Vaginismus is a condition in which involuntary muscle spasm interferes with vaginal intercourse or other penetration of the vagina. This often results in pain with attempts at sex. Often it begins when vaginal intercourse is first attempted. Vaginismus may be considered an older term for pelvic floor dysfunction. The formal diagnostic criteria specifically require interference during vaginal intercourse and a desire for intercourse, but the term vaginismus is sometimes used more broadly to refer to any muscle spasm occurring during the insertion of objects into the vagina, sexually motivated or otherwise, including speculums and tampons. The underlying cause is generally a fear that penetration will hurt. Risk factors include a history of sexual assault, endometriosis, vaginitis, or a prior episiotomy. Diagnosis is based on the symptoms and examination. It requires there to be no anatomical or physical problems (e.g., pelvic floor dysfunction, vulvodynia, vestibulodynia, etc.) and a desire for penetration. Treatment may include behavior therapy such as graduated exposure therapy and gradual vaginal dilation. Surgery is not generally indicated. Botulinum toxin (botox), a muscle spasm treatment, is being studied. There are no epidemiological studies of the prevalence of vaginismus. Estimates of how common the condition is are varied. One textbook estimates that 0.5% of women are affected, but rates in clinical settings indicate that 5–17% of women experience vaginismus. Outcomes are generally good with treatment.
Signs and symptoms Physical symptoms may include burning, and sharp pain or pressure in and around the vagina upon penetration. Psychological symptoms include increased anxiety. Pain during vaginal penetration varies. Despite being fairly common, there is low social awareness of vaginismus and women have difficulty finding support, even through the healthcare system. A 2023 integrative review found that studies on vaginismus show it often takes years to receive a diagnosis.
Causes
Primary vaginismus Vaginismus occurs when penetrative sex or other vaginal penetration cannot be experienced without pain. It is commonly discovered among teenage girls and women in their early twenties, as this is when many girls and young women first attempt to use tampons, have penetrative sex, or undergo a Pap smear. Awareness of vaginismus may not happen until vaginal penetration is attempted. Reasons for the condition may be unknown. A few of the main factors that may contribute to primary vaginismus include:
chronic pain conditions like vulvodynia and harm-avoidance behavior negative emotional reaction toward sexual stimulation, e.g. disgust both at a deliberate level and a more implicit level strict conservative moral education, which also can elicit negative emotions The cause of primary vaginismus is often unknown. Lamont has classified vaginismus by severity. Lamont describes four degrees of vaginismus: In first-degree vaginismus, the person's pelvic floor has a spasm that can be relieved by reassurance. In second-degree, the spasm is present but maintained throughout the pelvis even with reassurance. In third-degree, the person elevates the buttocks to avoid being examined. In fourth-degree (also known as grade 4) vaginismus, the severest form, the person elevates the buttocks, retreats, and tightly closes the thighs to avoid examination. Pacik expanded Lamont's classification to include a fifth degree, in which the person experiences a visceral reaction such as sweating, hyperventilation, palpitations, trembling, shaking, nausea, vomiting, losing consciousness, wanting to jump off the table, or attacking the doctor. Although the pubococcygeus muscle is commonly thought to be the primary muscle involved in vaginismus, Pacik identified two more spastic muscles in people who were treated under sedation. These include the entry muscle (bulbocavernosum) and the mid-vaginal muscle (puborectalis). Spasm of the entry muscle accounts for the common complaint that people often report when trying to have intercourse: "It's like hitting a brick wall".
Secondary vaginismus Secondary vaginismus occurs when a person who has previously been able to achieve penetration develops vaginismus. This may be due to physical causes, such as a yeast infection or trauma during childbirth, psychological causes, or a combination of causes. The treatment for secondary vaginismus is the same as for primary vaginismus, although, in these cases, previous experience with successful penetration can assist in resolution of the condition. Peri-menopausal and menopausal vaginismus, often due to a drying of the vulvar and vaginal tissues as a result of reduced estrogen, may occur as a result of "micro-tears" first causing sexual pain then leading to vaginismus.
Mechanism Specific muscle involvement is unclear, but the condition may involve the levator ani, bulbocavernosus, circumvaginal, or perivaginal muscles.
Diagnosis The diagnosis of vaginismus, as well as other diagnoses of female sexual dysfunction, can be made when "symptoms are sufficient to result in personal distress." The DSM-IV-TR defines vaginismus as "recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse, causing marked distress or interpersonal difficulty".
Treatment A 2012 Cochrane review found little high-quality evidence regarding the treatment of vaginismus. Specifically, it is unclear whether systematic desensitisation is better than other measures, including nothing.
Psychological According to a 2011 study, those with vaginismus are twice as likely to have a history of childhood sexual interference and held less positive attitudes about their sexuality, whereas no correlation was noted for lack of sexual knowledge or (nonsexual) physical abuse.
Physical
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