Surrogate Versus Couple Therapy in Vaginismus Itzhak Ben-Zion, MD,* Shelly Rothschild, MD,* Bella Chudakov, MD,* and Ronit Aloni, PhD † *Ben Gurion University, Beer-Sheva, Israel; † Tel Aviv Sex Therapy Clinic, Tel Aviv, Israel DOI: 10.1111/j.1743-6109.2007.00452.x ABSTRACT Introduction. Women who do not have a cooperative partner cannot complete the usual therapeutic process in the treatment of vaginismus, because they cannot progress to the stage of practicing the insertion of the man partner’s fingers and the insertion of a penis. Aim. To compare traditional couple therapy with therapy utilizing a surrogate partner. Methods. The study was controlled and retrospective. Data were obtained from the treatment charts of patients who had come to the clinic for treatment of vaginismus. Sixteen vaginismus patients who were treated with a man surrogate partner were compared with 16 vaginismus patients who were treated with their own partners. Main Outcome Measures. Successful pain-free intercourse upon completion of therapy. Results. One hundred percent of the surrogate patients succeeded in penile–vaginal intercourse compared with 75% in the couples group (P = 0.1). All surrogate patients ended the therapy because it was fully successful, compared with 69% in the couples group. Twelve percent of the couples group ended the therapy because it failed, and 19% because the couples decided to separate. Conclusions. Treating vaginismus with a man surrogate partner was at least as effective as couple therapy. Surrogate therapy may be considered for vaginismus patients who have no cooperative partner. Ben-Zion I, Rothschild S, Chudakov B, and Aloni R. Surrogate vs. couple therapy in vaginismus. J Sex Med 2007;4:728–733. Key Words. Vaginismus; Surrogate Therapy; Couple Therapy Introduction T reatment using a surrogate partner was first reported by Masters and Johnson in 1970 in treatment of erectile dysfunction in men without a partner [1]. Apfelbaum [2] described treatment with a surrogate combined with an additional therapist, for sufferers of a number of sexual dys- functions, which had a success rate of more than 90%. Dauw [3] reported a success rate of 89% in treatment of erectile dysfunction and problems with ejaculation and libido using treatment which included a woman surrogate. Daniel et al. [4] pointed out the importance of having a caring and cooperative partner for success in the treatment of sexual dysfunction in men. In previous studies, only heterosexual men without a suitable partner were treated with a woman surrogate [5]. Women surrogates have been used in the treatment of the disabled as a compre- hensive part of their rehabilitation process [6] with no reported legal or medical problems. Never- theless, some people consider surrogate partner therapy to be problematic from both an ethical and legal standpoint [6]. Partly for these reasons, many therapists do not use surrogate therapy, or use it only after the failure of other treatments. In one study, 70% of therapists polled voiced the opinion that surrogate partner therapy is important for the treatment of various problems; however, only a small percentage had actually utilized the therapy because of the ethical problems involved, lack of surrogates, or the high cost of the treatment [7]. Man surrogate partner therapy for women suf- fering from sexual dysfunction has never been studied. In 1994 men surrogates were trained for therapy with women, but there was no demand for them [6]. The attempt to treat women without partners through surrogate partner therapy is important for a number of reasons: 728 J Sex Med 2007;4:728–733 © 2007 International Society for Sexual Medicine