(196) Assessing Treatment Outcome of Primary Vaginismus Using Vaginal Dilators Among Women in Saudi Arabia
Authors: Gari R , Alyafi M , Gadi R , Abu Alsaud R 
Published: May 2023

Abstract

Introduction
Vaginismus is a pain disorder in which it is difficult to achieve vaginal penetration due to involuntary vaginal muscle spasms. It can occur during intercourse, vaginal examination, or insertion of a menstrual cup or tampon. Risk factors include family history, negative sex views, and cultural influences such as the value placed on the hymen. Moreover, fear of pain, injury, bleeding, and losing control can play a role in the development of vaginismus. Women with vaginismus are primarily treated with gradual desensitization to penetration using vaginal dilators. However, studies that record therapy duration and success are lacking the literature.

Objective
This study aims to assess the success rate of gradual exposure therapy to penetration using vaginal dilators for the treatment of primary vaginismus.

Methods
Women diagnosed with primary vaginismus between August 1st, 2019, and December 31st, 2021 at a tertiary care center in Jeddah, Saudi Arabia were included in this study. Those under 18 and those who did not use vaginal dilators were excluded. The primary investigator collected data by contacting participants over the phone to fill out a validated questionnaire, including questions from Female Sexual Function Index (FSFI) and Pain Anxiety Symptom Scale Short Form 20 (PASS-20). We project a total number of 50 participants at the end of the recruitment period by August 31, 2022. Data is collected on paper and entered into STATA 17. Demographic data included age, duration of the marriage, presence of romantic relationship prior to marriage, and education level. Our primary outcome is the degree of treatment success according to pain level and frequency scores during and after intercourse.

Results
The sample included 16 eligible patients. The mean age was 28.9 years (SD +/− 3.6). Almost all participants had a bachelor's degree or higher. 70% were married for two years or less with about 37% who were married for one year or less. 70% reported having a romantic relationship before marriage. We excluded 4 patients from further analysis who had never used vaginal dilators before. 33% of those who used vaginal dilators did not report any pain during or after intercourse. Only 37.5% of those who reported pain during or after sexual intercourse stated that the pain prevented them from having sexual intercourse. Among women who had sexual intercourse, 63% suffered moderate to a very high level of pain during intercourse and 25% experienced low to moderate pain after intercourse most of the time. Approximately 83% reported treatment success with vaginal dilators, while only 17% reported no success. The largest dilator size used was 6 (27%), and the most used plastic ones (50%). About 58% preferred conducting dilation therapy sessions at home instead of the clinic.

Conclusions
According to our findings, more than 80% reported success with vaginal dilators for treating primary vaginismus despite still experiencing pain during or after intercourse. Interestingly more than half of the patients preferred doing exercises at home, contradicting previous studies pointing out that one session with the therapist can predict higher success in treating vaginismus.

Disclosure
No