Vaginismus
What is this Condition?
Vaginal spasms are involuntary spastic constrictions of the lower vaginal muscles, usually caused by fear of vaginal penetration. It may coexist with painful intercourse and, if severe, may prevent successful intercourse. The condition affects women of all ages and backÂgrounds. The prognosis is excellent for a motivated woman who doesn’t have untreatable physical abnormalities.
What Causes it?
Vaginal spasms may be physical or psychological in origin. They may occur spontaneously as a protective reflex to pain, or they may result from organic causes, such as hymen abnormalities, genital herpes, obstetric injury, and atrophic vaginitis.
Psychological causes may include:
• childhood and adolescent exposure to rigid, punitive, and guiltÂridden attitudes toward sex
• fears resulting from painful or traumatic sexual experiences, such as incest or rape
• early traumatic experience with pelvic exams
• fear of pregnancy, venereal disease, or cancer.
What are its Symptoms?
The woman with this disorder typically experiences muscle spasms with pain when any object-such as a tampon, diaphragm, or speculum-is inserted into her vagina. She may express a lack of interest in sex or have a normal level of sexual desire.
How is it Diagnosed?
Diagnosis requires a sexual history and pelvic exam to rule out physical disorders. The sexual history includes early childhood experiences and family attitudes toward sex, previous and current sexual responses, contraceptive practices and reproductive goals, the woman’s feelings about her sexual partner, and specific details about the pain she feels on insertion of any object into the vagina.
A carefully performed pelvic exam confirms the diagnosis by showing involuntary constriction of the muscles surrounding the outer portion of the vagina.
How is it Treated?
Treatment is designed to eliminate abnormal muscle constriction and underlying psychological problems. In Masters and Johnson therapy, the woman inserts a graduated series of dilators into her vagina while tensing and relaxing her pelvic muscles. She controls the time the dilator is left in place and dilator movement. Together with her sexual partner, she begins sensate focus and counseling therapy to increase sexual responsiveness, improve communication skills, and resolve any underlying conflicts.