BackgroundRecent 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.Methods13 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.ResultsFour 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.ConclusionsAccessing 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-015-0201-6) contains supplementary material, which is available to authorized users.

Background: Men concerned about their penis size often consult professionals working in urology, andrology, surgery, and sexual medicine. Aim: To inform professionals in the sexual medicine field about small penis syndrome as a clinical syndrome and to provide recommendations for treatment. Methods: This was an overview of the existing literature combined with our extensive clinical experience. Results: Small penis syndrome is a syndrome with psychiatric comorbidities and social consequences that impair life. Men with these concerns tend to be susceptible for treatment that is not evidence based and potentially harmful. Clinical Implications: Treatment of men with concerns about penis size should start with a thorough biopsychosocial assessment, followed by extensive psychoeducation, counselling, and psychological interventions, even if surgery is being considered. Strengths & Limitations:The strength of this study is the concise overview of the existing literature combined with clinical experience which leads to important recommendations. Limitation is that this is not a systematic review. Conclusion:Complaints about penis size should be taken seriously, and a thorough biopsychosocial and multidisciplinary assessment is required.

Female sexual dysfunction can greatly affect a woman's quality of life. Affected patients need a comprehensive assessment that includes taking a sexual history, medical evaluation and, if appropriate, a manual examination in order to diagnose, treat or identify factors relevant for each individual woman. There may be biological, psychological, emotional and relationship issues. Any biological factors such as vaginal dryness, pelvic floor dysfunction or chronic pain need to be addressed first to help prevent more complex problems developing. Sexual problems may be the cause of or the result of dysfunctional or unsatisfactory relationships. Psychological and emotional factors can create difficulties in sexual response and, equally, they can be the result of unaddressed or untreated biological/medical issues. Nurses working in urology need to be aware of the physiology involved in sexual response and know which conditions and illnesses are likely to affect sexual functioning and which treatments can help.

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