A cognitive behavioural treatment model of vaginismus

Vaginismus is an idle research field in which studies with a good methodological approach are rare. Success rates of 80 per cent are claimed, irrespective of the type of treatment applied. Most commonly, some kind of behavioural therapy is used, e.g. systematic desensitization. The present article reports on a cognitive behavioural model for the assessment and treatment of patients with vaginismus. The main features of the treatment model are exposure to the phobic situation and systematic desensitization according to an individual hierarchy of anxiety-provoking situations. The presented model comprises three novel components: use of the pelvic examination situation in therapy, teaching the patient to train with her own fingers instead of with the use of instrumental “dilators” and the application of a newly constructed scale (Vaginismus Behaviour Scale, VABESC). The VABESC measures phobic responses in the penetration situation and therefore offers the therapist a useful tool by which to survey the progress of the therapy. The model and the scale are illustrated and described in detail in a case report which includes a one-and-a-half-year follow-up of a woman successfully treated for primary vaginismus.