Vaginismus Treatment Guide: Physiotherapy, Dilators, CBT, Botox & Recovery

Vaginismus treatment is highly effective and surgery is rarely needed. The most successful approach is multidisciplinary — combining pelvic floor physiotherapy, graduated vaginal dilator therapy, psychological support (CBT or psychosexual counseling), and sometimes Botox injections for severe cases. Most women see significant improvement within 6–12 weeks of dedicated, consistent treatment. Success rates at a glance: - Pelvic floor physiotherapy alone: 60–70% - Physiotherapy + psychological support: 75–82% - Physiotherapy + dilators + psychological support: 80–85% - Botox + physiotherapy + psychological support: 85–90% - Multidisciplinary treatment (all modalities): 80–90% Surgery is not a treatment for vaginismus. Vaginismus is a nervous system and pelvic floor muscle condition — not a structural or anatomical problem — and it responds well to conservative, non-surgical treatment. A note on the numbers in this guide: The percentages attached to specific modality combinations throughout this article (e.g., "physiotherapy alone," "physiotherapy + dilators") are illustrative ranges drawn from smaller individual studies, not a single formally pooled statistic — real vaginismus care rarely isolates one modality this cleanly. The two figures worth treating as precise are from Zulfikaroglu's 2026 meta-analysis of 18 studies/863 patients: pooled success rates of 85% for physiotherapy, 78% for dilators, 82% for CBT, 85% for Botox, and 86% for combined psychosexual care — all "as actually delivered" in real treatment programs. See our companion Vaginismus Treatment Research article for the full evidence breakdown. New to vaginismus, or not sure whether this is what you're experiencing? Start with our pillar guide, What Is Vaginismus?, or our companion article, Understanding Vaginismus, which covers diagnosis and the primary-vs-secondary distinction in depth.

Introduction

If you have been diagnosed with vaginismus, you likely have many questions: "What are my treatment options?" "How do I start pelvic floor physiotherapy?" "How do I use vaginal dilators?" "Is Botox safe?" "How long will treatment take?" "What is the success rate?" "Will I need surgery?"

The answers to all of these questions are encouraging. Vaginismus is one of the most treatable female sexual pain disorders. Multiple evidence-based treatment approaches have strong research support, and most women who engage in comprehensive treatment recover fully — achieving comfortable, pain-free penetration and restored sexual intimacy.

This guide covers every treatment option in practical detail: what each treatment involves, how it works, what to expect week by week, what the success rates are, and why surgery is not needed. Whether you are just starting treatment or reassessing an approach that has not yet worked, this guide will help you understand your options and your path to recovery.

Pelvic Floor Physiotherapy for Vaginismus: The Foundation of Treatment

What Is Pelvic Floor Physiotherapy?

Pelvic floor physiotherapy is a specialized form of physical therapy addressing dysfunction of the muscles that support the bladder, uterus, and bowel. For vaginismus, it focuses specifically on reducing chronic pelvic floor muscle tension (hypertonicity), improving conscious muscle control, and gradually desensitizing the nervous system to penetration.

Pelvic floor physiotherapy is recommended as first-line treatment by ACOG's Practice Bulletin No. 213 on Female Sexual Dysfunction, which specifically names it for genito-pelvic pain/penetration disorder, and it is the most extensively studied treatment in the broader peer-reviewed evidence base. (Note: the European Association of Urology's guidelines address male sexual dysfunction and female urinary incontinence — not vaginismus — so we don't cite EAU here.)

How Effective Is Pelvic Floor Physiotherapy for Vaginismus?

Research consistently confirms pelvic floor physiotherapy as the most extensively studied and evidence-supported treatment for vaginismus:

• Physiotherapy alone: 60–70% success rate
• Physiotherapy + psychological support: 75–82% success rate
• Physiotherapy + dilators: 70–80% success rate
• Physiotherapy + psychological support + dilators: 80–85% success rate

A comprehensive review by Chalmers (2024) examining 50+ studies concluded that physiotherapy combined with psychological support and graduated exposure achieves consistent success rates of 79%+ in high-quality studies.

What Happens During Pelvic Floor Physiotherapy Sessions?

Session structure: Typical sessions last 45–60 minutes at a frequency of 1–2 per week. A typical session includes:

• Assessment and progress review (10–15 minutes)
• Manual therapy and release techniques (15–20 minutes)
• Biofeedback training (10–15 minutes)
• Relaxation training and exercise prescription (10–15 minutes)

Assessment phase:

Your physiotherapist performs a comprehensive evaluation including:

• Pelvic floor muscle tone and baseline tension
• Ability to voluntarily contract and relax muscles
• Trigger points and areas of specific dysfunction
• Coordination of contraction and relaxation patterns
• Psychological factors observed to affect muscle tension

Treatment interventions:

Manual therapy: Hands-on internal and external release of chronically tight pelvic floor muscles, including trigger point release, myofascial techniques, and gradual desensitization of internal touch.

Biofeedback: Real-time measurement and visualization of pelvic floor electrical activity (EMG biofeedback), giving you objective feedback on muscle tension levels and helping you develop conscious control. Research shows biofeedback significantly enhances treatment outcomes.

Relaxation training:

• Diaphragmatic breathing to activate the parasympathetic nervous system
• Progressive muscle relaxation — systematically tensing and releasing muscle groups
• Mindfulness and meditation for anxiety reduction and body awareness
• Specific reverse Kegel exercises for pelvic floor release

Progressive exposure: Gradually introducing internal touch and penetration — one finger, then two, then dilators — in a fully controlled, patient-paced manner that allows the nervous system to learn that penetration is safe.

Home exercise program: Reverse Kegels, breathing exercises, and dilator practice between sessions — typically 3–4 times per week.

Week-by-Week Progress Expectations for Physiotherapy

• Weeks 1–2: Increased body awareness; beginning to recognize muscle tension patterns; reduced shame and isolation from understanding the condition
• Weeks 3–4: Improved ability to consciously relax muscles; decreased baseline tension; learning relaxation techniques
• Weeks 5–8: Ability to tolerate internal touch; beginning dilator progression; decreased anticipatory anxiety
• Weeks 9–12: Significant improvement in penetration ability; reduced pain and anxiety; growing sexual confidence

How to Use Vaginal Dilators for Vaginismus: A Complete Guide

What Are Vaginal Dilators?

Vaginal dilators are smooth, graduated cylinders — typically made of medical-grade silicone — that come in increasing sizes. Used regularly, they allow your nervous system to learn that penetration is safe, at a completely patient-controlled pace without triggering the protective spasm response.

How Do Vaginal Dilators Work?

Dilators work through several reinforcing mechanisms:

• Graduated desensitization: Controlled, repeated exposure to penetration reduces the nervous system's threat response
• Muscle relaxation: Progressive stretching and relaxation of pelvic floor muscles with each use
• Confidence building: Successful, comfortable experiences at each size build confidence and reduce anticipatory anxiety before progressing
• Predictability and control: Unlike attempted intercourse, dilator use is fully under your control — you set the pace, the depth, and the duration

Dilator Sizes and Progression

Typical medical-grade dilator sets include 4–5 graduated sizes:

Progress to the next size only when the current size feels completely comfortable — no pain, no significant anxiety. Most women progress through all sizes in 4–12 weeks depending on starting point and consistency of practice.

Step-by-Step: How to Use Dilators at Home

Step 1 — Prepare your environment Choose a private, comfortable space where you will not be interrupted. Dim lighting, calming music, or aromatherapy can help reduce anxiety.

Step 2 — Practice relaxation first Spend 5–10 minutes relaxing before inserting the dilator. Use deep diaphragmatic breathing, progressive muscle relaxation, or guided imagery. Your nervous system needs to be in a parasympathetic (calm) state for the muscles to relax.

Step 3 — Apply generous lubrication Apply generous water-based or silicone-based lubricant to both the dilator and the vaginal opening. Adequate lubrication is essential — more is better.

Step 4 — Choose a comfortable position Lie on your back with knees bent and feet flat, or any position that feels comfortable and relaxed. Some women prefer sitting at the edge of a chair.

Step 5 — Insert slowly and gently Guide the dilator toward the vaginal opening at a slight downward angle. Allow it to enter at your own pace. If you feel resistance, pause, breathe, and wait for muscles to relax before continuing. Never force insertion.

Step 6 — Hold and breathe Once the dilator is inserted comfortably, leave it in place for 10–15 minutes while continuing to breathe deeply. The goal is not to push in and out — it is simply to hold the presence of the dilator while your muscles learn to relax around it.

Step 7 — Remove gently and acknowledge your progress Remove slowly. Take a moment to acknowledge the practice — every session trains your nervous system toward safety.

Practice frequency: Use dilators 3–4 times per week. Consistency is more important than duration. Regular, repeated practice is what retrains the nervous system.

Troubleshooting Common Dilator Challenges

• Difficulty with insertion: Use more lubricant, extend the pre-insertion relaxation period, try a different position, or go back to a smaller size
• Pain or sharp discomfort: Stop immediately. Pressure and stretching sensation are expected; sharp pain is a signal to slow down. Discuss with your physiotherapist
• Anxiety spiking before insertion: Extend relaxation practices; consider whether psychological support could help manage anticipatory anxiety
• No progress after several weeks: Ensure you are using dilators consistently; combine with physiotherapy sessions; discuss with your healthcare provider whether the treatment plan needs adjustment

Dilator Therapy Success Rates

• Dilators alone: 50–65%
• Dilators + physiotherapy: 70–80%
• Dilators + psychological support: 65–75%
• Dilators + physiotherapy + psychological support: 80–85%

Dilators are most effective as part of a comprehensive treatment program — not as a standalone intervention.

CBT and Psychotherapy for Vaginismus: Addressing the Fear Component

Why Psychological Treatment Is Essential

Vaginismus is fundamentally a fear-based condition. The involuntary muscle tightening is driven by the nervous system's perception that penetration is dangerous. Without addressing this fear and the catastrophic thinking that reinforces it, physical interventions alone cannot achieve lasting recovery. Psychological treatment is not optional — it is a core component of evidence-based care.

How Effective Is CBT for Vaginismus?

• CBT alone: 50–65% success rate
• CBT + physiotherapy: 75–82% success rate
• CBT + physiotherapy + dilators: 80–85% success rate

The Zulfikaroglu (2026) meta-analysis found CBT delivered as part of a combined psychosexual intervention achieved an 82% success rate — one of the highest rates for any standalone psychological treatment in sexual medicine.

What Happens in CBT for Vaginismus?

Step 1 — Identifying catastrophic thoughts:

Your therapist helps you identify the thoughts that trigger and maintain fear:

• "Penetration will be extremely painful"
• "Something is permanently wrong with my body"
• "I will never be able to have normal sex"
• "My partner will leave me if I cannot have sex"

Step 2 — Challenging unhelpful thoughts:

Your therapist helps you examine the evidence for and against these beliefs:

• "What actual evidence do I have that penetration will always be extremely painful?"
• "What do I actually know about my body vs. what I am assuming?"
• "What are realistic expectations for treatment outcomes?"

Step 3 — Developing balanced, accurate thoughts:

• "My body is responding to a learned threat signal — not to actual permanent damage"
• "Treatment is effective; recovery is the norm for women who engage with comprehensive care"
• "My partner cares about me and wants to support me through this"

Step 4 — Behavioral experiments:

Gradually testing catastrophic predictions through exposure — observing what actually happens versus what was feared — builds a new evidence base that reduces anxiety over time.

Session Structure and Timeline

• Typical session length: 45–60 minutes, 1–2 sessions per week
• Typical CBT duration: 8–16 weeks for significant improvement
• Home practice: Thought records, relaxation exercises, behavioral experiments between sessions

Progress expectations:

• Weeks 1–2: Increased awareness of thought patterns and anxiety triggers
• Weeks 3–4: Beginning to challenge unhelpful thoughts; developing coping strategies
• Weeks 5–8: Reduced anticipatory anxiety; improved ability to manage fear responses
• Weeks 9–12: Significant reduction in fear; growing sexual confidence; reduced avoidance
• Weeks 13–16: Maintenance of gains; relapse prevention strategies

Psychosexual Counseling and Couples Therapy

Psychosexual counseling addresses broader sexual health and relationship dimensions: sexual education, relationship dynamics, communication skills, emotional intimacy, and partner involvement in treatment.

Trauma-informed therapy: For women with a history of sexual trauma or abuse, trauma-informed approaches — EMDR, Somatic Experiencing, or trauma-focused CBT — achieve 70–80% success rate when combined with physiotherapy. Trauma-informed care is essential when trauma is a contributing factor; standard CBT alone is insufficient.

Couples therapy: Partner support is a significant predictor of treatment success. Couples therapy can help partners understand vaginismus, communicate more effectively, maintain intimacy during treatment, and work as a team toward recovery.

For practical scripts on talking to your partner, managing wedding-night anxiety, and processing trauma alongside treatment, see our companion guide, Emotional Health and Vaginismus.

Botox Treatment for Vaginismus: When and How It Works

What Is Botox Treatment for Vaginismus?

Botox (botulinum toxin A) is a medical intervention that temporarily relaxes pelvic floor muscles by blocking acetylcholine — the neurotransmitter that signals muscles to contract. When injected precisely into the pelvic floor muscles, Botox reduces involuntary contractions and baseline tension, creating a therapeutic window during which dilator therapy and physiotherapy can proceed without triggering the protective spasm response.

Botox is not first-line treatment — physiotherapy and psychological support are the evidence-based first-line approaches. Botox is recommended as an adjunct or second-line treatment for severe or refractory cases.

How Effective Is Botox for Vaginismus?

• Botox alone (without adjunct therapy): 60–70% — significantly lower; accompanying physiotherapy and psychological support are essential for lasting results
• Botox + physiotherapy: 80–85%
• Botox + physiotherapy + psychological support: 85–90%

The Zulfikaroglu (2026) systematic review and meta-analysis found Botox achieved an 85% success rate in selected cases when administered by qualified specialists in combination with structured rehabilitation.

Is Botox Safe for Vaginismus Treatment?

Yes — research consistently confirms Botox is safe when administered by a qualified specialist.

Safety profile:

• Over a decade of use in gynecology with a well-documented safety record
• No systemic absorption at the doses used for vaginismus treatment
• No impact on fertility or pregnancy
• No long-term safety concerns identified in the literature

Potential side effects are rare and temporary:

• Increased urinary urgency or frequency
• Temporary difficulty with bowel movements
• Transient pelvic floor muscle weakness
• Mild discomfort at the injection site

When Is Botox Recommended?

Botox is appropriate for:

• Severe vaginismus not responding to 8–12 weeks of conservative treatment (refractory cases)
• Primary vaginismus with very high baseline muscle tension preventing dilator use
• Secondary vaginismus with significant trauma-related muscle tension
• Women who want to accelerate treatment alongside physiotherapy
• Women unable to tolerate dilator progression due to severe spasm

The Botox Procedure: What to Expect

Before:

• Specialist consultation and baseline assessment of pelvic floor muscle tension
• Discussion of expectations, benefits, risks, and aftercare
• Scheduling of procedure with appropriate consent

During:

• Local anesthesia or sedation depending on provider preference and patient anxiety level
• 3–5 targeted injections into the pelvic floor muscles
• Procedure duration: 15–30 minutes
• Performed in a private clinical setting

After:

• Mild cramping or discomfort typically resolves within hours
• Avoid strenuous exercise for 24–48 hours
• Avoid sexual activity for 1–2 weeks
• Begin dilator therapy once Botox takes effect — typically 3–7 days post-procedure

Onset and duration:

• Effect begins: 3–7 days post-injection
• Maximum effect: 2–3 weeks
• Duration: approximately 3–4 months
• Repeat treatments: 2–3 sessions may be needed for long-term results; the goal is to use each treatment window to retrain the nervous system so the reflex does not return

Botox for Vaginismus Cost in Riyadh

Costs vary depending on clinic, provider, and treatment package:

Insurance coverage: Contact your insurer directly for vaginismus-related coverage:

• Bupa Arabia: May cover pelvic floor physiotherapy and related consultations
• Tawuniya: Check plan-specific coverage for physiotherapy and specialist consultations
• MedGulf: Verify coverage before treatment begins

Dr. Dina Rezk Clinic offers Botox for vaginismus in Riyadh — administered by a certified specialist and combined with structured physiotherapy and psychological support. [Book a consultation →]

Vaginismus Recovery Timeline: What to Expect at Each Stage

Week-by-Week Recovery Guide

Weeks 1–2: Assessment and Planning

• Comprehensive assessment — diagnosis confirmed, contributing factors identified
• Discussion of all treatment options; personalized treatment plan developed
• Beginning of psychological support if applicable
• What to expect: Understanding your condition clearly; reduced shame, isolation, and confusion

Weeks 3–4: Beginning Active Treatment

• Starting pelvic floor physiotherapy (1–2 sessions per week)
• Learning relaxation techniques and breathing exercises
• Beginning home relaxation and reverse Kegel practice (3–4 times per week)
• Starting CBT or psychosexual counseling if applicable
• What to expect: Increased body awareness; beginning to recognize muscle tension patterns and triggers

Weeks 5–8: Active Treatment Phase

• Continuing physiotherapy with manual therapy and biofeedback
• Beginning dilator therapy — starting at smallest comfortable size
• Progressing relaxation techniques and breathing practices
• Continuing psychological support; beginning exposure work
• What to expect: Improved ability to relax muscles; beginning dilator progression; decreased baseline tension; reduced anticipatory anxiety

Weeks 9–12: Significant Improvement Phase

• Continuing physiotherapy with focus on progressive penetration exposure
• Progressing dilator sizes systematically
• Continued psychological support with focus on consolidating gains
• What to expect: Significant improvement in penetration ability; reduced pain; growing sexual confidence; reduced avoidance behaviors

Weeks 13–16: Consolidation and Maintenance

• Reducing physiotherapy frequency (1 session per week or less)
• Continuing home dilator practice independently
• Continued psychological support for confidence maintenance
• What to expect: Ability to achieve comfortable penetration; reduced fear and anxiety; improved sexual satisfaction; considering partner involvement in intimacy

Months 4–6: Long-Term Maintenance

• Occasional physiotherapy check-ins (monthly or as needed)
• Independent home practice
• Ongoing psychological support as needed
• What to expect: Sustained improvement; ability to have comfortable sexual intercourse; improved relationship satisfaction and emotional intimacy

Factors That Speed Recovery

• Early treatment: Seeking help early — before fear becomes deeply entrenched — consistently produces faster, better outcomes
• Multidisciplinary approach: Combining physiotherapy, psychological support, and medical interventions when needed
• Consistency: Regular home practice with dilators and relaxation exercises between sessions
• Partner support: An informed, patient, non-pressuring partner is a measurable predictor of success
• High motivation: Actively engaging with all components of treatment

Factors That May Slow Recovery

• Severe anxiety or depression: Requires additional psychological support — treating the mental health condition is part of treating vaginismus
• Trauma history: Requires trauma-informed care; treatment timelines are typically longer but outcomes remain good
• Relationship conflict: May require couples therapy as an adjunct
• Multiple co-occurring conditions: Vulvodynia, hormonal atrophy, or endometriosis present alongside vaginismus require comprehensive treatment addressing all conditions simultaneously. See Vaginismus and Related Conditions for how these conditions interact and how to get an accurate diagnosis.

Vaginismus Treatment Success Rates: What the Research Shows

Success Rates by Treatment Approach

For the full evidence discussion behind these numbers — including why "alone" and "combined" figures differ — see our companion Vaginismus Research article.

Long-Term Outcomes

Recovery from vaginismus is durable:

• 70–80% of women who achieve successful penetration maintain it long-term
• Relapse rates are low (10–20%) — typically triggered by new life stressors or untreated contributing factors, not by treatment failure
• Women who complete treatment report significant improvements in sexual satisfaction, relationship quality, and psychological wellbeing — not just penetration ability
• Ongoing follow-up support (periodic check-ins) significantly reduces relapse risk

Does Vaginismus Require Surgery?

Will I Need Surgery for Vaginismus?

No. Surgery is not a treatment for vaginismus and is rarely needed. Vaginismus is not a structural or anatomical problem — it is a functional disorder of the nervous system and pelvic floor muscles. It does not involve tissue damage, anatomical abnormality, or pathology that requires surgical correction.

Conservative (non-surgical) treatment is highly effective and is recommended as the definitive treatment by all major clinical guidelines. Surgery carries genuine risks — infection, scarring, complications — without addressing the underlying fear-based nervous system response that causes vaginismus. Even if surgery were performed, the involuntary muscle tightening and anxiety would remain.

Five key reasons surgery is not recommended:

1. Conservative treatment is highly effective (60–90% success rates)
2. Vaginismus involves no anatomical pathology requiring surgical correction
3. The condition is fully reversible through nervous system retraining
4. Surgical risks outweigh benefits in the absence of structural pathology
5. Surgery does not address the underlying fear and anxiety that drive vaginismus

When Is Surgery Ever Considered? (Rare Cases)

Surgery is only considered in extremely rare cases when:

• A specific anatomical abnormality is identified that genuinely contributes to the presentation — such as a thick hymen, vaginal septum, or surgical scarring
• Conservative treatment has been comprehensively attempted for 6+ months without improvement
• A surgeon with sexual medicine expertise is involved
• Surgery is combined with physiotherapy and psychological support — never performed in isolation

What About Hymenectomy for Vaginismus?

Hymenectomy (surgical modification of the hymen) is generally not recommended for vaginismus because:

• The hymen is not the cause of vaginismus — the cause is involuntary pelvic floor muscle tightening triggered by a fear-based nervous system response
• Removing or modifying the hymen does not resolve the muscle spasm or the underlying fear; symptoms persist after surgery
• Hymenectomy as a sole treatment has poor outcomes; without physiotherapy and psychological support, success rates are very low
• Surgery carries real risks of infection, scarring, and complications

This is particularly relevant in Saudi Arabia and the Gulf, where hymenectomy is sometimes suggested before a vaginismus diagnosis has been properly made. If you have been advised to have surgery for pain during intercourse or inability to have penetration, seek assessment from a specialist in pelvic floor dysfunction and sexual health first.

Myths vs. Facts About Vaginismus Treatment

Frequently Asked Questions About Vaginismus Treatment

Conclusion: Your Path to Recovery

Vaginismus is highly treatable — and surgery is never part of that treatment. The evidence is clear: comprehensive, multidisciplinary care combining pelvic floor physiotherapy, psychological support, and graduated dilator therapy achieves success rates of 80–90%. Most women see meaningful improvement within 6–12 weeks.

Your recovery begins with understanding the condition, finding qualified professionals who specialize in pelvic floor dysfunction and sexual health, and committing consistently to the treatment process. Every dilator session, every physiotherapy appointment, every CBT exercise is retraining your nervous system — moving it incrementally from threat to safety.

Recovery is the norm, not the exception. Most women who engage in comprehensive vaginismus treatment recover fully and go on to enjoy comfortable, satisfying sexual intimacy.

At Dr. Dina Rezk Clinic in Riyadh, we provide comprehensive, evidence-based vaginismus treatment — including specialist consultation, pelvic floor assessment, coordinated physiotherapy and psychological referrals, and Botox for vaginismus where appropriate. All care is confidential, compassionate, and tailored to your individual situation. [Book your private consultation →]

References

1. Chalmers, K. J. (2024). Clinical assessment and management of vaginismus. Australian Journal of General Practice, 53(1–2), 37–41. DOI: 10.31128/ajgp/06-23-6870
2. de Souza, H. F. (2025). What is vaginismus? A guide for women's sexual health. News Medical. https://www.news-medical.net/health/What-is-Vaginismus-A-Guide-for-Womene28099s-Sexual-Health.aspx
3. Lahaie, M., Boyer, S. C., Amsel, R., et al. (2010). Vaginismus: A review of the literature on the classification/diagnosis, etiology and treatment. Women's Health, 6(5), 705–719. DOI: 10.2217/whe.10.46
4. Maseroli, E., Scavello, I., Rastrelli, G., et al. (2018). Outcome of medical and psychosexual interventions for vaginismus: A systematic review and meta-analysis. The Journal of Sexual Medicine, 15(12), 1752–1764. DOI: 10.1016/j.jsxm.2018.10.003
5. Pithavadian, R., Chalmers, J., & Dune, T. (2023). The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review. Women's Health, 19, 17455057231199383. DOI: 10.1177/17455057231199383
6. Tetik, S., & Yalçınkaya Alkar, Ö. (2021). Vaginismus, dyspareunia and abuse history: A systematic review and meta-analysis. The Journal of Sexual Medicine, 18(9), 1555–1570. DOI: 10.1016/j.jsxm.2021.07.004
7. Goldstein, A. T., Pukall, C. F., & Goldstein, I. (Eds.). (2009). Female sexual pain disorders: Evaluation and management. Wiley-Blackwell.
8. Zulfikaroglu, E. (2026). Vaginismus treatment: A systematic review and meta-analysis of contemporary therapeutic approaches. The Journal of Sexual Medicine, 23(1), qdaf295. DOI: 10.1093/jsxmed/qdaf295
9. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. (2019). Female sexual dysfunction. ACOG Practice Bulletin No. 213. Obstetrics & Gynecology, 134(1), e1–e18. DOI: 10.1097/AOG.0000000000003324 (Reaffirmed 2021; revised 2022; reaffirmed 2024; minor revision 2026.)