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Vaginismus

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...

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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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Management of Dyspareunia and Vaginismus
From American Family Physician, 4/15/00 by Richard Sadovsky

Dyspareunia and vaginismus are the two most common sexual dysfunctions in women. Dyspareunia is recurrent genital pain caused by sexual activity. Primary dyspareunia is defined as constant pain during sexual activity, while secondary dyspareunia occurs after a period of pain-free lovemaking. Vaginismus is a conditioned pain caused by involuntary spasm of the muscles around the lower one third of the vagina, resulting from the association of sexual activity with pain and fear. Butcher reviews these two conditions and their respective management approaches and briefly discusses the role of orgasm in women.

Dyspareunia is best described according to the site of pain, either superficial or deep. Superficial dyspareunia occurs in or around the vaginal entrance and is characterized by early, initial discomfort. Common symptoms include superficial vulval pain, itching, burning and stinging. Pain may be constant or may be triggered by nonsexual activities such as walking. Identifying the cause is difficult, and patients quickly become frustrated with treatment. Vaginal pain is less common because of the paucity of nerve endings in the vagina. Common causes are inadequate lubrication, vaginal infection, topical irritants, urethral problems, radiotherapy or sexual trauma. Deep dyspareunia, pain resulting from pelvic thrusting during intercourse, is common and may be caused by pelvic inflammatory disease, local surgery, endometriosis, genital or pelvic tumors, irritable bowel syndrome, urinary tract infections or ovarian cysts. The woman's position during sexual activity is important, because deep thrusting by the partner could be hitting an ovary and causing pain.

The immediate cause of vaginismus is involuntary spasm of the muscles around the lower one third of the vagina. This initial response may be secondary to sexual abuse, frightening childhood medical procedures, painful first intercourse, relationship problems, sexual inhibition or fear of pregnancy. Primary vaginismus is diagnosed in women who have never experienced vaginal penetration, while secondary vaginismus denotes prior successful vaginal penetration. The symptoms can range from minor to severe, when the woman avoids all forms of sexual touching or intimacy. Patients in the latter category often have been unable to complete gynecologic examinations, have difficulty using tampons and fail to present for Papanicolaou tests.

The importance of orgasm varies in women. Some women find it an extremely important part of every sexual encounter, while others are content without it. Involuntary inhibition of the orgasmic reflex in women who are interested in orgasms is called anorgasmia. This inhibitory action is often linked to strong emotional causes, but the possibility of physical causes should be explored in patients with dyspareunia.

The author concludes that management of these problems can be difficult, but success is rewarding for the patient. Initial management of dyspareunia should focus on all physical causes, followed by use of a cognitive behavioral program similar to that used to treat vaginismus. For a list of the components of a cognitive behavioral program, see the accompanying table. The most successful programs help the woman feel that she owns her sexual organs and controls her sexual activity. Treatment of anorgasmia involves working with the patient individually and with the couple, when possible, to resolve conflicts and increase stimulation. Self-exploration, masturbation, resolution of unconscious fears of orgasm, exercises to heighten sexual arousal, and enhancing awareness of pleasure are useful ways to achieve orgasm with sexual activity.

RICHARD SADOVSKY, M.D.

Butcher J. Female sexual problems: sexual pain and sexual fears. WJM November/December 1999;171:358-60.

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