(203) A Clinical Case of Combined Treatment of 37 Year Old Woman with Long-Standing and Severe Vaginismus

Introduction Vaginismus is female sexual dysfunction that's considered as a rare disease, and it's defined as a recurrent or persistent involuntary spasm and contraction of the musculature of the outer third of the vagina during the attempt of vaginal penetration in the condition of fear for sexual intercourse. Objective To evaluate effectiveness of a combined multidisciplinary treatment approach, including psychotherapeutic and other interventions. Methods A 37- year-old married woman first came to our center in June 2022 compaining of muscule spasms and cramps in the vaginal, pelvis, hips, abdomen and thighs during penetration, accompanied by severe coitophobia. She had been married for 14 years, during this time there had never been a successful attempt at vaginal penetration. Based on her complaints, she was diagnosed with severe vaginismus. At the initial stage of treatment, she underwent a physical examination by a gynecologist, who confirmed severe vaginismus, which was evident in her severe tension and fear even when the gynecologist touched her lightly. She was also subjected to psychodiagnostic testing by clinical psychologist, after which generalized anxiety disorder and depression were identified. Due to her severe emotional background, she was referred to our clinic's psychiatrist, who prescribed her combined treatment with a sexologist. Complex and combined treatment of vaginismus included: 1. Conservative therapy by selective serotonin reuptake inhibitors, as well as local procedures (hot baths in the pelvic area and vaginal suppositories with hyaluronidase). 2 Psycho therapeutic intervention by "Sensitive focus" method with the modification of Porf. Z. Marshania. Results After 5 months of treatment, the patient was able to resume regular sexual intercourse and got pregnant after 3 months from treatment. During the treatment, she was periodically examined by a gynecologist who could also confirm the reduction in her vaginal spasms. She was also regularly interviewed by a psychiatrist and a sexologist. After successfully administering prescribed medications and local procedures, the patient's psychoemotional state improved significantly, spasms and tension were relieved, and she was able to have sexual intercourse. After she began having regular sexual intercourse (2-3 times a week) with her husband without complications, the sexologist gradually removed medication. Today she already has perfect sex and has a child, she has been waiting for many years. Conclusions Although severe vaginismus is difficult to treat, especially when there have been unsuccessful attempts for so long and there is also a concomitant depressive state. The patient's patience, the correct implementation of the treatment by the sexologist and his colleagues, allowed the patient to overcome vaginismus even extremely long-standing (13 years), and severe vaginismus complicated with generalized anxiety disorder and depression. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: LTD Prof. Zurab Marshania