Effectiveness of Internet-Based Cognitive-Behavioral Therapy in Iranian Women With Vaginismus: A Randomized Controlled Trial Publisher



Bina M ; Merghati Khoei E ; Rahimzadeh M ; Lotfi R
Source: International Journal of Sexual Health Published:2026

Abstract

Background: Vaginismus can substantially affect sexual and relationship well-being, yet evidence regarding internet-based interventions remains limited, particularly in non-Western settings. This study evaluated a culturally adapted, therapist-supported internet-based cognitive-behavioral therapy (CBT) program for Iranian women with primary vaginismus. Methods: In this randomized controlled trial, 40 women with primary vaginismus were randomly assigned to an intervention or waitlist control group (n = 20 each). The intervention group received eight sessions of internet-based CBT. Outcomes were assessed at baseline, immediately post-treatment, and at 4-week follow-up. The primary outcome was successful vaginal (coital) penetration assessed by item 1 of the Penetration Behavior Questionnaire (PBQ). Secondary outcomes were Successful Non-Coital Penetration (SNCP), catastrophic thoughts, and pelvic-floor tightening. Per-protocol analyses included 17 intervention and 20 control participants. Results: Successful vaginal penetration was reported by 12/17 intervention participants (70.6%) versus 0/20 controls immediately post-treatment (risk difference, 70.6 percentage points; 95% CI, 41.9–86.7; P <.001), and by 14/17 (82.4%) versus 0/20 at 4-week follow-up (risk difference, 82.4 percentage points; 95% CI, 54.0–93.8; P <.001). Median SNCP improvement was 4 points in the intervention group versus 0 in controls at both assessments (Holm-adjusted P <.001 and P =.006, respectively). Improvements in catastrophic thoughts and pelvic-floor tightening were also greater in the intervention group at both assessments (both Holm-adjusted P <.001). Conclusion: Therapist-supported internet-based CBT was associated with improved short-term penetration outcomes and reductions in catastrophic thoughts and pelvic-floor tightening. Further evaluation in larger and more diverse samples with longer follow-up is warranted. © 2026 Taylor & Francis Group, LLC.