| Sumario: | AbstractBackgroundMethodsResultsConclusionVaginismus 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.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.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; <italic>P</italic> < .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; <italic>P</italic> < .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 <italic>P</italic> < .001).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.
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