The online version of this article (doi:10.1186/s12905-015-0201-6) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
KM This research was conducted by KM as part of a doctorate in Clinical Psychology, she had primary responsibility for all stages of the design, recruitment, interviewing, coding, analysis and writing. She read and approved the final version of the manuscript. AG provided support with developing recruitment materials and gaining service user feedback on drafts of study materials, also recruited participants and provided feedback on findings, earlier versions of the manuscript and read and approved the final version of the manuscript. DN helped with recruitment, provided consultation regarding study feasibility throughout the project, giving feedback on earlier versions of the guidelines and manuscript and read and approved the final version of the manuscript. RdN (research supervisor) supported the design of the study including choice of method, development of the interview schedule and advice on coding. Secondary analysis and thematic mapping were done jointly with KM, as was the drafting of this manuscript. He read and approved the final version of the manuscript.
KM is a Clinical Psychologist who completed this research as part of her doctorate in clinical psychology. Her research interests include sexual health, pain and their impact on identity.
AG is an experienced psychosexual therapist at the Chandos Clinic, with a particular interest in treating vaginismus.
DN is a Consultant Gynecologist with expertise in treating vulval pain and vulval dermatological conditions, his publications include a number of articles concerning the identification and treatment of vulvodynia.
RdN is a Clinical Psychologist, Honorary Associate Professor, and Research Tutor for the Trent Doctorate in Clinical Psychology. His research interests and publications include sexuality, pain and identity. He has published a book on Intersectionality, sexuality and psychological theories.
Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes ‘performance-based’ sexuality which may be detrimental. Despite this, little has been done to seek women’s views about their treatment. This study set out to explore women’s experiences of vaginismus treatment with vaginal trainers, and to use their voices to propose guidelines for improving treatment.
13 women who had used vaginal trainers for vaginal penetration difficulties diagnosed as vaginismus were recruited through a specialist clinic, university campuses, and online forums. The women took part in semi-structured individual interviews (face-to-face/telephone/Skype), which were audio-recorded, transcribed verbatim and analysed using Thematic Analysis.
Four superordinate themes were elicited and used to draft ‘better treatment’ guidelines. Themes were: (1) Lack of knowledge, (2) Invalidation of suffering by professionals, (3) Difficult journey, and (4) Making the journey easier. This paper describes themes (3) and (4). Difficult Journey describes the long and arduous ‘Journey into treatment’, including difficulties asking for help, undergoing physical investigations and negotiating ‘the system’ of medical referrals. It also describes the sometimes demoralising process of ‘being in treatment’, which includes emotional and practical demands of treatment. Making the journey easier highlights the importance of and limits to ‘partner support’. ‘Professional support’ comprises personal qualities of professionals/therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. ‘Peer support/helping each other’ describes the importance of supportive vaginimus networks and sharing tips with other women.
Accessing effective treatment for vaginal penetration difficulties is difficult. The practical and emotional demands of using vaginal trainers may be underestimated by professionals, resulting in inadequate provision of support and information in practice. At times vaginal trainers may be prescribed to women who are unlikely to benefit from this treatment in isolation. Core communication skills like non-judgemental listening are important for supporting women through treatment. However professionals also need greater specialist knowledge, which in turn requires more detailed research. New ways to disseminate specialist knowledge and suggestions for further research are discussed.
Additional file 1 Guide for good practice approved by particpants.12905_2015_201_MOESM1_ESM.doc
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- Women’s experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study
Roshan das Nair
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