Internet-Based Guided Self-Help for Vaginal Penetration Difficulties: Results of a Randomized Controlled Pilot Trial.
Difficulties with vaginal penetration can severely affect a woman's desire to have sexual intercourse, her sexual and general well-being, or her partnership. However, treatment opportunities for vaginismus are scarce.



To evaluate the efficacy of an internet-based guided self-help intervention for vaginismus in a randomized controlled pilot trial.



Seventy-seven women with vaginismus (primary inclusion criterion = no intercourse ≥ 6 months) were randomly assigned to an intervention group (IG) and a waitlist control group (WCG). The intervention consisted of 10 sessions involving psychoeducation, relaxation exercises, sensate focus, and gradual exposure with dilators. Participants received written feedback on completed sessions from an eCoach.



The primary outcome was successful sexual intercourse. Secondary outcomes were non-intercourse penetration, fear of coitus, sexual functioning, and dyadic coping. Self-reported assessments were scheduled at baseline, 10 weeks, and 6 months.



More participants (10 of 40, 34.48%) in the IG had intercourse compared with those in the WCG (6 of 37, 20.69%) at least once at 10 weeks or 6 months (odds ratio = 2.02). The difference was not significant (χ21= 1.38, P = .38), but in the IG, there was a significant increase in intercourse penetration from baseline to 6 months (d = 0.65). No such increase was found in the WCG (d = 0.21). There were significant between-group effects concerning non-intercourse penetration (self-insertion of a finger or dilator or insertion by the partner) in favor of the IG. Fear of coitus and dyadic coping significantly decreased in the IG. Overall satisfaction with the training was high.



This randomized controlled trial showed promising effects of an internet-based intervention by increasing participants' ability to have intercourse and non-intercourse penetration while experiencing high treatment satisfaction. The WCG also showed improvement, although participants had vaginismus for an average duration of 6 years. Internet-based interventions could be a treatment modality to complement other methods in stepped care for vaginal penetration difficulties.
Department Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen-Nuremberg, Germany; Leuphana University, Luneburg, Germany. Electronic address: Anna-Carlotta.Zarski@fau.de.
Anna-Carlotta
AC
Zarski
Department Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen-Nuremberg, Germany.
Matthias
M
Berking
Division of Online Therapy, Schön Clinic Bad Arolsen, Bad Arolsen, Germany.
Christina
C
Fackiner
Clinical Institute for Psychosomatic Medicine and Psychotherapy, Düsseldorf, Germany.
Christian
C
Rosenau
Department Clinical Psychology and Psychotherapy, Friedrich-Alexander University, Erlangen-Nuremberg, Germany.
David Daniel
DD
Ebert
D000223:Adaptation, Psychological; D000328:Adult; D003075:Coitus / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D020407:Internet; D010146:Pain; D010865:Pilot Projects; D012648:Self Care / Q000379:methods*; D057566:Self Report; D012725:Sexual Behavior / Q000523:psychology; D012747:Sexual Partners; D013813:Therapy, Computer-Assisted / Q000379:methods*; D052065:Vaginismus / Q000523:psychology* / Q000628:therapy*
Female Sexual Functioning; Genito-Pelvic Pain/Penetration Disorder; Internet Intervention; Randomized Controlled Trial; Sexual Dysfunction Disorder; Vaginismus