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.
