Sexual function outcomes after a multicomponent protocol incorporating 1-minute daily vaginal dilation for genito-pelvic pain/penetration disorder: a retrospective multicentre study

BACKGROUND: Vaginal dilators are used to manage genito-pelvic pain/penetration disorder, but longer daily sessions may increase treatment burden. This study evaluated achievement of intercourse and sexual-function outcomes following a multicomponent protocol incorporating 1-min daily vaginal dilation (AM-1 protocol). METHODS: This retrospective multicentre observational study screened 156 consecutive women with genito-pelvic pain/penetration disorder treated at YPK Mandiri Hospital and Bunda General Hospital, Jakarta, Indonesia, between January 2021 and October 2024. Of these, 123 initiated the AM-1 protocol as sole treatment, and 113 had complete paired pre-treatment and post-treatment Female Sexual Function Index-6 (FSFI-6) data for analysis. The AM-1 protocol combined psychoeducation, pelvic floor relaxation, cognitive reframing and progressive 1-min daily dilation. Outcomes were patient-reported successful unassisted penile-vaginal intercourse and paired FSFI-6 scores assessed at least 4 weeks after successful intercourse. RESULTS: Successful intercourse was documented in 113 of 123 women who initiated the AM-1 protocol as sole treatment (91.9%; 95% CI 85.6-96.0%); 10 women had no documented follow up and their outcomes were unknown. Among 113 complete cases, median total FSFI-6 score increased from 14 (interquartile range 10-16) before treatment to 22 (IQR 20-26) after treatment, with a median within-participant increase of 10 points (IQR 8-12; P < 0.001). Probable female sexual dysfunction decreased from 100% to 23.9% (P < 0.001). CONCLUSIONS: In this study, the AM-1 protocol was associated with documented successful intercourse and improved FSFI-6 scores. Comparative studies are needed to determine whether the brief dilation duration improves adherence or outcomes.