Darla Cathcart Talks About Her New Course: Vaginismus and Vulvovaginal Dyspareunia

Darla Cathcart, PT, DPT, WCS, CLT  graduated from Louisiana State University (Shreveport, LA) with her physical therapy degree, performed residency training in Women’s Health PT at Duke University, and received her Ph.D. from the University of Arkansas Medical Sciences. Her dissertation research focus was on using non-invasive brain stimulation to augment behavioral interventions for women with lifelong vaginismus, and her ongoing line of research will continue to center around pain with intercourse. Darla is part of Herman & Wallace's core faculty and instructs Pelvic Floor Level 1, Level 2A, and Level 2B, the Pregnancy & Postpartum Series, and recently launched her own course Vaginismus and Vulvovaginal Dyspareunia.

How is this class different from the information in Pelvic Floor 2B?
The main difference is in the questions that these two courses answer: "what treatments can I use" versus "how can I use those treatments effectively?" In Pelvic Floor Level 2B, participants are told about various methods for addressing pain with intercourse (such as using vaginal trainers/dilators and manual therapy techniques), with brief descriptions of how to use some of these tools. In this Vaginismus and Vulvovaginal Dyspareunia course, we go into depth on how to use these treatments specifically based on a patient's examination findings and goals.

What are the top 5 takeaways a practitioner could hope to gain from this class?
1. Vaginal Trainers (dilators) can be more effective when going beyond "just sticking them in."Traditionally, patients have been taught to just insert "dilators" to a point of stretching and discomfort, and to hold that stretch, maybe even distract themselves from the activity by watching TV or reading a book. As with other areas of the body, using active methods to increase tissue flexibility, such as incorporating contract-relax and breathing techniques, can really enhance the treatment! During the labs in this 100% remote course (a combination of self-paced preview videos and live online instruction), participants will be guided through step-by-step instructions for using and progressing through vaginal trainers and other treatments (the same step-by-step instructions you can use with your patients on Monday morning!). Additionally, as in other areas of the body, focusing on the body part that is being worked on is beneficial for increasing motor control, which is also desirable for addressing pelvic floor muscles that have too much tone and tenderness or pain with attempts at insertion. Participants will also be walked through activities that increase the brain's connection with and control of the pelvic floor and genitals, thus tapping into contemporary pain science concepts as well. And speaking of pain science . . .

2. As a practitioner, you likely already know that our words, verbiage for questions and instruction, and analogies and stories matter! Throughout the course, we will talk about why some words or terms can be harmful or less helpful, and how to replace them with healing or more neutral terms. For instance, we will talk about how the traditional term "dilator" can be a bit scary and anxiety-provoking for someone who has had lifelong vaginismus; but the term "trainer" suggests that the muscles are being taught and retrained on how to function. We will also walk through examples of approaching and discussing sexual abuse and trauma, general sexual history and activity, and patient goals. We will review some basics about contemporary pain science, and analogies that we can share with our patients to help decrease their fear and anxiety surrounding treatment for and engaging in sexual function. Participants should leave the course feeling more confident in talking about sex with their patients!

3. How do we incorporate the female sexual cycle/response (arousal, desire, orgasm), sexual positioning, and sexual assist devices and props into helping our patients? These are topics that will be tackled and broken down in both the preview material, with key concepts being reviewed or covered during the live remote portion of the course. We will talk about using the timing of sexual responses to a patient's advantage with transitioning to sexual function.

4. When should a patient move from vaginal trainers to the bedroom? Should the patient's partner(s) be involved? How do I answer questions about specific sexual positions? How do I answer my patient's questions about libido concerns? These are all concepts that will be tackled, with both specific examples and cases and also with general guidelines for applying the information to your individual patients.

5. You will have the opportunity to practice or follow along with the very things you will teach your patients during the live remote lab portion of the course, from the privacy of your own home or private treatment room in your office. I believe a great advantage that rehabilitation professionals have in treating patients is that we have experienced many of the examination and treatment techniques while practicing them in a class, course, or another setting. Personally testing out these techniques gives you, as a practitioner, a strong advantage in knowing how to best describe the nuances of applying treatments to aid in your patient's understanding. It also gives you a good dose of empathy for being the person on the table!

What special interest do you have in this topic?
As a pelvic health therapist for over 20 years, working with patients who have lifelong vaginismus, acquired vaginismus, and dyspareunia has been one of my primary passions. In completing a Ph.D. in 2020, my line of research began with a clinical randomized controlled trial working with patients with lifelong vaginismus and vaginal trainers, using neuroscience and pain science concepts to incorporate contract-relax and breathing techniques to enhance treatment. I never tire of having a patient return to the clinic excited that they finally had pain-free intercourse! I am passionate about teaching other therapists, healthcare providers, patients, and their partners about the concepts I've learned in my many years of practice.

Who is the audience for this class?
This course is for any pelvic health rehabilitation or health care provider who is a novice or wants to enhance their skills for working with patients with vaginismus and vulvovaginal dyspareunia.

Why was it needed and developed?
This course, Vaginismus and Vulvovaginal Dyspareunia, is needed to move beyond the basic concepts about what we can do to help patients having pain with intercourse. This course takes a deep dive into the detail of how to make the rubber meet the road to not only get treatment started but to really help progress a patient into a satisfying sex life. This course was developed so that the participant could leave this course and understand how to really approach the examination, history taking, and step-by-step procedures in instructing and using vaginal trainers and other tools for patients having painful intercourse. Additionally, this course should increase the practitioner's confidence in incorporating instructions and education related to a patient's concerns about the female sexual cycle and response (arousal, desire, orgasm), sexual positioning, lubrication, and partner integration.

Vaginismus and Vulvovaginal Dyspareunia

Course Date:
February 4

Price: $375
Experience Level: Beginner
Contact Hours: 15

Description: This course is for the pelvic health practitioner who is new to treating patients with vaginismus/vulvovaginal dyspareunia or to vaginal trainer(dilator) use or pelvic health rehabilitation; or for the experienced practitioner who has found that patients with vaginismus/vulvovaginal dyspareunia plateau with vaginal trainers or other treatments. In this course, pelvic health rehabilitation providers will learn about the different types of vaginismus and dyspareunia. Definitions and history of terminology will be explained related to pain with sexual activity and intercourse, including Genito-Pelvic Pain/Penetration Disorder, Lifelong or Primary Vaginismus, Acquired or Secondary Vaginismus, Dyspareunia, Vulvodynia, and others.

From a pain-science viewpoint, verbiage and terminology to reduce patient fear and anxiety will be discussed and incorporated throughout the course. Evidence for focalized dystonia as a component of lifelong vaginismus and how that impacts treatment will be reviewed. Causes for acquired vaginismus (such as postpartum healing or hormonal changes) will be addressed. Treatment approaches for reducing patient fear and anxiety, addressing medical and/or sexual trauma/abuse history, and promoting patient empowerment will be covered. The remote live portion of the course will also focus on rehabilitation treatments, including walking the participant through the functional use of vaginal trainers (commonly known as dilators), and methods for progressing their use. Clinical cases will be provided to illustrate a variety of treatment approaches based on different patients’ treatment goals, history, examination findings, and sexual pain diagnosis.