Managing Vaginismus with Assisted Dilatation Multidisciplinary Protocol – Retrospective Cohort Study from Indonesia’s Largest Dedicated Centre

Robbi Asri Wicaksono,1 Elvine Gunawan,2,3 Santy Fitriansari,1 Peter T Pacik,4 Kevin Dominique Tjandraprawira1 1Department of Obstetrics and Gynecology, Limijati Women and Children Hospital, Bandung, Indonesia; 2Department of Psychiatry, Limijati Women and Children Hospital, Bandung, Indonesia; 3Doctoral Program in Medical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 4Retired Scholar, Dunbarton, New Hampshire, USACorrespondence: Robbi Asri Wicaksono, Department of Obstetrics and Gynecology, Limijati Women and Children Hospital, Jalan LLRE Martadinata No. 39, Bandung, 40115, Indonesia, Email [email protected]: Vaginismus is a gynecologic disorder with persistent vaginal spasm whenever any penetration is attempted. This leads to a failure of penetration. Vaginismus’ true prevalence is unknown and reporting heavily biased. A similar condition is happening in Indonesia, where our facility treats > 200 new cases/year. No standardized vaginismus treatment protocol is available internationally, so this retrospective study evaluates our multidisciplinary assisted dilatation protocol and the obstetric outcomes of our patients.Methods: This is a retrospective cohort study of all patients presenting with vaginismus undergoing assisted dilatation between 01/01/2022 and 31/12/2023. Diagnosis is through the presence of vaginal muscle spasms precluding penetration and/or severe penetrative pain, as confirmed by history and physical examination. We included all patients undergoing assisted dilatation in this timeframe. We employed a standardised multidisciplinary approach involving gynaecologist, psychiatrist and specialist nurses. It combines botulinum toxin A injections, dilator exercises and psychiatric medications. Patients are followed up 6– 8 weeks post-dilatation and their obstetric outcomes are recorded through an online questionnaire.Results: We included 513 patients. 85.4% (438/513) presented due to failure of penetration. The average age at consultation was 30.39 ± 4.75 years. Most patients came from the island of Java (76.8%; 394/513), were undergraduates (83.3%; 309/371) and worked in the private sector (49.5%; 254/513). The median duration of vaginismus prior to presenting for treatment was 36 months (range 1– 252 months). 45.8% (235/315) had experienced medical trauma previously, 46.6% (239/513) had marital trauma and 56.7% (291/513) had social trauma. 61.2% (314/513) attended follow-up and 89.4% (281/314) achieved penetration post-discharge. 23.7% (52/219) displayed involuntary movements during follow-up examination. Patients required a median of 4 weeks to achieve penetration and most achieved penetration at 1st attempt. 51% (159/312) reported pregnancy post-procedure with 85.1% (120/141) achieving it spontaneously. 9.2% (13/141) experienced splash pregnancies. 88% (102/116) of pregnancies were term but 94.2% (98/104) opted for caesarean section.Conclusion: Our assisted dilatation protocol, emphasizing on both multidisciplinary and multimodal approach, may be offered for standardized vaginismus treatment.Keywords: vaginismus, assisted dilatation, multidisciplinary, botulinum toxin