Synanyms; vaginism and genito-pelvic pain disorder
Definition: Recurrent or Persistent involuntary spasm of the musculature of the outer third of the Vagina that interferes with Sexual intercourse
Vaginismus may be mild, moderate or severe. History of pain during the gynaecological exam will give a clue to the diagnosis.
Ateology: Commonly Vaginismus is a psychosomatic problem. It may arise from a natural protective reflex to pain originating from any lesion of external genitalia or vaginal introitus
Psychological Causes:
– Negative conditioning to Sex by Religious or Cultural
– Intercourse Phobia
– Childhood Sexual Abuse
– Homosexual orientation
– Pregnancy Phobia…etc
Organic Cause:
– Hymenal Abnormalities
– Genital Infections
– Obstetric Trauma
– Senile atrophic Vaginitis
– Endometriosis’s
– Stenosis of Vaginal orifice
Types: Primary & Secondary Vaginismus
Primary vaginismus
A woman is said to have primary vaginismus when she is unable to have penetrative sex or experience vaginal penetration without pain. Women with vaginismus may be unaware of the condition until they attempt vaginal penetration.
Secondary vaginismus
It occurs when a women who has previously been able to achieve penetration develops vaginismus.
Causitive Factors:
- Trauma during childbirth,
- Fear of losing control
- Not trusting one’s partner
- Self-consciousness about body image….etc
Examination
It begins by simple inspection of External genitalia to detect spasm about Vagina & rigidity in muscles along the interior of the Thighs or along the Peritonium.
Vaginismus is an involuntary response & it can not be diagnosed in presence of voluntary guarding, So patient is asked to do deep breathing exercise so as to relax.
Management
– Couple Therapy is more successful than individual Therapy.
– Sex Education & Counseling
– Systemic Desensitisation by Master & Johnson Method/ Kaplan method
– Systemic Desensitisation by Physical approach
– Regular Sexual activity with more Forplay
– Preferable Coitus Position – Female Superior Position
Regular Follow-Up & Sexual activities along with Kegel Exercise will help to come out of this problem as earliest.