Vaginismus treatment: a systematic review and meta-analysis of contemporary therapeutic approaches

Abstract

Introduction: Vaginismus is a psychosexual disorder characterized by involuntary pelvic floor muscle contraction that causes pain and hinders vaginal penetration. Despite the availability of various treatments, consensus on the most effective therapeutic strategy remains limited.

Objectives: To systematically evaluate and compare the effectiveness of contemporary treatment approaches for vaginismus, including cognitive-behavioral therapy (CBT), pelvic floor physiotherapy, vaginal dilators, botulinum toxin injections, and combined interventions.

Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted for articles published between January 2015 and March 2025. Eligible studies reported treatment outcomes in clinically diagnosed vaginismus cases. Data on intervention type, sample size, therapeutic success rate, and follow-up duration were extracted. Meta-analysis was performed when possible.

Results: Eighteen studies encompassing 863 patients were included. Combined psychosexual interventions demonstrated the highest pooled therapeutic success rate (86%), followed by CBT (82%), botulinum toxin injection (85%), pelvic floor physiotherapy (85%), and vaginal dilator therapy (78%). Studies varied in diagnostic criteria and outcome definitions, contributing to moderate heterogeneity.

Conclusion: Integrative, multidisciplinary approaches appear to be the most effective in managing vaginismus, particularly when psychological and physical therapies are combined. Future research should focus on standardized protocols, long-term outcomes, and culturally tailored interventions to enhance clinical guidance and treatment accessibility.

Keywords: botulinum toxin; cognitive-behavioral therapy; female sexual dysfunction; meta-analysis; pelvic floor therapy; sexual pain; systematic review; vaginismus.