First-line treatment options for vaginismus should focus on a multidisciplinary approach centred on pelvic floor physical therapy and psychological support. Initial management typically involves pelvic floor muscle training to reduce involuntary muscle spasm and improve muscle control, which is supported by NICE guidelines on pelvic floor dysfunction NICE NG210. This includes guided exercises, relaxation techniques, and the use of vaginal dilators to gradually desensitize and stretch the vaginal muscles.
Psychological interventions such as cognitive behavioural therapy (CBT) or sex therapy are also recommended to address the anxiety and fear components commonly associated with vaginismus NICE NG210. These therapies help patients overcome the anticipatory pain and emotional distress that contribute to muscle tightening.
Recent literature reinforces the importance of pelvic floor physical therapy as a cornerstone of treatment, highlighting its effectiveness in improving pelvic floor muscle function and reducing symptoms in women with pelvic floor dysfunction, including vaginismus Wallace et al. 2019. This evidence supports the NICE recommendation for non-surgical management focusing on physical therapy techniques.
Therefore, the first-line treatment should combine pelvic floor physical therapy with psychological support, tailored to the individual patient's needs, to achieve the best outcomes.