Addressing anxiety in vivo in physiotherapy treatment of women with severe vaginismus: a clinical approach.

Rosenbaum T, J of Sex and Marital Ther 2011;37:89-93.

 Pelvic Physiotherapy Distance Journal Club July 11,2012.

Beth Shelly PT, DPT, WCS, BCB PMD

Progress in cases of sever anxiety

At each step the patient is asked to rate their anxiety on a scale of 0 (none) to 5 (sever). Then she is asked what needs to happen to get her anxiety to a 0 or 1 (possibly reverting to an earlier stage or using “lower anxiety” tools such as breathing).  She can always go back to a stage where she feels safe.  Progress when anxiety is 0 to 1.
·         Step one – lying on the table with cloths on covered with a sheet
·         Step two – as above with legs bent and knees apart
·         Step three  – as above without sheet
·         Step four – as above with shorts on first with sheet and then without sheet
·         Step five – as above with underwear only, with and without sheet
·         Step six – as above without underwear, with and without sheet

Progress in a similar manor to

·         Self touch
o   Of genitals
o   Of vulvar vestibule
o   Vaginal finger insertion
·         Graduated dilator use – also can be called “trainers”  to decrease fear
o   Self insertion of dilator
o   Self insertions with partner also holding dilator
o   Partner inserting dilator with patient’s hand also on dilator
o   Partner inserting dilator

Goal is for the female to be both physically and emotionally present during the examination. Patients should be encouraged to perceive the exact moment that she begins to feel anxiety.  To pay attention to her feeling (not her thoughts).  And to be aware of when she can feel relaxation.

Discussion

1.      How do you react when your patient has anxiety? What tools do you use to keep relaxed?
2.      What tools other than breathing would you use?
3.      How do you feel about helping patients with anxiety?  Is this the role of the PT?

Suggestions from the group – teach patients about muscles and muscle pain, tell patients there are others with the same challenges / conditions