Erroneous Assumptions About Treatment

A number of assumptions about the treatment of vaginismus occur in the clinical literature. These must be challenged, especially when working with long-standing, treatment-refractory cases.

Assumption l: Husbands Are Only Peripherally Important in Treatment

Both women and their partners are quick to identify vaginismus as a woman's problem. Even some therapists believe that because the problem preceded marriage and would probably occur with any partner, the female patient must be the exclusive focus of treatment.

In fact, partners are critically important in determining treatment outcome. If the partner sabotages treatment by placing continual pressure on the woman to attempt coitus before she is ready, the woman often reacts in a passive-aggressive manner, avoiding the assigned sexual exercises. Some partners avoid sexual encounters at times when their participation is crucial if the treatment is to move forward. They may go to sleep early, start quarrels, or express sexual disinterest at times when their participation is needed. It is not uncommon for a husband to become uncooperative when the wife has made significant progress and is close to attempting penile penetration. At such times, the partner may feel insecure about his ability to either achieve or maintain an erection or may become so fearful about inflicting pain that he avoids sex altogether. It is essential that the therapist be empathic to the frustration the male partner has experienced in living with a vaginismic woman and understanding of the anxiety he may feel once progress has been made. Not including the male partner throughout treatment can compromise the success of the therapy.

Assumption 2: Treatment Is Straightforward and Usually Successful

This view was expressed more than 100 years ago by J. Marion Sims, an American gynecologist in an address to the Obstetrical Society of London in l862:

From personal observation I can confidently assert that I know of no disease capable of producing so much unhappiness to both parties of the marriage contract and I am happy to state that I know of no serious trouble that can be cured so easily, so safely, and so certainly. (Quoted in Drenth 1988, p. 126)