Evaluation of Treatment Research
Vaginismus has traditionally been considered as an easily treatable sexual dysfunction. The elevated success rates, reported in the literature must, however, be considered in light of uncontrolled designs, small sample sizes, elevated or unreported drop-out rates, which are not evaluated with intent-to-treat statistics, as well as a lack of long-term follow-up data. In fact, the only randomized controlled treatment trial does not support the notion that vaginismus is an easily treatable condition.
A basic issue in treatment evaluation is how a successful treatment outcome is defined. The great majority of studies have defined success as the ability to achieve vaginal penetration through sexual intercourse. While successful penetration is clearly a crucial first step, if it is not accompanied by pleasurable feelings, then treatment success is questionable. For instance, Schnyder et al. found that although 98% of the women in their sample were able to have intercourse by the end of treatment with vaginal dilators, 50% were still experiencing pain during penetration. Similarly, although nine out of ten participants in the Ter Kuile et al. fear reduction study were able to experience penetration, none of the measures of sexual enjoyment or pleasure significantly improved. While it appears that high success rates in vaginal penetration may soon be achievable, the therapeutic challenge of increasing vaginismic women's pleasure has not even been approximated.
Women's Health. 2010;6(5):705-719. © 2010
Future Medicine Ltd.