Effectiveness of Internet-Based Cognitive-Behavioral Therapy in Iranian Women with Vaginismus: A Randomized Controlled Trial

Background Vaginismus can substantially affect sexual and relationship well-being, yet evidence regarding internet-based interventions remains limited, particularly in non-Western settings. This study evaluated a culturally adapted, therapist-supported internet-based cognitive-behavioral therapy (CBT) program for Iranian women with primary vaginismus.Methods In this randomized controlled trial, 40 women with primary vaginismus were randomly assigned to an intervention or waitlist control group (n = 20 each). The intervention group received eight sessions of internet-based CBT. Outcomes were assessed at baseline, immediately post-treatment, and at 4-week follow-up. The primary outcome was successful vaginal (coital) penetration assessed by item 1 of the Penetration Behavior Questionnaire (PBQ). Secondary outcomes were Successful Non-Coital Penetration (SNCP), catastrophic thoughts, and pelvic-floor tightening. Per-protocol analyses included 17 intervention and 20 control participants.Results Successful vaginal penetration was reported by 12/17 intervention participants (70.6%) versus 0/20 controls immediately post-treatment (risk difference, 70.6 percentage points; 95% CI, 41.9–86.7; P < .001), and by 14/17 (82.4%) versus 0/20 at 4-week follow-up (risk difference, 82.4 percentage points; 95% CI, 54.0–93.8; P < .001). Median SNCP improvement was 4 points in the intervention group versus 0 in controls at both assessments (Holm-adjusted P < .001 and P = .006, respectively). Improvements in catastrophic thoughts and pelvic-floor tightening were also greater in the intervention group at both assessments (both Holm-adjusted P < .001).Conclusion Therapist-supported internet-based CBT was associated with improved short-term penetration outcomes and reductions in catastrophic thoughts and pelvic-floor tightening. Further evaluation in larger and more diverse samples with longer follow-up is warranted.