A Novel Multimodal Treatment Method and Pilot Feasibility Study for Vaginismus: Initial Experience With the Combination of Sacral Erector Spinae Plane Block and Progressive Dilatation

Emsal Pinar Topdagi Yilmaz,Yakup Kumtepe,Serkan Tulgar,Muhammed E Aydin,Ali Ahiskalioglu,Elif Oral Ahiskalioglu

doi:10.7759/cureus.10846

Emsal Pinar Topdagi Yilmaz, Yakup Kumtepe + Show 4 more

Open Access

https://doi.org/10.7759/cureus.10846

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Journal: Cureus	Publication Date: Oct 8, 2020
Citations: 9	License type: cc-by

Affiliation: Atatürk University, Maltepe University

Abstract

BackgroundGenito-pelvic pain/penetration disorder, commonly referred to as vaginismus, is a relatively common condition in women of childbearing age and has physical and psychological aspects. Various cognitive and behavioral therapies, dilatators, botulinum injections, and so on have been tried in the treatment. We hypothesize that the combination of sacral erector spinae plane (ESP) block and progressive dilatation treatment increases treatment quality.MethodsWe performed the sacral ESP block and progressive dilatation, which we added to multimodal treatment for resistant vaginismus cases. After the procedure, all patients were followed up during one menstrual cycle. They were recommended to have sexual intercourse on the day of the procedure.ResultsIn 15 of our treatment-resistant cases, when we added the sacral ESP block, successful penetration after the first block was 73%. Pregnancy occurred in eight patients after the initial one-month follow-up. Four of the 15 patients needed a second block.ConclusionsThe sacral ESP block added to the multimodal treatment protocol significantly improves treatment quality.

Highlights

Vaginismus is a state that is seen in about 1% to 7% of women in the reproductive age group; its cause has still not been fully clarified [1]
We hypothesize that the combination of sacral erector spinae plane (ESP) block and progressive dilatation treatment increases treatment quality
The sacral ESP block added to the multimodal treatment protocol significantly improves treatment quality

Summary

Introduction

Vaginismus is a state that is seen in about 1% to 7% of women in the reproductive age group; its cause has still not been fully clarified [1]. The facts that it has a high rate of incidence in Middle Eastern countries, that virginity is blessed, that female sexuality is suppressed, and that sexuality is perceived as immorality or crime constitute the basis of cultural reasons for the difference between societies [2]. This penetration disorder, which is known as the most common cause of failed marriages, is thought to be an involuntary and uncontrolled reflex behavior. We hypothesize that the combination of sacral erector spinae plane (ESP) block and progressive dilatation treatment increases treatment quality

Objectives

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Conclusion