Vaginismus as a Cause of Unconsummated Marriage: An Egyptian Case Series

Abstract

Background: Vaginismus, a prevalent genito-pelvic pain/penetration disorder in the Middle East, often leads to unconsummated marriages, with a significant impact on marital and social well-being. Traditional treatments have shown limited success in refractory cases. Objective: To evaluate the effectiveness of an integrated treatment program, including Botulinum Toxin A (BTXA) injections, gradual vaginal introitus dilation, and psychological support, in treating refractory vaginismus in Egyptian women. Patients and Methods: This retrospective case series analyzed 1,400 women with refractory vaginismus, treated between January 2013 and 2023. The program comprised BTXA injections in the perineal muscles, followed by guided physiotherapy for muscle dilation and psychological counseling. Success was defined as painless vaginal penetration. Results: Of the initial 1,512 cases, 1,400 completed the program. The average age of participants was 28 years. Most patients (93%) had tried conventional treatments without success. Post-treatment, 92.6% (1,288/1,400) achieved painless penetration. The majority required 3 to 5 dilatation treatment sessions for success. Mild adverse effects were reported in 28% of cases. Conclusion: The integrated treatment program, combining BTXA injections, gradual dilation, and psychological support, is highly effective in managing refractory vaginismus in Egyptian women, with a success rate of over 90%. This approach offers a promising solution for couples facing unconsummated marriages due to vaginismus.