Therapist-aided exposure for women with lifelong vaginismus: A replicated single-case design.

Abstract

Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other object. Lifelong vaginismus occurs when a woman has never been able to have intercourse. A replicated single-case A-B-phase design was used to investigate the effectiveness of therapist-aided exposure for lifelong vaginismus. A baseline period (Phase A) was contrasted with exposure + follow-up (Phase B), using random switching between phases. The main outcome measure (intercourse ability) was assessed daily for 24 weeks. Ten women participated. The exposure consisted of a maximum of three 2-hr sessions during 1 week at a university hospital. The participant performed vaginal penetration exercises on herself, in the presence of a female therapist. Two follow-up sessions were scheduled over a 5-week period. Nine of the 10 participants reported having intercourse after treatment, and in 5 of the 9, intercourse was possible within the 1st week of treatment. The results remained at 1-year follow-up. Furthermore, exposure was successful in decreasing fear and negative penetration beliefs posttreatment and at 3-month and 1-year follow-ups. Therapist-aided exposure appears to be an effective treatment for lifelong vaginismus.

The Single-Case Data Analysis Package: Analysing Single-Case Experiments with R Software

“…What follows will illustrate the functionality of the package with an example from ter Kuile et al (2009). A more detailed manual can be found in the Appendix.…”

“…Ter Kuile et al (2009) investigated the effectiveness of therapist-aided exposure for lifelong vaginismus. Lifelong (or primary) vaginismus occurs when a woman has never been able to have sexual penetrative intercourse during her whole life.…”

“…Ter Kuile et al (2009) used a replicated single-case AB-phase design to test whether the therapy would lead to an increase in sexual intercourse. In an ABphase design all baseline measurements (A) precede all treatment measurements 455 (B).…”

“…Another metaanalytical procedure is statistically combining the p-values of several sequentially replicated single-case experiments, to determine whether a general significant result is obtained (Figure 8: SCDA -> SCMA -> Combine P-values). Ten women with primary vaginismus participated in the study of ter Kuile et al (2009). When combining their results with the additive method for combining independent pvalues, a general significant result of p = .0016 was obtained.…”

Governance of Sexual Functioning by General vs. Special Psychological Mechanisms Remains an Empirical Issue

“…Nine out of ten participants reported having had penilevaginal intercourse after treatment and in five out of nine responders, intercourse was accomplished within the first week of treatment. These results remained at a 1 year follow-up (ter Kuile et al, 2009). A subsequent randomized, waiting-list controlled study (N = 50) of women with lifelong vaginismus demonstrated that, after the exposure week, 80% of the treated women were able to have intercourse, again compared with none in the waiting-list condition.…”