Vaginal tightness,
or difficulty or inability to allow penetration for intercourse is
the primary symptom of Vaginismus. Normally, the vaginal sphincter
keeps the vagina closed until (sexual stimulation) the need to expand
and relax. This relaxation allows intercourse, childbirth, medical
examination and insertion of tampons. Therefore, vaginismus occurs
when the vagina is unable to relax and permit the penetration of the
penis during intercourse however, when vaginismus does occur, the
sphincter goes into spasm resulting in the tightening of the vagina.
With some women, vaginismus prevents all attempts at successful intercourse.
Vaginismus is not uncommon and may occur later in life, even if a
woman has a history of enjoyable and painless intercourse.
The woman repeatedly has spasms of the vaginal muscles that interfere
with sexual intercourse.
It causes
marked distress or interpersonal problems.
Except
for another Sexual
Dysfunction, no other Axis I disorder (such as Somatization
Disorder) accounts for it better.
It is
not directly caused solely by a general medical condition.
Recent or
Past Sexual Trauma.
Fearful of
Sexual Acts or Disgust.
Guilt.
Differential Diagnosis
Some disorders
have similar or even the same symptoms. The clinician, therefore,
in his/her diagnostic attempt has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
A
General Medical Condition - a pelvic disease.
Cause:
The cause of vaginismus is often a result of an aversive stimulus
associated with penetration. Some of the more common aversive stimuli
are traumatic sexual assaults, painful intercourse, and traumatic
pelvic exam.
Vaginismus may not only result from past sexual trauma but also the
patient having strong inhibitions about sex stemming from strict religious
orthodoxy or cultural norms.
This disorder does not mean that women suffering from this disorder
are frigid. Many are very sexually responsive and may have orgasms
through clitoral stimulation. Many women with vaginismus may seek
sexual contact and sexual foreplay as long as actual intercourse/vaginal
penetration is avoided.
Concepts such as penetration, intercourse and even sex can cause fear
or trepidation in the mind of may a young inexperienced woman who
may hear stories about painful first intercourse, which then reinforce
the fear of penetration. This fear can compound and create a pattern
of sexual anxiety, causing the vagina to remain dry and unrelaxed
before intercourse.
In some cases, vaginismus may occur after a history of successful
and enjoyable intercourse due to a vaginal infection, the physical
after-effects of childbirth, tiredness or some other cause. This may
be triggered by painful intercourse, due to the condition and then
possibly lead to a pattern of further vaginismus even though the original
cause has disappeared.
Treatment:
The treatment of vaginismus is usually a therapy program that includes
vaginal dilation exercises using plastic dilators. It is important
that the use of dilators proceeds in a systematic progression under
the direction of a sex
therapist and should actively involve the woman's sexual partner.
The treatment include gradually more intimate contact eventually culminating
in successful and pain free intercourse. Sex education is also very
important to counter sexual naivety and dispel any misinformation
which has been identified as a factor in 90% of vaginismus cases.
This education should include information about sexual anatomy, physiology,
the sexual response cycle, and common myths about sex.
