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. Vaginismus is involuntary spastic constriction of the lower vaginal muscles, usually from fear of vaginal penetration. This disorder may coexist with dyspareunia and, if severe, may prevent intercourse. Vaginismus affects females of all ages and backgrounds. The prognosis is excellent for a motivated patient who doesn't have untreatable organic abnormalities.
Some women with vaginismus have a history of sexual abuse, rape or other trauma and have an intense fear of further pain, penetration or violation. The tightening of the vaginal muscles may be an unconscious effort by these women to protect them.
CAUSES
* Vaginismus may be physical or psychological in origin.
* It may occur spontaneously as a protective reflex to pain or result from organic causes, such as hymenal abnormalities, genital herpes, obstetric trauma, and atrophic vaginitis.
PSYCHOLOGICAL CAUSES
* Childhood and adolescent exposure to rigid, punitive, and guilt-ridden attitudes toward sex
* Fears resulting from painful or traumatic sexual experiences, such as incest or rape
* Early traumatic experience with pelvic examinations
* Fear of pregnancy, sexually transmitted disease, or cancer.
SIGNS AND SYMPTOMS
* The female with vaginismus typically experiences muscle spasm with constriction and pain on insertion of any object into the vagina, such as a tampon, diaphragm, or speculum.
* She may profess a lack of sexual interest or a normal level of sexual desire.
TREATMENT
* Treatment is designed to eliminate maladaptive muscle constriction and underlying psychological problems.
* In Masters and Johnson therapy, the patient uses a graduated series of dilators, which she inserts into her vagina while tensing and relaxing her pelvic muscles.
* The patient controls the amount of time that the dilator is left in place and the movement of the dilator. Together with her sexual partner, she begins sensate focus and counseling therapy to increase sexual responsiveness, improve communication skills, and resolve any underlying conflicts.
* Kaplan therapy also uses progressive insertion of dilators or fingers (in vivo/desensitization therapy), with behavior therapy (imagining vaginal penetration until it can be tolerated) and, if necessary, psychoanalysis and hypnosis.
* Practitioners of both Masters and Johnson and Kaplan therapies claim a 100% cure rate.
HEALTH EDUCATION
* Pelvic examination may be painful for the patients with vaginismus, so, proceed gradually at the patient's own pace.
* Support the patient throughout the pelvic examination, explaining each step before it's done. Encourage her to verbalize her feelings, and take plenty of time to answer her questions.
* Teach the patient about the anatomy and physiology of the reproductive system, contraception, and human sexual response. This can be done quite naturally during the pelvic examination.
* Ask if the patient is taking any medications that may affect her sexual response, such as antihypertensives, tranquilizers, or steroids.
* If she has insufficient lubrication for intercourse, tell her about different types of lubricating gels and creams that are available over-the-counter.
* If a woman finds intercourse painful, she should seek medical evaluation right away.
* When pain continues to be endured as part of sex, it increases the risk of conditioning a vaginismus response.
