Implementing Virtual Reality Exposure Therapy for Vaginismus: From Efficacy to Clinical Integration (VIVID 3) (VIVID 3)

July 30, 2026 updated by: Lori Brotto, University of British Columbia
Vaginismus, a condition characterized by involuntary tightening of the pelvic floor muscles due to strong fear of vaginal insertion, impact ≥6% of the female population and can make vaginal intercourse and medical exams difficult. This project explores virtual reality exposure (VRE) as a new treatment approach. Building on our two previous studies showing that VRE is feasible and effective in helping patients to gradually face feared sexual encounters in a virtual environment, we aim to implement our VRE protocol at the BC Centre for Vulvar Health (BCCVH). We will assess barriers/facilitators to implementation, clinician uptake, and patients' outcomes and engagement.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

PURPOSE: Vaginismus is a gynecologic condition characterized by involuntary tightening of the pelvic floor muscles. It is defined by intense fear of vaginal insertion, leading to persistent difficulties with vaginal intercourse and gynaecological exams The anticipation of pain provokes hypervigilance, negative cognitions, and avoidance behaviour, leading vaginismus to be conceptualized as a phobia. Equipped with data from Studies 1 and 2 from our 3-stage program for VRE to treat vaginismus, we have demonstrated that our VRE paradigm is feasible to deliver, usable, satisfactory to participants, and highly efficacious. We are now ideally positioned to evaluate the implementation of our VRE paradigm at VCH's BCCVH, which offers multidisciplinary treatment for individuals with chronic and distressing vulvo-vaginal pain and fear of vaginal insertion. Our goal is to use implementation science to study the phased implementation of our VRE protocol within the BCCVH, ultimately leading to better treatment options for women with vaginismus.

JUSTIFICATION: Lack of effective treatments: While vaginismus is common, believed to impact 6% of the female population, it remains underdiagnosed, effective treatment options are limited, and patients often feel dismissed by care providers. Available psychological treatments for vaginismus rely on gradual self-insertion of vaginal dilators at home combined with psychological therapy. However, many individuals experience severe fear and avoidance that make it difficult to engage with these exercises, reducing treatment success. VRE Theoretical approach: This project uses a theoretical approach recognizing that the psychological fear of pain drives hypervigilance to sexual stimuli, leading to physiological responses such as tightening of the pelvic floor muscles which in turn causes physical pain. Thus, addressing fear is a key piece of managing this condition and can be achieved through fear extinction approaches such as exposure therapy. Traditionally, this approach involves repeatedly exposing an individual to the fear-inducing stimulus until their fear decreases (habituates). When exposure is successful, a new association develops and inhibits the retrieval of the original fear memory. Our VRE paradigm is built upon this theory. VRE immerses people in 3D simulations of feared situations and is as effective as real-life exposure for specific phobias. VRE for vaginismus is gradual exposure to feared sexual encounters in a virtual environment and can diminish phobic responses to vaginal insertion. Given that people with vaginismus cope via intense avoidance and often do not perform recommended at-home exposure exercises, the "immersive" nature of VRE ideally target this avoidance.

PROOF OF CONCEPT: Findings from Study 1 & 2 of this 3-stage VRE research program showed that: 1) VR sexual stimuli elicit a greater fear in individuals with vaginismus relative to individuals without, 2) most participants would participate in a VRE intervention in clinic if it was available, and 3) participants strongly support the efficacy of the VRE approach. Together, these findings support the readiness to move forward with preparing for clinic implementation of this approach. The BCCVH is a provincial referral centre providing interdisciplinary, evidence-based care for vulvar and pelvic pain conditions, seeing 250 new patients each year. Its established clinical infrastructure, patient volume, and commitment to innovation make it an ideal setting to evaluate the implementation of VRE within existing clinic workflow.

OBJECTIVES: Our goal is to use implementation science to study the phased implementation of our VRE protocol within the BCCVH. The specific aims are to: (1) Conduct a barriers/facilitators assessment; (2) Evaluate clinician uptake, feasibility, and acceptability with pilot implementation of VRE; and (3) Assess patient reported outcomes of anxiety, sexual distress, pain, and home treatment engagement after VRE.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
167

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • Canada
    • British Columbia
      • Vancouver, British Columbia, Canada, V5Z 1M9
        • Gordon and Leslie Diamond Health Care Centre
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Diagnosis of vaginismus defined by a "marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or because of vaginal penetration" (criterion from the DSM-5 definition of Genito-Pelvic Pain Penetration Disorder)
  • Aged >19 y, of any sexual orientation
  • Fluent in English (psychoeducational materials and questionnaires delivered in English)
  • Normal or corrected-to-normal vision (to view the VR scenes during exposure)
  • Able to travel to Vancouver

Exclusion Criteria:

  • Presence of: unprovoked vaginal pain
  • Vulvar skin condition (i.e., lichen sclerosus)
  • Epilepsy characterized by photosensitive seizures.

Note: provoked vulvar pain is not an exclusion criterion because at least 40% of people with vaginismus report pain with attempted penetration.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Implementation of Virtual reality exposure
The investigators designed the VRE protocol based on our two studies: one proof-of-concept study, and a second study measuring VRE efficacy (both manuscripts under review). We found our VRE protocol to be highly feasible, usable, satisfying, and to lead to significant improvements in our outcomes focused on ease of vaginal insertion and associated vaginal pain. Participants will take part in a one-time 120-minute session, in addition to standard clinical care at the BCCVH, and complete study questionnaires before the VRE session and at follow-up time points to evaluate clinical outcomes. The VRE session will adhere to 3 key principles: (i) Exposure is prolonged; patients view a sexual scene multiple times; (ii) Treatment proceeds gradually, with the sexual activities depicted moving from non-penetrative (low fear) to penetrative (high fear); and (iii) Exposures are repeated, with participants re-watching the videos until their fear response has habituated.
Behavioral: Implementation of Virtual Reality Exposure

To inform implementation, clinicians at BCCVH (n=6) will participate in individual semi-structured interviews prior to implementation to identify barriers and facilitators. Findings from these interviews will refine the implementation protocol. Following implementation, clinicians will complete questionnaires assessing implementation outcomes, including adoption, implementation, and maintenance.

Participants (n=167) will receive a single VRE session in addition to standard clinical care at the BCCVH. The VRE session is designed to support treatment of vaginismus and will be delivered according to the study protocol. Participants will complete study questionnaires at baseline and follow-up.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
VRE session duration
Time Frame: Assessed every session through study completion, 20 months
Time duration of a VRE session will be measured from start to end of each VRE sessions in minutes and logged by facilitators in an Excel session log.
Assessed every session through study completion, 20 months
Staff time & resource utilization
Time Frame: Assessed every session through study completion, 20 months
Staff time, personnel type and equipment used per VRE session will be measured each VRE session and logged by facilitator in an Excel session log.
Assessed every session through study completion, 20 months
Cost of VRE delivery
Time Frame: Assessed at study completion
Estimated cost per session based on staff time, equipment and other resources used to deliver VRE will be calculated from the Excel resource-use log.
Assessed at study completion
Technical challenges & adaptations
Time Frame: Assessed every session through study completion, 20 months.
Number and types of technical challenges encountered when conducting VRE session, and adaptations to protocol made as a result. This will be documented in an Excel study log.
Assessed every session through study completion, 20 months.
Fidelity of VRE delivery
Time Frame: Assessed every session through study completion, 20 months.
Percentage of planned VRE components delivered as intended. Measured using an Excel fidelity log completed by facilitator that conducts VRE session.
Assessed every session through study completion, 20 months.
Clinicians trained in VRE delivery
Time Frame: Assessed at time of training (unknown for now).
Number and proportion of eligible clinicians and staff members receiving training for VRE session delivery. Measured by training attendance log.
Assessed at time of training (unknown for now).
Adoption of VRE
Time Frame: Assessed 6-months and 12-months after implementation.
Adoption will be measured as the proportion of clinicians who report willingness to incorporate VRE into routine clinical practice following implementation, assessed through a survey.
Assessed 6-months and 12-months after implementation.
Maintenance of VRE
Time Frame: Assessed before implementation, 6-months and 12-months after implementation.
Clinicians will answer questionnaires on their intention to use VRE, confidence implementing VRE, and perceived skills and readiness to implement VRE.
Assessed before implementation, 6-months and 12-months after implementation.
Reach
Time Frame: Assessed yearly through study completion, 20 months.
Number of patients seen in one year at the BCCVH who are offered and accept the VRE session.
Assessed yearly through study completion, 20 months.

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Mean change from baseline in State-Trait Inventory for Cognitive and Somatic Anxiety-State score
Time Frame: Baseline at 48 hours before VRE session, 48 hours after VRE session, and 6-months after VRE session.
Participants will answer the State-Trait Inventory for Cognitive and Somatic Anxiety, a 21-item measure, 48 hours before the VRE session, 48 hours after the VRE session, and 6-months following the VRE session. Change will be calculated separately from baseline (48 hours before the VRE session) to 48 hours and 6 months after the VRE session.
Baseline at 48 hours before VRE session, 48 hours after VRE session, and 6-months after VRE session.
Mean change from baseline in Vaginal Penetration Cognition score
Time Frame: Baseline at 48 hours before VRE session, 48 hours after VRE session, and 6-months after VRE session.
Participants will answer the Vaginal Penetration Cognition Questionnaire, a 40-item questionnaire, 48 hours before the VRE session, 48 hours after the VRE session, and 6-months following the VRE session. Change will be calculated separately from baseline (48 hours before the VRE session) to 48 hours and 6 months after the VRE session.
Baseline at 48 hours before VRE session, 48 hours after VRE session, and 6-months after VRE session.
Mean change from baseline in Female Sexual Distress score
Time Frame: Baseline at 48 hours before VRE session, 48 hours after VRE session, and 6-months after VRE session.
Participants will answer the Female Sexual Distress Scale-Revised, a 13-item questionnaire, 48 hours before the VRE session, 48 hours after the VRE session, and 6-months following the VRE session. Change will be calculated separately from baseline (48 hours before the VRE session) to 48 hours and 6 months after the VRE session.
Baseline at 48 hours before VRE session, 48 hours after VRE session, and 6-months after VRE session.
Mean change from before to after VRE in Shortened State scale of the State-Trait Anxiety Inventory score
Time Frame: Immediately before VRE session and immediately after VRE session.
Participants will answer the Shortened State scale of the State-Trait Anxiety Inventory, a 6-item measure, immediately before and immediately after completing the VRE session. Change will be calculated as the immediately post-VRE score to immediately pre-VRE score.
Immediately before VRE session and immediately after VRE session.
Igroup Presence Questionnaire score
Time Frame: Immediately after VRE session.
Participants will answer the Igroup Presence Questionnaire, a 14-item questionnaire, immediately after completing the VRE session. Score will indicate the sense of presence in the virtual environment experienced by the participant.
Immediately after VRE session.
Reported ease of vaginal accommodator insertion
Time Frame: Immediately after VRE, if optional vaginal accommodator insertion attempted.
Participants who choose to attempt vaginal accommodator insertion during the VRE session will rate the ease of insertion on a scale from 0 to 10, where 0 indicates "unable to insert-too difficult" and 10 indicates "could insert with ease".
Immediately after VRE, if optional vaginal accommodator insertion attempted.
Reported pain with vaginal accommodator insertion
Time Frame: Immediately after VRE, if optional vaginal accommodator insertion attempted.
Participants who choose to attempt vaginal accommodator insertion during the VRE session will rate the pain with insertion on a scale from 0 to 10, where 0 indicates "no pain" and 10 indicates "worst possible pain".
Immediately after VRE, if optional vaginal accommodator insertion attempted.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of British Columbia

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Lori Brotto, The University of British Columbia

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 1, 2028

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 1, 2028

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
July 7, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 30, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
August 5, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 5, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 30, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • H26-01276

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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