Vaginismus Disease

DESCRIPTION

Involuntary painful contraction of perineal muscles prior to or during vaginal intercourse. The experience of or even the anticipation of pain on vaginal entry causes theses muscles to contract, occluding the vaginal opening and causing further pain when penetration is attempted.

System(s) affected: Reproductive
Genetics: N/A
Incidence/Prevalence in USA: 6-8% of women in some studies report complete vaginismus and up to 30% some degree of vaginismus
Predominant age: Postpubertal
Predominant sex: Female

SIGNS AND SYMPTOMS

Inability to allow entry for vaginal sexual intercourse secondary to involuntary muscle spasms
Reluctance or avoidance of pelvic examination
Relationship discord or difficulty
Infertility
Sexual satisfaction may be independent of sexual function!

CAUSES

Primary: Often multifactorial
- Negative messages about sex and sexual relations in upbringing may cause phobic reaction
- Poor body image of genital area
- History of sexual trauma, although rates of vaginismus appear to be similar in sexually abused and un-abused populations of women (studies show incidence of sexual abuse of women to be from 12-40%)
Secondary
- New onset of infection
- Surgical or post delivery scarring
- Endometriosis
- Inadequate vaginal lubrication

RISK FACTORS

Previous sexual trauma, but rates appear to be similar in abused and non-abused women
Often associated with other sexual dysfunctions

LABORATORY

N/A
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Rarely found in primary vaginismus, but may be varied such as endometriosis or scarring in secondary vaginismus

SPECIAL TESTS

Psychiatric consultation if not responsive to primary physician's therapy or if primary provider not comfortable with caring for sexual problems

IMAGING

N/A

DIAGNOSTIC PROCEDURES

General and sexual history
At some point, a careful pelvic examination to rule out medical cause

APPROPRIATE HEALTH CARE

Outpatient care

GENERAL MEASURES

Can often treat vaginismus successfully without defining/treating its etiologies!!
No published controlled studies on success of psychotherapy for vaginismus
Patient education as noted below on pelvic anatomy and sexual function
Kegel's exercises to control perineal muscles
Stepwise vaginal desensitization exercises:
- A) with vaginal dilators (patient inserts/controls)
- B) with woman's own finger(s) (promotes sexual self-awareness)
Valsalva can help with vaginal entry
Advance to husband's fingers with patient's control
Coitus after achieving largest vaginal dilator or 3 fingers; important to begin with sensate focused exercises/sensual caressing without necessarily a demand for coitus
- A) Female superior at first; passive (non-thrusting); female directed
- B) Later, thrusting may be okay

SURGICAL MEASURES

Contraindicated

ACTIVITY

Simple techniques of gentle, progressive, patient-controlled vaginal dilation

DIET

Simple techniques of gentle, progressive, patient-controlled vaginal dilation

PATIENT EDUCATION

Education about pelvic anatomy, nature of the vaginal spasms, normal adult sexual function
Hand held mirror can help the woman visually learn to tighten and loosen perineal muscles
Important to teach the partners that the spasms are not under conscious control and are not a reflection on the relationship or a woman's feelings about her partner
Instruction in techniques for vaginal dilation
Resources
- American College of Obstetricians & Gynecologists (ACOG), 409 12th St., SW, Washington, DC 20024-2188, (800)762-ACOG
- Valins L. When a Woman's Body Says No to Sex: Understanding and Overcoming Vaginismus. New York: Penguin, 1992.

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Precipitation of memory of incest prior to patient's readiness to deal with it

EXPECTED COURSE AND PROGNOSIS

Some studies show high degrees of success (58-70%) with behavioral interventions
History of sexual abuse does not predict outcome negatively or positively

ASSOCIATED CONDITIONS

Marital stress, family dysfunction
Dyspareunia

AGE-RELATED FACTORS

Vaginismus is generally primary, e.g. happens with first attempt at intercourse
Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

Pregnancy can occur in patients with vaginismus via perineal ejaculation

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.