Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Outline steps that should be taken during the pelvic exam to diagnose secondary vaginismus 2. Describe protocols for use of vaginal dilators
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Vaginismus is the involuntary tightening of the vaginal muscles, which can cause painful intercourse. History and physical examination are important to make the correct diagnosis and direct appropriate therapy
Consider secondary vaginismus in a situation where a woman who previously did not have pain during intercourse now describes pain on penetration in the following scenarios
When there is no improvement after patient’s regular use of estrogen creams for the treatment of postmenopausal symptoms related to vaginal atrophy/atrophic vaginitis
Postpartum patients who complain of sexual pain but no obvious clinical source can be visualized
During the pelvic exam
The practitioner should attempt to insert a medium vaginal dilator
If unable to do so, the provider should work with patient on inserting the largest size vaginal dilator possible with minimal pain, gradually increasing size of dilators until she is able to insert a dilator approximate to the size of partner’s penis
In both cases, vaginal dilators should be used in addition to local estrogen treatments
Women with postmenopausal atrophy are most commonly treated with topical estrogen. Practitioners may also consider whether the muscles have concomitantly tightened, causing pain during intercourse. This can be true of post-partum women as well. The use of vaginal dilators to re-stretch the muscles which have tightened can significantly help to alleviate the pain experienced by the patient.
Tight vaginal muscles often accompany postmenopausal atrophy and postpartum pain and this is generally not tested nor detected
Introduction of vaginal dilators of the appropriate size is a simple treatment option that should accompany treatment with local, topical estrogen or estrogen/testosterone
Initial attempt can be made by using a size medium dilator
If this is not successful, practitioner can introduce a smaller one
Patient can use the dilators at home for 10 minutes a day, increasing the size each week until they can insert a dilator which is approximately the size of their partner’s penis with no pain
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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