Vaginismus is involuntary spastic constriction of the outer third vaginal muscles. This disorder may coexist with dyspareunia and, if severe, may prevent intercourse (a common cause of unconsummated marriages). Vaginismus affects females of all ages and backgrounds. The prognosis is excellent for a motivated patient who doesn’t have untreatable organic abnormalities.
Vaginismus may be physical or psychological in origin. It may occur spontaneously as a protective reflex to pain or result from organic causes, such as hymenal abnormalities, genital herpes, obstetric trauma, and atrophic vaginitis.
Psychological causes may include:
❑ childhood and adolescent exposure to rigid, punitive, and guilt-ridden attitudes toward sex
❑ fears resulting from painful or traumatic sexual experiences, such as incest or rape
❑ early traumatic experience with pelvic examinations
❑ fear of pregnancy, sexually transmitted disease, or cancer.
Vaginismus is uncommon, affecting less than 2% of women in the United States.
The female with vaginismus typically experiences muscle spasm with constriction and pain on insertion of any object into the vagina, such as a tampon, diaphragm, or speculum. She may profess a lack of sexual interest or a normal level of sexual desire.
Diagnosis depends on the sexual history and pelvic examination to rule out physical disorders. The sexual history must include early childhood experiences and family attitudes toward sex, previous and current sexual responses, contraceptive practices and reproductive goals, feelings about her sexual partner, and specific details about pain on insertion of any object into the vagina.
When the disorder causes marked distress or interpersonal difficulty, it may fulfill diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Treatment is designed to eliminate maladaptive muscle constriction and underlying psychological problems. In Masters and Johnson therapy, the patient uses a graduated series of dilators, which she inserts into her vagina while tensing and relaxing her pelvic muscles. The patient controls the amount of time that the dilator is left in place and the movement of the dilator. Together with her sexual partner, she begins sensate focus and counseling therapy to increase sexual responsiveness, improve communication skills, and resolve any underlying conflicts.
Kaplan therapy also uses progressive insertion of dilators or fingers (in vivo or desensitization therapy), with behavior therapy (imagining vaginal penetration until it can be tolerated) and, if necessary, psychoanalysis and hypnosis. Practitioners of both therapies claim a 100% cure rate.
❑ Because a pelvic examination may be painful for the patient with vaginismus, proceed gradually, at the patient’s own pace. Support her throughout the pelvic examination, explaining each step before it’s done. Encourage her to verbalize her feelings, and take plenty of time to answer her questions.
❑ Teach the patient about the anatomy and physiology of the reproductive system, contraception, and human sexual response. This can be done quite naturally during the pelvic examination.
❑ Ask if the patient is taking medications that may affect her sexual response, such as antihypertensives, tranquilizers, or steroids. If she has insufficient lubrication for intercourse, tell her about lubricating gels and creams.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
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