From a purely somatic point of view, constriction or an obstruction can be solved by using a scalpel. Although Walthard rejected surgical intervention for the treatment of vaginismus as early as in 1909 (45), and Sikkel-Bufinga (46), who performed a follow-up study found that only one vaginistic patient had benefitted from the surgical knife, until recently a few doctors could still be found who opted for such a surgical approach (47). The least vigorous method is dilatation plasty, in contrast with the far more drastic perineal plasty or levator plasty, in which part of the pelvic floor muscles are also cleaved through the midline. The emotional consequences of such an operation can be enormous. The most important consequence is that the woman loses control of her pelvic floor muscles, together with the control over her body and her right to self-determination. This is even more painful when the phenomenon vaginismus is used as a solution for relationship problems. It is remarkable that although this form of therapy was commonplace until recently, very little has been published on it. Treatment with pharmacotherapy including benzodiazepines and Botulinum toxin injections has been mentioned in the literature but no controlled trials are available (48,49).
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