Vaginismus

Are you suffering from pain during sex? Does the mere thought of an intercourse make you anxious and jittery? You are probably suffering from a sexual disorder known as Vaginismus. Read and know all about this disease, including its possible causes, symptoms, diagnosis and treatment options.

Vaginismus Definition

It is a condition in which the muscular walls of the female vagina contracts or suffers a spasm whenever an attempt at intercourse is made. The spasms lead to a closure of the vagina. The contraction can be slightly uncomfortable or give rise to searing pain in a woman.

The condition may cause difficulties in certain normal activities, such as having a pelvic exam or having sex. It is sometimes also referred to as “Vaginism.”

Vaginismus ICD9 Code

The ICD9 Code for this condition is 306.51.

Vaginismus Incidence

It is not unknown how many women are exactly affected by this disorder. However, as many as 24% women fail to achieve an orgasm. According to some studies, 40% of the female population experience problems in their sex lives. The prevalence of Vaginismus ranges from 0.5 to 1% as per community estimates. In clinical and specialist settings, the figure increases and ranges anywhere between 4 and 42%.

Vaginismus Causes

This is a sexual problem. It can arise due to any of the following factors:

• Psychological problems
• Past case of sexual abuse or trauma
• Past history of discomfort during sexual intercourse

In some cases, it can occur even in the absence of any apparent cause.

Vaginismus Types

The condition is typically classified into two types:

Primary Vaginismus

The majority of women affected by this type of the condition are found to have a repressed upbringing. They have false impressions about their body and sex, generally imbibed from their parents. They are usually under the following notions:

• Sex is dirty
• Sex is extremely painful
• Vaginal penetration causes severe injury and distress
• Vagina is small and narrow in shape

In some cases, ill-informed doctors reinforce such beliefs or put sufferers under the false assumption that they have a thick hymen which can penetration too painful and difficult for them. Such women may also marry to have a normal wife, but become unable to form a satisfying sexual relationship for her as well as her husband.

Secondary Vaginismus

It is less common and arises in women with severe vaginal injuries, such as those occurring after being sexually assaulted or raped. This form may also arise due to a case of childhood abuse. Such untoward sexual experience may have a damaging effect on the psyche of affected women and make them develop Vaginismus as a protective response.

The disorder may also as a secondary symptom of some painful gynecological condition, such as postmenopausal vaginitis or endometriosis. It may also be triggered by traumatic events, surgery, relationship issues or bodily changes like menopause.

Vaginismus Symptoms

The condition is mainly manifested by the following signs and symptoms:

• Pain during sex or at the time of pelvic examination
• Difficulty or complete inability to have vaginal penetration
• Anxiety about sexual intercourse

However, any women affected by this condition can get aroused and have an orgasm when their clitoris is stimulated.

It should be remembered that an affected woman does not consciously control the spasms in her vagina. The condition can be compared to the automatic shutting of the eye in response to any object coming too close to it. The intensity of pain and spasm varies greatly from one woman to another at the time of penetration.

Vaginismus Presentation

The condition may be suspected in women who display the following behavior:

• Non-interest in sexual activities, especially intercourse, even when urged by partner
• Lack of lubrication and dryness of vagina
• Inability to get stimulated, even after proper foreplay
• Inability to have an orgasm (anorgasmia)
• Dyspareunia, due to poor lubrication or lack of arousal but may also suggest the presence of other conditions like Endometriosis, Pelvic Inflammatory Disease (PID) or conditions resulting in vestibular irritation

Patients usually seek medical care when they view the problem as a serious one. In many cases, sufferers are found to seek medical attention on being forced by their partners to consult a GP.

Vaginismus Diagnosis

The problem can be detected by a pelvic examination. Physicians must also conduct a complete physical examination as well as analyze the medical history of patients to rule out other possible causes of pain during sex (Dyspareunia).

Vaginismus Treatment

The treatment of this disorder involves:

Exercises

The workouts for this condition include:

Kegel exercises

These involve contraction and relaxation exercises for the pelvic muscles. Patients have to squeeze the muscles that are used to stop urination.

The steps to performing this exercise involve:

• Contracting the pelvic muscles
• Holding the posture for 2-3 seconds
• Relaxing the muscles

The exercise should at first be performed for around 10-20 times. The number of repetitions should gradually be increased with time and growing ease at performing them. A few days later, the workouts should be performed by inserting a finger slowly inside the vagina. The nail of the finger to be inserted should be clipped. The tip of the finger should also be moistened with the help of a lubricating jelly. Some patients perform the workout in a bathtub filled with slightly warm water. Water acts as a natural lubricant in such cases.

The finger should be pushed only 5-6 cms, or about the first joint of the knuckle, inside the vaginal aperture. Patients should start with only one and gradually use three fingers in imitation of a penis. Fingers are preferred as they allow sufferers to experience the contraction of the vaginal muscles. It is also easy to remove them if any discomfort is felt.

Vaginal dilation exercises

Physiotherapists recommend using plastic dilators to perform these. These are special inserts made of plastic that increase in width and size and let women affected by Vaginismus to train their vagina to open normally – without any muscular contraction.

These workouts should be performed under the guidance of a sex therapist or any other professional health care provider with similar expertise. Some sex therapists suggest that a sexual partner should also be made a part of the therapy. The contact should slowly be made more intimate, ultimately culminating in an intercourse. This can ease the psyche about the environment associated with a partner.

Education and counseling

Sufferers have to be informed about their sexual response cycle, sexual anatomy and imparted useful knowledge about intercourse by their healthcare providers.

Therapy

Therapy can ease anxieties and fear about sex and relax the worries associated to an intercourse. Therapy and counseling are often considered to be part of the treatment program for women with this condition.

Women with this condition often suffer from a fear of all forms of touching that they believe might lead to intercourse. This has to be overcome through a series of activities that bring her closer to her partner. Over a period of time, she is likely to get over her fear and gradually open up to being touched. Massaging or light touching each others’ body, without the intent of having sex, would gradually open up the mind of affected individuals and make sexual activities more approachable to them.

A sensate focus program, which involves gradually making the affected person and her partner familiar with each other and increasing their physical contact, is often deemed as necessary. In the initial stages, intercourse is prohibited. It should be allowed when the affected individual overcomes her anxiety and becomes comfortable with the touch of her partner.

Vaginismus Management and Supportive Cure

The treatment of this disorder should be tailored to the individual needs of sufferers, and possibly also her partner if she is in a sexual relationship. The sexual objectives of the suffering person should be properly explored. If conception is the objective, cure and management should focus on assisting conception. In perimenopausal women and those suffering from post-hysterectomy problems, hormone replacement therapy should be considered.

In cases where pain is the main complaint, Lidocaine has been used with successful results. Botox injections have been found to be effective in refractory cases.

Vaginismus Complications

A woman affected by this disorder may not be able to take part in a cervical screening program even when she might not have experienced a penetrative intercourse. She might fall into a lower-risk group for a condition known as cervical carcinoma.

Vaginismus Risk Factors

The risk factors for this disorder have not been fully understood due to flaws in the methodology adopted for research in this case. Although causative factors have not been exactly pinpointed, certain contributory factors have come to light. These include:

• Negative perceptions about sex and own sexuality
• Bad sexual experience in the early years of life or at some time in the past
• Harsh genital or pelvic examination

In some cases, there is an organic factor at work. This is Vestibulodynia, a tender region at the point of entry to the vagina. It may result from factors like:

• Defects of the hymen
• Pelvic radiotherapy
• Postmenopausal estrogen deficiency
• Injuries related to genital operation
• Genital tract infections

Vaginismus Prognosis

The disorder has a high rate of success with proper treatment options. However, affected women often continue to face problems for years due to this condition before opting for cure. This is frequently due to embarrassment or shame. Many women are found unwilling to come forward and participate in treatment programs. With proper cure, spontaneous improvement has been noted in around 10% affected women.

The outcome of this condition is usually found to be very good when sex therapists are used for the treatment of this disease.

It is important to seek early treatment for this condition. Ignoring the disease can not only give rise to dissatisfactions in a sexual relationship but also cause injuries due to possible rupturing of muscles as a result of forced penetration. Many healthcare providers recommend visiting a physician immediately if intercourse is painful or impossible. If you suspect yourself to be suffering from this disorder, consult your gynecologist and provide him or her with as many details as possible for a proper diagnosis and treatment.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002457/

http://women.webmd.com/guide/vaginismus-causes-symptoms-treatments

http://www.wisegeek.com/what-is-vaginismus.htm

http://www.patient.co.uk/doctor/Vaginismus-and-Orgasmic-Problems-in-Women.htm