Vaginismus

Vaginismus is an involuntary spastic constriction of the lower vaginal muscles. It usually stems from a fear of vaginal penetration. If severe, it may prevent intercourse. Vaginismus affects women of all ages and backgrounds. The prognosis is excellent for a motivated patient who has no untreatable organic abnormalities.

Vaginismus is very uncommon. It occurs in less than 2% of women in the US.

Causes

Vaginismus may be physical or psychological in origin. It may occur spontaneously as a protective reflex to pain, or it may result from organic causes, such as abnormalities of the hymen, genital herpes, obstetric trauma, and atrophic vaginitis.

Psychological causes of vaginismus 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
• phobias of pregnancy, venereal disease, or cancer
• dysfunctional childhood experiences and family attitudes toward sex
• concern about contraception and potential pregnancy
• conflicts with the sexual partner

Symptoms

Difficulty or inability to allow vaginal penetration for intercourse is the primary symptom. Vaginal pain with attempts at intercourse or during attempted pelvic exam is common.

Diagnosis

A gynecological examination is often used to confirm vaginismus. During the examination, there is usually an involuntary muscle contraction when fingers are inserted into the vagina, and this usually reproduces the pain the woman feels with intercourse.

A medical history and complete exam is important to rule out other causes of pain with sexual intercourse.

Treatment

Appropriate treatment is designed to eliminate maladaptive muscle constriction and underlying psychological problems. In Masters and Johnson therapy, the patient uses a graduated series of plastic dilators, which she inserts into her vagina while tensing and relaxing her pelvic muscles. The patient controls the time the dilator is left in place (if possible, she retains it for several hours) and the movement of the dilator. Together with her sexual partner, she begins sensate focus and counseling therapy to increase sexual responsiveness, improve communications skills, and resolve any underlying conflicts.

Kaplan therapy also uses progressive insertion of dilators or fingers (in vivo desensitization therapy), with behavior therapy (imagining vaginal penetration until it can be tolerated) and, if necessary, psychoanalysis and hypnosis. Both Masters and Johnson and Kaplan report a 100% cure rate; however, Kaplan states that the patient and her partner may show other sexual dysfunctions that necessitate additional therapy.

Prevention

If a woman finds intercourse painful, she should seek medical evaluation right away. When pain continues to be endured as part of sex, it increases the risk of conditioning a vaginismus response.