Vaginismus—the hypno?therapeutic approach

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Abstract
Vaginismus being a reaction of avoidance of an anxiety‐producing situation, is readily amenable to treatment by systematic desensitization. This may proceed in two main ways: “in vitro” or “in vivo”. In order to strengthen and speed‐up the desensitization process, we used hypnotic techniques in a dynamic approach. The first session of both methods is dedicated to building an adequate doctor‐couple relationship, careful history‐taking and dissipation of myths and fallacies regarding sexuality or hypnosis. Any attempts at sexual intercourse are forbidden at this stage. The “in vitro” treatment proceeds with the imagery, under hypnosis, of an “anxiety hierarchy” of increasingly erotic and sexually intimate situations, which will be reproduced at home with the partner, until sexual intercourse is achieved. In the “in vivo” method the patient learns self‐hypnosis and then inserts into her vagina first her finger, then Hegar dilators of gradually increasing size. The partner, the patient and the physician will then successively proceed to the insertion, forming a team work situation. This continues until the “female superior position”, practiced first with the largest dilator, is reproduced at home by intercourse.