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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.

Associated Features:

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.

Counseling and Psychotherapy [ See Therapy Section ]:

In cases where there is a strong phobic avoidance component, the use of hypnosis and self-hypnotic relaxation can also be useful.


DSM Code

306.51 Vaginismus Not Due To General Mdical Condition

N94.2 Vaginismus

Disorder Sheets

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Recommended Book

Private Pain - It's
About Life, Not Just Sex: Understanding Vaginismus and Dyspareunia - Click Here to View

 

Vaginismus

Misc Information

 

 

Sexual Disorder's - Female