Vaginismus refers to involuntary tightness of the vagina during attempted sexual intercourse, insertion of tampons into the vagina and per vaginal gynaecological examinations. It is the main cause of unconsummated relationships. The tightness of the vaginal walls is caused due to involuntary contraction of the pelvic floor muscles especially the pubococcygeus also known as the PC muscle. This reflex contraction of the muscles is an involuntary reaction that is the woman does not voluntarily or consciously control the spasm. This spasm of the muscle makes any kind of vaginal penetration especially sexual intercourse extremely painful or even impossible. It can be divided into two types primary and secondary.
Primary vaginismus: A woman is said to be suffering from primary vaginismus when she has never been able to undergo any form of vaginal penetration without pain. In such a case a woman is unable to have a sexual intercourse or even insert tampons or undergo a gynaecological examination. Any attempt to penetrate the vagina is accompanied by severe burning, pain and discomfort. A few causes which may contribute to development of primary vaginismus are urinary tract infections, vaginal yeast infections, vaginal vestibular syndrome, past history of sexual or physical abuse in the woman, witnessing any violent act related to sexuality, anxiety and fear of rupture of the hymen, stress, generalized anxiety disorder or in some cases idiopathic.
Secondary vaginismus: It is a condition in which a woman has previously attempted pain free intercourse but experience vaginismus later in life. It affects women, having temporary problems like urinary or yeast infections, birth trauma experienced after the birth of a child, menopause or surgery. Once the patient experiences pain, it is seen that the response becomes a conditioned one resulting in a progressive and continued worsening of vaginal pain and tightness on attempted intercourse. If left untreated the intensity and duration of involuntary contraction of the PC muscle worsens. As the severity worsens women may suffer from severe pain and discomfort during vaginal penetration or even tampon insertion.
Treatment: There are a variety of causes that contribute to development of vaginismus. However an individualized approach must be used in each and every case. The treatment can be divided into physical and psychological. Physical treatment involves usage of probes of different sizes. Vaginal probes are introduced into the woman’s vagina under the guidance of a doctor or a nurse. The probes are introduced usually with her own hand so that she can physically control the rate of insertion and eventually overcome her fear of penetration. Most cases of primary vaginismus are due to some traumatic experience in the past, notions of sex being wrong or morally incorrect especially seen among those having a strict religious upbringing, fear and anxiety of painful intercourse or a history of sexual abuse or traumatic physical abuse in childhood. Hence in such patients it is important to address these psychological aspects of the problem. Emotional issues and psychological problems are more important to be addressed in primary vaginismus, while those suffering from secondary vaginismus may rely on a physical than psychological treatment.
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