Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

Objective

Alternate approach to managing conception goals in Primary Vaginismus.

Methods

A 34-year old Chinese lady with 3 years of unconsummated marriage presented for fertility assessment and was diagnosed with Vaginismus. Vagina desensitisation therapy working towards intercourse was unsuccessful but facilitated receptivity to digital insertion and syringe insemination. Due to anxiety about declining fertility potential with increasing maternal age, she eventually requested for In Vitro Fertilisation (IVF). A multidisciplinary approach involving a gynaecologist, psychologist and physiotherapist was adopted. Treatment addressed sexual knowledge deficiencies, incorporating Sensate focus exercises, cognitive-behavioural-therapy and intra-vaginal desensitisation. The initial goal focused on achieving penile- vaginal penetration. Subsequently, focus shifted to enabling receptivity for intra vaginal procedures to facilitate fertility processes. Information surrounding fertility procedures was also provided.

Results

The patient underwent transvaginal fertility investigations and completed IVF treatment, conceiving successfully.

Conclusion

With vaginismus, the etiological role of anxiety is well-documented (1). Penile penetration and coitus is aspired to as the end goal but can be difficult or unachievable (1). For subsets of patients, the desired goal is urgent conception. Maladaptive cognitions surrounding themes of urgency to hasten progress often prevail with coitus perceived as a precursor to the eventual goal. Beside pain, intensive attention is focused on failure consequences (2).This likely generates low efficacy expectations (3) and worry built on themes of incompetence and helplessness (4). This is consistent with studies finding higher sexual dysfunction and lower marital satisfaction among women with fertility concerns (5). Exposure exercises based on a step-wise approach of gradual progression till penile penetration is less effective due to high anxiety levels associated with urgency themes. We recommend personalising hierarchies of exposure factoring in individuals’ goals instead of assuming a generalised approach. For patients with urgent conception desires, consider facilitating tolerance of intra-vaginal medical procedures as a treatment end point. References 1. ter Kuile, M. M., van Lankveld, J. J. D. M., de Groot, H. E., Melles, R., Neffs, J. & Zandbergen, M. (2007). Cognitive-behavioral therapy for women with lifelong vaginismus: Process and prognostic factors, Behaviour Research and Therapy, 45, 359–373. 2. Barlow, D. H. (1986). The causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54, 140-148. 3. Bach, A.K., Brown, T.A, & Barlow, D.H. (1999): The effects of false negative feedback on efficacy expectancies and sexual arousal in sexually functional males. Behavior Therapy, 30 (1), 79-95. 4. Nobre, P.J. & Pinto-Gouveia, J. (2009). Cognitive Schemas associated with negative sexual events: a comparison of men and women with and without sexual dysfunction. Arch Sexual Behaviour, 38(5),842-851. 5. Wischmann, T (2013) Curr Opin Obstet Gynecol Sexual disorders in infertile couples: an update. Volume 25 Number 00

You do not currently have access to this article.
Download all slides