Emerging treatment options for vaginismus: a comprehensive review of current evidence and future directions

Abstract

Vaginismus is a condition characterized by involuntary vaginal muscle contraction leading to pain and distress that significantly impacts sexual health, psychological well-being, and quality of life. While conventional treatments, including behavioral therapy, physical therapy, and vaginal dilators, remain the cornerstone of management, their efficacy is often limited, and barriers such as stigma and access persist. Advancements such as botulinum toxin injections and topical agents show promise in reducing pain and muscle hypertonicity. Technological innovations, including laser and radiofrequency (RF) therapy, as well as neurostimulation techniques, aim to enhance muscle relaxation and modulate nerve activity. Additionally, psychological and integrative interventions, such as virtual reality-based exposure therapy and mind-body practices, address the emotional and psychological dimensions of the condition. Advances in personalized medicine, including biomarker research, offer the potential to tailor treatments to individual patient needs. Despite these developments, challenges remain in ensuring accessibility, overcoming stigma, and conducting robust clinical trials to establish efficacy and safety. Osteopathic physicians may contribute to multidisciplinary management by addressing musculoskeletal dysfunction associated with pelvic floor disorders through osteopathic manipulative medicine (OMM). This review highlights the importance of a multidisciplinary, patient-centered approach to managing vaginismus and underscores the need for further research to refine and expand therapeutic options. A comprehensive literature search of the PubMed, JSTOR (Journal Storage), and EBSCO databases was conducted between December 2024 and August 2025, and articles were selected based on accessibility and relevance. The majority of the studies evaluated multimodal approaches, including pelvic floor physical therapy (PFPT), cognitive behavioral therapy (CBT), pharmacologic interventions, and combined strategies. Reported success rates varied widely (71–100 %). Newer technological advances such as laser and RF therapies, photobiomodulation (PBM), and virtual-reality therapies all found significance (p<0.05) in treatment protocols and outcome definitions. Limited data were available regarding long-term outcomes, recurrence rates, and cultural/ethnic variations. Current evidence supports a multimodal approach as the most effective strategy for managing vaginismus. However, heterogeneity in study design, diagnostic criteria, and outcome measures limits the generalizability. Standardized protocols and larger, high-quality trials are needed to improve diagnosis and optimize care for patients with vaginismus.