules. Assessments took place prior to randomisation, at 10-week and 6-month-follow-up. The primary outcome was sexual intercourse. Secondary outcomes were fear of sexuality, female sexual functioning and dyadic coping. Results: In the ability to have sexual intercourse, no significant differences were found between groups (F=0.16, p=.69; F=0.07, p=.79). The intervention group showed higher noncoital penetration abilities at both time points compared to the control group (d=0.30, CI:-0.26-0.86 - d=0.64, CI: 0.07-1.20). Within the intervention group, a significant reduction in coital fear and dyadic coping between pre- and post-measurements was found (d=0.26, CI:-0.40-0.91 - d=0.56, CI: -0.29-1.42). Discussion: This first randomised controlled trial evaluating the efficacy of an Internet-intervention for vaginismus shows the potential usefulness of low-threshold self-help interventions in treatment of vaginismus. Recommendation of action for interventions on the new DSM-5 diagnosis genito-pelvic pain / penetration disorder could be derived.