The comprehensive treatment of VVS should include some form of supportive therapy. VVS disrupts intimate relationships and causes great distress. Because of the intimate nature of their pain, many women delay seeking treatment; those who do are often frustrated and demoralized after appointments with multiple clinicians or after trying numerous interventions without success (15). Because of the significant impact of VVS on intimate relationships and psychological well-being, optimal treatment must address both the psychosexual and physical aspects of the disease. Clinicians must be willing to probe emotional and sexual concerns with sensitivity and be able to make referrals to mental health professionals if necessary (46,49). Supportive psychosocial approaches (such as cognitive-behavioral sex therapy) can serve as primary or adjunctive therapy. Some clinicians advocate integrated treatment programs consisting of physical therapy (including biofeedback), pain management, and psychosexual support as the principal forms of intervention (66).
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