title: Women's experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinical Psychology, University of Nottingham, Nottingham, UK. kjm033@hotmail.co.uk.|Clinical Psychology, Division of Psychiatry & Applied Psychology, University of Nottingham, YANG Fujia Building, B Floor, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK. kjm033@hotmail.co.uk.
authors.forename: Kat
authors.initials: K
authors.lastname: Macey
authors.affiliation: Chandos Clinic, Nottingham University Hospitals NHS Trust, Nottingham, UK. Angela.Gregory@nuh.nhs.uk.
authors.forename: Angela
authors.initials: A
authors.lastname: Gregory
authors.affiliation: Division of Obstetrics & Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK. David.Nunns@nuh.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Nunns
authors.affiliation: Clinical Psychology, University of Nottingham, Nottingham, UK. Roshan.Nair@nottingham.ac.uk.|Dept. of Clinical Psychology & Neuropsychology, Nottingham University Hospitals NHS Trust, Nottingham, UK. Roshan.Nair@nottingham.ac.uk.
authors.forename: Roshan
authors.initials: R
authors.lastname: das Nair
mesh_terms: D000328:Adult; D004106:Dilatation / Q000295:instrumentation*; D005260:Female; D006801:Humans; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010349:Patient Compliance / Q000523:psychology*; D036301:Qualitative Research; D011788:Quality of Life; D052065:Vaginismus / Q000150:complications / Q000534:rehabilitation*; D016387:Women's Health