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Vaginismus is a condition which affects a woman's ability to have sexual intercourse, insert tampons and undergo gynaecological examinations. This is due to a conditioned muscle reflex in the PC muscle, they clamp shut making penetration either extremely painful or in many cases, impossible. The woman does not choose for this to happen; it is a learned reflex reaction. A comparison which is often made, is that of the eye shutting when an object comes towards it. This, like vaginismus is a reflex reaction designed to protect our bodies from pain. more...

VACTERL association
Van der Woude syndrome
Van Goethem syndrome
Varicella Zoster
Variegate porphyria
Vasovagal syncope
VATER association
Velocardiofacial syndrome
Ventricular septal defect
Viral hemorrhagic fever
Vitamin B12 Deficiency
VLCAD deficiency
Von Gierke disease
Von Hippel-Lindau disease
Von Recklinghausen disease
Von Willebrand disease

A woman with vaginismus expects pain to come with penetration and so her mind automatically sends a signal to her PC muscles to clamp shut, thus making penetration either impossible or very painful. The severity of vaginismus varies from woman to woman.

The condtioned reflex creates a vicious circle for vaginismic women. For example, if a teenage girl is told that the first time she has sex it will be very painful, she may develop vaginismus because she expects pain. If she then attempts to have sexual intercourse, her muscles will spasm and clamp shut which will make sex painful. This then confirms her fear of pain as does each further attempt at intercourse. Every time the fear is confirmed, the brain is being "shown" that sex does hurt and that the reflex reaction of the PC muscles is needed. This is why it is important that if a woman suspects she has vaginismus, she stops attempting to have sexual intercourse. This does not mean women with vaginismus can not partake in other sexual activities, as long as penetration is avoided. It is a common misconception that these women do not want to have sex as a lot of the time, they desperately do.

There is no one reason that a woman may have vaginismus and in fact, there are a variety of factors that can contribute. These may be psychological or physiological and the treatment required will usually depend on the reason why the woman has the condition. Some examples of causes of vaginimus include sexual abuse, strict religious upbringing, being taught that sex is dirty or wrong or simply the fear of pain associated with penetration, and in particular, losing your virginity. These are just some of the reported reasons behind vaginismus and there are many, many more. It is a very personal condition and so each case must be looked at individually as causes and treatment can not be generalised to all women with vaginismus.

Most women who suffer from vaginismus do not realise they have it until they try to insert a tampon or have sex for the first time and so it may come as quite a shock to them. Whether they choose to treat the problem or not is entirely their choice and they should never be led to believe that vaginismus must be treated. It is not an illness or a dysfunction and therefore the only physical effect it will have on a woman is making penetration painful or impossible. It will not get worse or more serious if left untreated unless the woman is continuing to have sex/use tampons despite feeling pain on penetration.

Primary vaginismus

Primary vaginismus occurs when a woman has never been able to have sexual intercourse or achieve any other kind of penetration. It is commonly discovered in teenagers and women in their early twenties as this is when the majority of women will attempt to use tampons, have sexual intercourse or complete a pap smear for the first time. It can often be very confusing for a woman when she discovers she has vaginismus as we are led to believe that sex is something that comes naturally to us. It can be even more confusing if the woman does not know why she has the condition, as is true for many women.


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First vulvodynia guideline published
From OB/GYN News, 3/1/05 by Jane Salodof MacNeil

HOUSTON -- A new guideline for the diagnosis and treatment of vulvodynia offers multiple treatment options, including experimental and complementary therapies, for the controversial disorder.

"We have oceans of lotions, potions, and notions out there for vulvodynia. There is not going to be one simple cure," Hope K. Haefner, M.D., the lead author of a paper detailing the guideline, said at a conference on vulvovaginal diseases sponsored by Baylor College of Medicine.

What is clear, she said, is, "We have to do a lot more than say, 'Love burns.'"

Dr. Haefner, director of the University of Michigan Center for Vulvar Diseases in Ann Arbor, recruited a panel of vulvar disease experts to draft the guideline at the request of the American Society for Colposcopy and Cervical Pathology (ASCCP). The guideline is published in the society's journal and can be accessed at (J. Lower Gen. Tract Dis. 2005; 9:40-51).

General gynecologists are increasingly aware of vulvodynia but need to start treatment early, according to Dr. Haefner. "The longer a patient has the pain, the less likely we are going to be able to cure" her, she said.

The guideline uses terminology the International Society for the Study of Vulvovaginal Disease (ISSVD) recently adopted for vulvodynia, which has had multiple names, including vulvar vestibulitis syndrome and vulvar dysesthesia. The ISSVD defined vulvodynia as "vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable neurologic disorder."

Symptoms are not necessarily caused by touch or pressure to the vulva, such as with intercourse or bicycle riding, but these activities often exacerbate the symptoms.

The guildeline also classified vulvodynia according to whether pain is generalized or localized. (Dr. Haefner cited vestibulodynia, clitorodynia, and hemivulvodynia as examples of localized pain.)

The ASCCP guideline recommends cotton swab testing along with the taking of a complete medical history for diagnosis. Health care providers should use the swab to test various locations of the vulva, including the labia majora, the labia minora, the interlabial sulci, and the vestibule at the clock positions of 2:00, 4:00, 6:00, 8:00, and 10:00. The degree of pain at each location should be recorded.

They should also do vaginal cultures to rule out conditions such as yeast infection.

Treatment recommendations start with gentle care for the vulva. This includes wearing cotton underwear and nonirritating menstrual pads, avoiding irritants, and using mild soap. Patients are urged to pat the vulva dry.

Other suggestions include lubrication during intercourse, cold packs for irritation, and rinsing and drying the vulva after urination.

The guideline lists the following topical medications as useful for vulvar pain but with caveats and suggests that stopping all treatments may bring relief to some women who are using multiple topical medications:

* Lidocaine ointment 5% (various forms) is the most commonly prescribed topical treatment.

* Plain petrolatum (petroleum jelly) can relieve symptoms.

* Estrogen has had variable results; however, Dr. Haefner questions how it works, given that many vulvodynia patients have low estrogen-receptor expression.

* Capsaicin is cited for neuropathic pain, but again, Dr. Haefner was skeptical that it works because this agent is an irritant.

* Nitroglycerine in one study improved vulvar pain and dyspareunia temporarily but caused headaches.

* Baclofen 2% (Lioresal) and amitriptyline 2% in a water-washable base can soothe point tenderness and vaginismus.

Topical corticosteroids, testosterone, and antifungal medications have not benefited vulvodynia patients, according to the guideline. Dr. Haefner also warned against use of benzocaine in these patients, which she said could cause rebound vasodilation and pain.

Oral medications for vulvodynia generally fall into two classes: antidepressants and anticonvulsants. If these are used, the guideline warns health care providers to check for drug interactions with other medications the patient is taking.

Dr. Haefner said tricyclic antidepressants such as amitriptyline, desipramine, and nortriptyline have had a 65%-70% response rate in multiple studies. When they are prescribed for pain management, smaller doses are recommended than for depression. Selective serotonin reuptake inhibitors such as venlafaxine are another option. Dr. Haefner said she has also used duloxetine (Cymbalta), but a controlled study is needed to assess its efficacy in vulvodynia patients.

The guideline also cites the use of anticonvulsants gabapentin (Neurontin) and carbamazepine.

Other guideline recommendations include biofeedback and physical therapy, intralesional injections in patients with localized pain, and surgery as a last resort in patients with vestibulodynia. Surgery is also an option in rare cases of pudendal nerve entrapment.

"The one time I do surgery without trying the other treatments discussed is when they have a lot of redundant tissue that is painful and tears with intercourse. Then I just resect that tissue," Dr. Haefner said.

The guideline notes without judgment that many women use complementary and alternative therapies "before, during, and after seeking conventional medical diagnosis and treatment for their vulvar pain symptoms." These include acupuncture, calcium citrate, low-oxalate diets, oatmeal water and saltwater baths, and, according to Dr. Haefner, hypnosis and botulinum toxin (Botox) injections.

"There are a lot of different things out there that need to be duplicated in different studies," she said, describing low-oxalate diets, in particular, as being controversial.

Finally, the guideline says that vulvodynia is not a psychopathologic condition, but patients should receive emotional and psychological support during treatment.

For more information about vulvodynia and other vulvovaginal diseases, contact the International Society for the Study of Vulvovaginal Disease by calling 704-814-9493 or go to

RELATED ARTICLE: Experts Dispute Psychosexual Factors in Vulvodynia

The new vulvodynia guideline rejects the assumption that vulvar pain without a clinically identifiable cause is all in a woman's head but notes that "sex therapy, couples counseling, psychotherapy, or a combination thereof" can be very helpful to patients.

"For years, there were people who thought it was a psychosomatic illness, and there are some people who still do believe that," Dr. Haefner said. "I don't think it is. However, psychologically, many of our patients are depressed."

The first description of vulvodynia in an 1880 medical textbook called the condition "hyperaesthesia of the vulva," she said.

Although it has become more prevalent following recent media attention to women's accounts of the disorder, vulvodynia affects far more women and has been around far longer than has been recognized, she said.

Just what causes vulvodynia is still unclear. Dr. Haefner cited current thinking that the condition is neurologic or inflammatory in origin. (She leans toward neurologic but acknowledged it could be both.) While she discounted sexual abuse as no more common in vulvodynia patients than in the general population, she said that it could be a factor in individual cases.

Elizabeth "Libby" Edwards, M.D., chief of dermatology of the Southeast Vulvar Clinic in Charlotte, N.C., said that many vulvodynia patients have psychosexual issues but also described them as a result of the illness.

"Depression, anxiety, psychosexual dysfunction is rarely, if ever, a cause of vulvodynia. I don't discount the possibility that it may occasionally happen," said Dr. Edwards, also of the University of North Carolina at Chapel Hill.

Dr. Edwards, a dermatologist who specializes in vulvar disorders, said she encourages patients to go for counseling, but most won't go. She said her message is "not 'You're crazy, and that makes you hurt,' but 'You hurt, and that will make you crazy.'"

Sexual abuse is a major underlying factor for vulvodynia patients, according to Esperanza McKay, M.D., a biofeedback clinician at the Pain Management Center in Houston. That should not cause anyone to underestimate the women's suffering, she advised.

"Their pain is really very real," Dr. McKay said. "The first thing I do is listen to them. You will be amazed at how many have been sexually abused."

Dr. McKay recommended waiting 3 or 4 months until a treatment begins to succeed before bringing up counseling. Many patients do not trust psychiatry and need to develop trust in the clinician before they will agree to go for counseling, she said.

Peter J. Lynch, M.D., a professor emeritus at the University of California, Davis, also advocated psychiatric help, warning that extreme cases can be the result of severe sexual abuse. "I happen to believe that psychosexual issues are an important cause of vulvodynia," he said.

--Jane Salodof MacNeil


Contributing Writer

COPYRIGHT 2005 International Medical News Group
COPYRIGHT 2005 Gale Group

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