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contraction of the outer third of the vagina interfering with sexual intercourse
It is involuntary reflex precipitated by real or imagined attempts at vaginal penetration
In general population: The exact prevalence rate is not known. Rare(1%) In family planning clinic in Iran: 12% In sexual dysfunction clinics: 5-40%
situational (able to use a tampon & can tolerate a pelvic examination but cannot have intercourse)
Cycle of vaginismus
Fear of vaginal penetration Involuntary muscle spasm
Relationship breakdown
Pain
Infertility
I. Psychological
1. An unpleasant experience: Past sexual abuse, painful first attempt of coitus or vaginal examination
2. Extreme fear of penetration because of wrong belief that her vagina is too small to accommodate an erect penis, fear of pregnancy or intimacy 3. Unexpressed negative feelings towards her husband
4. Religious orthodoxy
5. Pain-tension-pain cycle
tender scar
partially imperforate hymen vaginal stenosis
Aim:
To break the vicious cycle & replacing pain by pleasure & spasm by relaxation
To make the women feels that she owns her own vagina & can share it for sexual activity should she wish.
Requirements:
Warm, empathetic attitude & great patience
Lines of treatment:
1.Exploration of phobia
2.Sex education
3.Guided tour 4.Control of muscles: Adductor muscles
& P coccygeus
1. Exploration of phobia.
It is the most difficult part of the treatment. Psychological causes should be addressed. If there is a history of childhood traumatic experience, this has to be recalled & the emotions which accompanied it relived in order to help the woman to come to terms with them
2. Sex education
How their genital organs are put together & how they both function.
Patient in semi-sitting position & legs apart & mirror placed in front of her vulva, she explores her genitalia with the doctor explaining the anatomy & physiology.
During these maneuvers she learns muscle relaxation & eventually allows access to the vagina.
Once the muscle is identified, the woman can practice contracting it repeatedly whenever she has time. She simply flexes this muscle 20 times in a row 3 to 5 times every day till it is firm.
desensitization of the fear of vaginal penetration Vaginal dilatation exercises are a misnomer because the vagina is not physically stretched
Trainers: fingers, commercial dilators, tampons, of gradually increasing diameter, specifically designed specula such as Simms, Amiell, Stanley. The choice depend on the patient preference &
5. Systematic vaginal
Approaches
Program
Step 1: Insertion of a trainers under controlled relaxation:
In private, in a relaxed & nonsexual setting. The protocol for use of dilators is explained to the patient while she is in the office, but the actual placement of the dilators is done by the patient when she is at home.
The dilators should be covered with a warm, water soluble lubricant. If she is unable to relax enough to place the smallest dilator in her vagina propranolol, or alprazolam may also help reduce anxiety. Once the patient has been able to place the smallest dilator in her vagina, she can progressively insert the largest dilators, practicing Kegel s exercises while dilator in place.
6. Drugs
Anxiolytics & antispasmodics have nothing to offer (Guirguis,1984). The only indication for drugs when vaginismus is a part of a more generalized syndrome of sexual phobia. A trial of imipramine 30-75 mg daily
7. Surgical treatment
Almost never required & may be detrimental to achieving success. The resulting scar may
aggravate the condition.
1. Vaginismus is recurrent or persistent involuntary contraction of the outer third of the vagina interfering with sexual intercourse.
2. Vaginismus causes marked stress, anxiety, break down of marital relationship & infertility
3. Vaginismus is caused mainly by psychological factors
Exploration of phobia, sex education, guided tour, control of the adductors & P coccygeus muscles, systematic vaginal desensitization & drugs . Surgical treatment is almost never required & may be detrimental to achieving success