Vaginismus

Vaginismus refers to the involuntary contraction or spasm of the muscles surrounding the vaginal entrance, often causing discomfort, burning, penetration problems, or complete inability to have intercourse. This reflex muscle tightening is usually painful and can affect sexual intercourse, gynecological examinations, and even the insertion of tampons.

Etiology

The exact cause of vaginismus remains unknown. However, it's often linked to anxiety or fear related to sexual activity. This could be due to traumatic experiences such as sexual abuse or a painful first sexual encounter. Some women may develop vaginismus after menopause when vaginal dryness might cause sex to be painful. In some cases, vaginismus begins later in life, even after years of pain-free intercourse.

Types of Vaginismus

There are generally two types of vaginismus:

• Primary Vaginismus: Women with primary vaginismus have experienced it their entire lives, with attempts at inserting tampons or engaging in sex often resulting in severe pain.
• Secondary Vaginismus: Secondary vaginismus occurs when a person who has previously been able to achieve penetration experiences the condition later in life. This can be due to physical causes such as childbirth, surgery, or menopause, or it can be due to psychological causes.

Diagnosis

Diagnosis is usually made through a combination of a woman's history, physical examination, and sometimes a gynecological exam. During the exam, the doctor may attempt to insert a finger or cotton swab into the vagina to confirm the diagnosis of vaginismus.

Management

Management of vaginismus involves a multidisciplinary approach that may include psychological therapy, behavioral exercises, and physical therapy.

• Psychological Therapy: Therapy can address underlying psychological issues, such as fear or anxiety associated with penetration.
• Behavioral Exercises: These may involve exercises that help relax the muscles around the vagina. This could include Kegel exercises or use of dilators.
• Physical Therapy: Physical therapy can help improve muscle tone and control, and reduce muscle spasms.

Prognosis

With appropriate treatment, the prognosis for vaginismus is very positive, and most women can achieve pain-free intercourse.

References

• Binik YM (December 2005). "Should dyspareunia be retained as a sexual dysfunction in DSM-V? A painful classification decision". Archives of Sexual Behavior. 34 (1): 11–21. doi:10.1007/s10508-005-0998-3. PMID 15772767.
• Crowley T, Goldmeier D, Hiller J (February 2009). "Diagnosing and managing vaginismus". BMJ. 338: b2284. doi:10.1136/bmj.b2284. PMID 19542109.

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