Hypnotherapeutic KARAV Algorithm in Vaginismus Treatment: A Retrospective Evaluation of a Novel Therapeutic Approach

Objective: To evaluate the clinical efficacy of a one‐day, four‐session KARAV hypnotherapy algorithm in women with primary vaginismus. Materials and Methods: In this prospective, multicenter cohort study, 101 women aged 21–45 years meeting DSM-5 criteria for lifelong vaginismus underwent four sequential 60–75-minute hypnotherapy sessions in a single day. The KARAV protocol integrated psychoeducation, arranged sequential inductions (Dave Elman, hand-drop, parts therapy), regression, hypnodrama, and associative reframing, interspersed with partner-assisted auto-hypnosis and graded exposure exercises. Primary outcome was achievement of pain-free vaginal penetration on treatment day. Secondary outcomes included pre- to post-intervention changes in Female Sexual Function Index (FSFI) subscales (desire, arousal, lubrication, orgasm, satisfaction, pain), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), patient satisfaction (0–10 visual analog scale), and three-month relapse rate. Paired t-tests and chi-square analyses were used; significance was set at p < 0.05. Results: All participants (100 %) achieved pain-free penetration on Day 0. Mean FSFI total score increased from 16.5 ± 4.3 to 27.3 ± 6.3 (p < 0.001). Significant improvements were observed in FSFI subdomains of desire, arousal, orgasm, and satisfaction (all p < 0.0001). Mean BDI decreased from 19.7 ± 9.3 to 11.0 ± 6.6 and STAI from 49.6 ± 5.1 to 10.5 ± 7.4 (p < 0.001 for both). Patient satisfaction averaged 8.5 ± 1.0, and relapse at three months was 4 %. Conclusion: The KARAV algorithm delivers rapid, robust, and durable remission of vaginismus symptoms in a single day, offering a time-efficient, highly acceptable intervention for primary vaginismus.