Outcome of Medical and Psychosexual Interventions for Vaginismus: A Systematic Review and Meta-Analysis

Unconsummated marriage: a systematic review of etiological factors and clinical management

BACKGROUND

Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse.

AIM

The study sought to systematically review current evidence regarding the etiological factors and clinical management of UCM.

METHODS

A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in June 2023. Studies were selected if they described married couples who never had sexual intercourse in case report or case series evaluating the related causes and/or management and reporting data with qualitative, quantitative, or mixed methods. The review was reported according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) statement and registered in PROSPERO with ID CRD42023433040.

RESULTS

A total of 27 studies including 1638 males and 1587 females were selected. Eight (29.6%) articles were case reports involving a single couple and 19 (70.4%) studies were case series. Mean Murad score was 4.1 (range, 1-8) showing low-intermediate overall study quality. All articles had a level of evidence of 4. Most of studies were conducted in Egypt (n = 5 [18.4%]), Israel (n = 4 [14.9%]), and the United States (n = 4 [14.9%]). The mean age of males and females varied between 24.2 and 37.6 years and from 21 to 27.4 years, respectively. The reasons for the medical visit that led to the diagnosis of UCM were inability to consummate in 23 (85.2%) studies, inability to conceive in 1 (3.7%) article, and mixed in 3 (11.1%) articles. The mean duration of UCM varied from 7 days to 3.5 years. Eight studies involving both men and women showed that vaginismus (8.4%-81%) and erectile dysfunction (10.5%-61%) were the most common causes of UCM. Three articles reported that 16.6% to 26% of all UCM cases were due to both male and female factors. Sildenafil, tadalafil, intracavernosal injection, penile plication, female genital reconstructive surgery, vaginal dilators, lubricants, psychosexual therapy, and sex education were the various treatment modalities in 27 studies to achieve consummation rate of 66.6% to 100%.

STRENGTHS & LIMITATIONS

A strength is that this is the first systematic review covering the entire spectrum of UCM. Limitations comprised the low quality of most of the included articles and the large percentage of UCM cases probably not published.

CONCLUSION

Erectile dysfunction and vaginismus are the most reported causes of UCM; however, a strong psychological component certainly underlies a significant number of cases. A multidisciplinary approach based on strategic integration of sex education, medical therapy, psychosexual support, and surgical treatment would seem the most suitable option to manage couples with UCM.

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

PURPOSE

Erectile dysfunction (ED) is one of the most prevalent male sexual dysfunctions. ED has been in the past mistakenly considered a purely psycho-sexological symptom by patients and doctors. However, an ever-growing body of evidence supporting the role of several organic factors in the pathophysiological mechanisms underlying ED has been recognized.

METHODS

The Italian Society of Andrology and Sexual Medicine (SIAMS) commissioned an expert task force involving several other National Societies to provide an updated guideline on the diagnosis and management of ED. Derived recommendations were based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

RESULTS

Several evidence-based statements were released providing the necessary up-to-date guidance in the context of ED with organic and psychosexual comorbidities. Many of them were related to incorrect lifestyle habits suggesting how to associate pharmacotherapies and counseling, in a couple-centered approach. Having the oral therapy with phosphodiesterase type 5 inhibitors as the gold standard along with several other medical and surgical therapies, new therapeutic or controversial options were also discussed.

CONCLUSIONS

These are the first guidelines based on a multidisciplinary approach that involves the most important Societies related to the field of sexual medicine. This fruitful discussion allowed for a general agreement on several recommendations and suggestions to be reached, which can support all stakeholders in improving couple sexual satisfaction and overall general health.

The effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment: a randomized controlled study

INTRODUCTION AND HYPOTHESIS

The purpose of this study is to determine the effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment.

METHODS

A total of 34 women at the vaginismus treatment stage, including 17 in the experiment group and 17 in the control group, were included in the study with a randomized controlled design. In addition to the routine treatment protocol, women in the experiment group were provided with pelvic relaxation and sexual counseling based on the Information, Motivation, Behavior (IMB) model consisting of four sessions. The control group received the routine treatment protocol. The assessments were made at the 3rd week and 2nd month after coitus. The women filled out an Information Form, the validated Female Sexual Function Index (FSFI), and the Vaginal Penetration Cognition Questionnaire (VPCQ).

RESULTS

The mean age of the women was 27.59±5.32, and their mean duration of marriage/relationship was 33.44±12.11 months. After the treatment statistically significant increases were observed in the total FSFI scores and the desire, arousal, and pain dimension scores of the experiment group in comparison with the control group (p<0.05). In the VPCQ total scores, there was a significant reduction in the experiment group in comparison with the control group and after the treatment in comparison with before the treatment (p<0.01).

CONCLUSIONS

The sexual counseling based on the IMB model and pelvic relaxation interventions provided to the women who were receiving vaginismus treatment affected their sexual function positively. It may be recommended to conduct comparative studies with a broader sample and different models.

Unconsummated marriage among Chinese couples: a retrospective study

Background

Unconsummated marriage (UCM) is a significant problem among couples who are unable to achieve successful sexual intercourse and penovaginal penetration, and the etiology and clinical characteristics of UCM in Chinese couples remain unknown.

Aim

In a retrospective analysis of patients with UCM, we investigated clinical characteristics and treatment outcomes among Chinese couples with UCM.

Methods

During the period from January 2019 to May 2021, we examined 127 consecutive couples with unconsummated marriage. The couples were evaluated separately by andrologists and gynecologists, and combined treatments were conducted by therapists.

Outcomes

We calculated the distribution of etiologies of UCM in Chinese couples.

Results

Among the couples whose data were evaluated, 93 couples visited the andrologist first and 34 couples visited the gynecologist first. The most common complaints associated with sexual dysfunction were erectile dysfunction (ED) in male patients and vaginismus and dyspareunia in female patients. Unconsummated marriage among Chinese couples was caused primarily by female factors (55.8%). With couple-oriented treatment conducted by sexual therapists, the success rate was 67.7%.

Clinical Translation

If a couple is diagnosed with UCM, both the husband and wife should be treated individually receive guidance from a sex therapist toward successful sexual intercourse.

Strengths and Limitations

This is to our knowledge the first report regarding the etiology of UCM in Chinese couples. Here we report our routine diagnostic and therapeutic workups. However, we were not able to perform hormonal and imaging studies of the female partners. Moreover, patients presenting with UCM who visited our department without a partner were not included in the statistics.

Conclusions

Unconsummated marriage among Chinese couples may be caused byfactors affecting both the husband and wife or the husband and wife individually; however, factors affecting women are the predominant causes of UCM. Lack of knowledge about sex-related issues, as well as cultural beliefs, play an important role. A preliminary evaluation by an andrologist and a gynecologist, followed by couple treatment conducted by the sex therapist, is highly `recommended to treat UCM effectively.

Quality analysis of YouTube videos on vulvodynia

Background

Social media, with its low cost and easy accessibility, represents an ideal medium for sharing medical interests, but the quality of its content is questionable.

Aim

The primary aim of this study was to evaluate the quality of video content related to vaginismus on YouTube as a source of information by using scores of established classification systems. The secondary aim was to examine the relationship between objective and subjective measures of their quality.

Methods

The term vaginismus was typed into the YouTube search bar (http://www.youtube.com). The first 50 videos with the highest number of views were included in the study. All videos were assessed on August 18, 2022, by a gynecologist and/or a urologist experienced in vulvodynia. Data of all the videos were recorded, such as source, content, duration, day since upload date, number of views, number of likes, number of comments, and views per day. The Global Quality Scale (GQS) and modified DISCERN score were employed to assess the quality of the videos.

Outcomes

The primary outcomes of this study were the scores of established classification systems and the measures relating to the preference and evaluation of viewers of YouTube videos on vulvodynia.

Results

A total of 50 videos were evaluated. The sources of 32 (64%) of these videos were “universities/professional organizations/nonprofit physicians/physicians” and “stand-alone health information websites.” The GQS and modified DISCERN scores of the videos whose source was “universities/professional organizations/nonprofit physicians/physicians” were higher than those whose source was “talk show programs/television programs” (P = .014 for GQS score, P = .046 for modified DISCERN score). When classified according to GQS score, the quality level of 58% of the videos was low. Of the videos whose source was “universities/professional organizations/nonprofit physicians/physicians,” 56.3% were of good quality.

Clinical Implications

The quality of information was very low and suggested that health care professionals should take on a more active role in configuring the qualitative characteristics of the material available online about the given health issues.

Strengths and Limitations

To the best of our knowledge, this is the first study to investigate the quality of YouTube videos on vaginismus (vulvodynia). However, the limitation of this study is the relatively subjective evaluation of videos, including the risk of observer bias, although we attempted to overcome this problem with the inclusion of 2 independent reviewers and the use of validated tools.

Conclusion

YouTube videos may offer a huge amount of information about this condition, but the quality of the available sources is heterogeneous.

Successful management of penetration disorder: A holistic approach to an age-old problem

Penetration disorder, formerly referred to as vaginismus, is the recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration. It is a common female psychosexual problem and is a cause of significant personal and relationship distress. In this report, we describe the successful treatment of vaginismus in a 28-year-old woman by using a combination of different interventions. This involved providing sexual education, psychotherapy, serial dilation using graded plastic dilators, sensate-focused therapy, and anti-anxiety medication.

Comparative Study of 150 vs. 200 Units of Botulinum Toxin as Treatment for Vaginismus

OBJECTIVE

 To comparatively evaluate the outcome of treatment with 150 versus 200 units (U) of botulinum toxin in achieving pain-free intercourse and relieving muscle contraction in order to allow gynecological examination.

METHODS

 In this comparative prospective observational study, 99 patients with vaginismus were treated with botulinum toxin injections from September 2016 to August 2021. Diagnosis and grading of vaginismus severity were assessed using a Female Sexual Function Index (FSFI) questionnaire. Under local or general anesthesia, botulinum toxin diluted with preservative-free saline (150 U and 200 U) was injected into, above, and below the right and left bulbospongiosus muscle and the lateral submucosal areas of the introitus and perineal body using an insulin syringe. Patients were recalled after 2 weeks, and the postoperative outcome was recorded using a similar preoperative questionnaire.

RESULTS

 Overall, the mean age of patients was 30.2 years. The baseline and clinical characteristics were comparable between the 2 groups (p > 0.05). Significant improvements were seen in the pain and anxiety scores of finger penetration, dilator use, intercourse, and cotton swab in individual groups. The intergroup comparisons between 150 U and 200 U of Botox were not statistically significant (p > 0.05).

CONCLUSION

 Low-dose Botox (150 U) is equally effective as high dose Botox injections (200 U) in vaginismus patients. Therefore, Botox-150 U can be used to treat vaginismus as an alternative to high doses of the same substance.

Common Pitfalls in the Management of Vaginismus in Couples With Subfertility in India

Vaginismus is described as an involuntary pelvic muscular spasm that occurs due to “fear of pain” associated with vaginal penetration which prevents a woman from experiencing penovaginal sexual intercourse despite her wish to do so. In the context of heterosexual couples with subfertility, untreated vaginismus may result in unconsummated marriage and/or reduced quality of sex life and/or can affect a woman’s perception about her potential of femininity and motherhood. Though vaginismus is an easily diagnosable and treatable condition in many instances, it often gets ignored or inadequately/inappropriately managed. There is paucity of practice-informed clinical data on management of vaginismus in couples with subfertility that is contextualized to the Indian setting. The present viewpoint is based on real-world clinical scenarios who presented as couples to a tertiary fertility center with unconsummated marriage as their chief complaint. The intent of this viewpoint is not only to highlight the common pitfalls in the management of vaginismus but also showcase a clinically proven interdisciplinary management approach for assessment and management of vaginismus and any associated sexual problems.

The Inferto-Sex Syndrome (ISS): sexual dysfunction in fertility care setting and assisted reproduction

PURPOSE

Infertility represents a peculiar social burden affecting more than 15% of couples, provoking it a real threat to the general quality of life and to the sexual health. The medicalization (diagnosis, therapy and follow up) of the lack of fertility is frequently a challenge in term of personal and couple's involvement. In particular, while the Assisted Reproductive Technology (ART) has allowed many infertile couples to achieve pregnancy, the therapeutic process faced by the couple bears a strong psychological stress that can affect the couple's quality of life, relationship and sexuality. Despite infertility affects both female and male sexual health, only recently the interest in the effects of ART on the couple's sexuality has grown, especially for women.

METHODS

A literature research on the sexual dysfunction in fertility care and particularly in ART setting was performed.

RESULTS

Literature largely found that intimacy and sexuality appear specifically impaired by intrusiveness of treatments and medical prescriptions. Moreover, there is a close relationship between emotional, psychological and sexual aspects, which can be integrated in the new concept of Inferto-Sex Syndrome (ISS) that can impair the ART treatment outcomes. Evidence demonstrates that the assessment of sexual function is necessary in couples undergoing diagnosis of infertility and ART.

CONCLUSION

A close relationship between infertility and sexuality, both in the female and male partners, was detected. ART treatments may heavily impact on the couple's psychosexual health. A couple-centred program for the integrated management of psychological and sexual dysfunction should be considered in the context of ART programs.

Vaginismus, Dyspareunia and Abuse History: A Systematic Review and Meta-analysis

BACKGROUND

Genito-pelvic pain/penetration disorder, which consists of a combination of vaginismus and dyspareunia, is considered a new diagnosis in the latest version of the Diagnostic and Statistical Manual of Mental Disorders. Although the etiology of this diagnosis is not well known, a history of abuse has been suggested to be a primary factor in the emergence of this disorder.

AIM

This systematic review and meta-analysis aimed to determine the association of abuse history with vaginismus and dyspareunia diagnosis.

METHODS

Related keywords were used to search articles in PubMed, PsycArticles, PsycINFO, Scopus, Web of Science, and the Turkish scientific information database (TRDizin). All articles published in English and Turkish until August 2020 were systematically reviewed. A total of 14 case-control studies, including 1428 participants, were included in the final analysis. The fixed-effects model was used to pool odd ratios (ORs) and 95% confidence intervals (CIs) of the studies. Heterogeneity was evaluated using the I² statistic.

OUTCOMES

Case-control studies that reported vaginismus or dyspareunia outcomes in individuals with or without a history of abuse.

RESULTS

A significant relationship was found between a history of sexual (1.55 OR; 95% CI, 1.14-2.10; 12 studies) and emotional abuse (1.89 OR; 95% CI, 1.24-2.88; 3 studies) and the diagnosis of vaginismus. A significant relationship was found between sexual abuse and dyspareunia (1.53 OR; 95% CI, 1.03-2.27; 6 studies). No statistically significant relationship was observed between physical abuse, vaginismus, and dyspareunia. No significant difference was found between sexual or physical abuse in terms of assessment methods for the diagnosis of vaginismus and dyspareunia.

CLINICAL IMPLICATIONS

This systematic review and meta-analysis points out that in the assessment of vaginismus patients, the risk of sexual and emotional abuse and in the assessment for dyspareunia patients, the risk of sexual abuse should be questioned and addressed in its treatment.

STRENGHT AND LIMITATIONS

The strength of the current meta-analysis is the inclusion of all forms of abuse, and studies published in Turkish and English with a broad and reproducible search strategy. The limitations of this meta-analysis are the exclusion of sources and design other than journal articles and case-control studies, including studies both childhood and adult abuse, which in some studies were not differentiated, having potential language and recall bias.

CONCLUSION

The study analysis suggests an association of vaginismus with sexual and emotional abuse and dyspareunia with sexual abuse. However, both disorders showed no association with physical abuse. S. Tetik, ÖY. Alkar, Vaginismus, Dyspareunia, and Abuse History: A Systematic Review and Meta-analysis. J Sex Med 2021;18:1555-1570.

The role of personal factors in quality of life among Iranian women with vaginismus: a path analysis

Background

The aim of this study was to provide a path model for assessing the direct and/or indirect effects of psychological/behavioral parameters on health-related quality of life among women with vaginismus.

Methods

A cross-sectional study was conducted on a sample of 236 women with vaginismus disorder attending to sex clinics in Tehran, Iran from April 2017 to March 2018. Data were collected using a demographic questionnaire, the marital satisfaction scale, the hospital anxiety and depression scale, the rosenberg self-esteem scale, the body image concern inventory, the short-form health survey (SF-12) and the female sexual quality of life questionnaire. In addition to descriptive statistical data, the fitness of the proposed model was investigated using path analysis.

Results

The results of path analysis demonstrated that the final model had a good fit to the data (Chi-Square/degrees of freedom (Normed Chi²) = 2.12, root mean square error of approximation = 0.069, goodness fit index = 0.99, both comparative fit index = 0.99 and Tucker–Lewis index = 0.96). In this model, anxiety and depression significantly predicted health-related quality of life as measured by the SF-12.

Conclusions

Anxiety and depression are important components in predicting health-related quality of life among those suffering from vaginismus.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01799-5.

The effect of biofeedback interventions on pain, overall symptoms, quality of life and physiological parameters in patients with pelvic pain : A systematic review

Background

Biofeedback is recognized as an effective additive method for treating certain phenotypes of chronic pelvic pain syndrome and is a therapeutic option in other pelvic pain conditions. This review aims to evaluate evidence from the literature with a focus on the effect of biofeedback on pain reduction, overall symptom relief, physiological parameters and quality of life.

Methods

A systematic literature search was conducted using the databases PubMed, MEDLINE, Embase, Cochrane Library and PEDro from inception to July 2020. Data were tabulated and a narrative synthesis was carried out, since data heterogeneity did not allow a meta-analysis. The PEDro scale and the McMaster Critical Review Form—Quantitative Studies were applied to assess risk of bias.

Results

Out of 651 studies, 37 quantitative studies of primary research evaluating pelvic pain conditions in male and female adults and children were included. They covered biofeedback interventions on anorectal disorders, chronic prostatitis, female chronic pelvic pain conditions, urologic phenotypes in children and adults and a single study on low back pain. For anorectal disorders, several landmark studies demonstrate the efficacy of biofeedback. For other subtypes of chronic pelvic pain conditions there is tentative evidence that biofeedback-assisted training has a positive effect on pain reduction, overall symptoms relief and quality of life. Certain factors have been identified that might be relevant in improving treatment success.

Conclusions

For certain indications, biofeedback has been confirmed to be an effective treatment. For other phenotypes, promising findings should be further investigated in robust and well-designed randomized controlled trials.

Effect of psychiatric symptoms and male sexual function of couples on the success of treatment for vaginismus

Background This study evaluated psychiatric factors and sexual functions of women with vaginismus and their partners during the treatment process.

METHODS

The study was performed on 110 women diagnosed with vaginismus and their partners. The women underwent cognitive behavioural therapy (CBT), and couples were divided into two groups: successful and unsuccessful therapy. Sexual function in couples was evaluated using the Golombok Rust Index of Sexual Satisfaction (GRISS) in men and the Female Sexual Function Index in women. The psychopathological symptoms of participants were evaluated using the Symptom Check List-90-Revised (SCL-90-R).

RESULTS

Of the 110 women in this study, 98 completed CBT and treatment was successful for 59 (60.2%). GRISS scores pertaining to the subscales of infrequency (66.7% and 39.0%), non-communication (56.4% and 22.0%), avoidance (76.9% and 52.5%), impotence (56.4% and 33.9%) and premature ejaculation (64.1% and 32.2%) before treatment were significantly lower in the successful than unsuccessful treatment group (P < 0.05). Furthermore, there was a positive correlation between complaints of impotence and premature ejaculation in men and symptoms of depression and anxiety in men. In the successful treatment group, pretreatment values were lower for the SCL-90-R subscales of anxiety and depression in men and anxiety, depression, phobic anxiety and obsessive compulsiveness in women than in the unsuccessful treatment group.

CONCLUSIONS

The psychiatric symptoms and sexual functions of couples were found to affect the success of treatment for vaginismus. As such, treatments should be administered in accordance with other symptoms present in couples.

Importance of gynecological assessment for the treatment of vaginismus as a predictive value

AIM

In this study, we aimed to analyze the impact of a detailed anamnesis and gynecological examination findings of women with vaginismus on its treatment success in a tertiary therapy center with 18 years of experience.

METHODS

The socio-demographical factors, gynecological examination notes and the treatment results of 281 vaginismus patients were analyzed between July 2018 and July 2019. The relationship with these parameters and the number of sessions for treatment were evaluated.

RESULTS

The women with higher vaginismus grade had a longer duration of marriage (P < 0.001) and they needed more CBT sessions (P = 0.004). On the other hand, the age of the patient, duration of the relationship, education level, and surgical intervention (hymenotomy, hymenectomy) or presence of anatomically pathological hymen did not affect the outcomes regarding the number of sessions, duration of the treatment and the rate of successful penetration.

CONCLUSION

Gynecological evaluation and detailed anamnesis that is taken upon the first admission has an important impact on the management of therapy and the treatment success.

Assessment of the Association of Cannabis on Female Sexual Function With the Female Sexual Function Index

Introduction

Cannabis use has increased in the last decade, and the impact of cannabis on female sexual function remains unclear.

Aim

To assess the impact of frequency of use, chemovar (tetrahydrocannabinol, cannabinol, or both) type, and method of consumption on female sexual function among cannabis users.

Methods

Adults who visited a single-partner cannabis dispensary's locations were invited to participate in an uncompensated, anonymous online survey October 20, 2019 and March 12, 2020. The survey assessed baseline demographics, health status, cannabis use habits as well as used the validated Female Sexual Function Index (FSFI) to assess sexual function.

Main Outcome Measure

The main outcomes of this study are the total FSFI score (sexual dysfunction cutoff <26.55) and subdomain scores including desire, arousal, lubrication, orgasm, satisfaction, and pain.

Results

A total of 452 women responded with the majority between the ages of 30–49 years (54.7%) and in a relationship or married (81.6%). Of them,72.8% reported using cannabis more than 6 times per week, usually through smoking flower (46.7%). Women who reported more cannabis use, reported higher FSFI scores (29.0 vs 26.7 for lowest vs highest frequencies of reported use, P = .003). Moreover, an increase in cannabis use frequency by one additional use per week was associated with an increase in total FSFI (β = 0.61, P = .0004) and subdomains including desire domain (P = .02), arousal domain (P = .0002), orgasm domain (P = .002), and satisfaction domain (P = .003). For each additional step of cannabis use intensity (ie, times per week), the odds of reporting female sexual dysfunction declined by 21% (odds ratio: 0.79, 95% confidence interval: 0.68–0.92, P = .002). Method of consumption of cannabis and chemovar type did not consistently impact FSFI scores or odds of sexual dysfunction.

Conclusion

Increased frequency of marijuana use is associated with improved sexual function among female users, whereas chemovar type, method of consumption, and reason for use does not impact outcomes.

Kasman AM, Bhambhvani HP, Wilson-King G, et al. Assessment of the Association of Cannabis on Female Sexual Function With the Female Sexual Function Index. Sex Med 2020;8:699–708.

Biofeedback versus electrical stimulation for sexual dysfunction: a randomized clinical trial

INTRODUCTION AND HYPOTHESIS

Sexual dysfunction is a common problem in the general population. We compared the effects of biofeedback and electrical stimulation on the symptoms of sexual pain dysfunction in women with urinary stress incontinence.

METHODS

We carried out a parallel randomized clinical trial in an outpatient department for physical medicine and rehabilitation at a university hospital. Based on DSM-5 criteria for sexual dysfunction, 22 patients with sexual dysfunction and stress incontinence were included and randomly allocated to each study arm. The primary outcome measure was the total score on the Female Sexual Function Index. Each group underwent pertinent treatment for 100 min, two times a week for 6 weeks.

RESULTS

Both groups showed favorable outcomes in increasing Female Sexual Function Index mean scores and their domains. However, for improving sexual function, women in the biofeedback group benefited more than those receiving electrical stimulation. Biofeedback raised desire, arousal, lubrication, orgasm, and satisfaction scores more than electrical stimulation (all p ≤ 0.025). Both interventions decreased pain during or following vaginal penetration similarly (p = 0.985).

CONCLUSIONS

Both biofeedback and electrical stimulation increased the Female Sexual Function Index score. However, to improve sexual function, women undergoing biofeedback seem to benefit more than those receiving electrical stimulation. We recommend considering the prescription of biofeedback for the treatment of sexual dysfunction because of its efficacy, lack of adverse effects, and easy application.