Dilators are typically prescribed for Vaginismus, for example, to promote muscle control and to achieve a systematic desensitization in order to diminish or completely prevent involuntary reactions. Similarly, in the treatment of PVD, dilators can be used to make the vagina and surrounding area much less sensitive and reactive. They are used in sequence: the first tube is so narrow that it can be inserted without causing much pain. After practicing with that size and getting comfortable with it, you can then move on to the next size up, beginning a process of gradually accepting broader dilators comfortably. We’ve found that mastery of pain in this way increases the patient’s confidence and makes for a favorable therapeutic outcome.


The second type of physical therapy we like to use when treating PVD is called Sensate Focus. It is a practice widely used to help couples regain the physical confidence lost because of a sexual problem. You and your partner are asked to touch each other according to a very structured pattern of progression. The idea is to focus on the feelings of intimacy that you get simply from touching each other, without worrying about sexual performance. In this phase, in order to keep you focused, you’re actually banned from having intercourse. Sensate Focus is designed to help couples become comfortable with each other’s bodies before moving to penetration. In the case of PVD, we ask patients to engage in Sensate Focus at the same time as using the dilator tubes.

This helps build confidence with each other after what is often a period of physical estrangement; regain physical intimacy, share the emotional load and overcome the uneasiness of the vaginal exercises. We’ve found this approach allows the patient to take control of vaginal pain while getting emotionally closer to her partner.

Alternative treatments for women who show no response to initial treatment for PVD include acupuncture and injections of various combinations of drugs (methylprednisolone acetate, lidocaine, and betamethasone) directly into the affected site.

As a last resort, surgery involving removal of the vaginal vestibule may be considered for women who do not respond to other treatment. Although it is highly effective in curing PVD, it is an extreme measure, and only suitable for a minority of well-motivated patients.


A Combined Approach Works Best


Because I am qualified as an MD, a gynecologist and a sex therapist, I have a good understanding of how the female genital equipment works. Crucially, this combination of expertise means I can tailor treatment to emphasize physical therapy, the use of drugs or behavioral sex therapy, as I see fit in each individual case. This greatly improves the outcome, as each case of PVD is unique, and requires a fine-tuned approach using every available methodology.

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