What is vaginismus?
Vaginismus is ‘persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger, and or any object, despite the woman’s expressed wish to do so.’ (Basson et al 2004) This tightness is usually caused by a tensing of the vaginal muscles, although infact in most cases it has been observed that the woman will tense all her muscles, as if responding to a threat. Over the years vaginismus has been confused with dyspareunia, a condition in which vaginal pain causes the vaginal tightness, this has led to a combined definition which covers the two conditions ‘Genito-Pelvis Pain / penetration Disorder’ (GPPPD) (Binik and Hall 2014)
Vaginismus can be sub-categorised as either (Crowley et al 2009)
- Primary; lifelong
- Secondary; acquired after a period normal sexual functioning.
Some Gynaecologist employ the Lamont scale (from Pacik 2011) when classifying vaginismus, it is specifically intended for responses in a gynaecological examination but may still be useful in providing some measure with which to judge the severity of symptoms.
What is vaginismus? – how common is it?
Vaginismus has been observed in a wide variety of counties and cultures, including Sri lanka (Munasinghe et al 2004), Ireland (O’Sullivan, K. 1979), Turkey (Kabakci & Batur 2003, Dogan 2009), Scandinavia (Wijma & Wijma1997) and traditional Islamic populations (Yasan & Akdeniz, 2009). Historically its general prevalence has been difficult to identify (Spector & Carey 1990). One study (Read et al 1997) study of 170 women presenting at the general practitioners (GP’s) who agreed to conduct a questionnaire on sexual problems found that 30% reported Vaginismus, however this can be contrasted with a study from Morocco which found only 6.2% (Kadri et al 2002). Simons, & Carey’s 2001 review of the previous decade’s evidence suggested a general population prevalence of 0.5-1%.
What is vaginismus? – causes
There is no one simple answer to this question as no single cause has ever been established. Most of what we suspect to be causes are in fact correlation which often appear with vaginismus but cannot be said with certainty to be causes. These possible causes include pain, threat and disgust regarding sex or penetration, a history of sexual abuse may also be a factor as can be low-self esteem or a strong moral upbringing. For a more detailed see ’causes of vaginismus’
What is vaginismus – treatment options
There are a number of options to treat vaginismus the most well researched are the psychological and behavioural approaches which include;
Cognitive Behavioural Therapy (CBT) – this helps the sufferer to identify their own assumptions, beliefs and automatic thoughts about sex, to challenge the limiting ones and then to enter sexual situations with new beliefs.
Desensitisation – a process of graded exposure in which the patient is deeply relaxed and then enters, or imagines entering, sexual anxiety producing situations. With depth of relaxation and repetition the body learns to be relaxed in that situation. Sometimes this is used in CBT for greater efficacy.
Pelvic floor exercises – these strengthen the pelvic floor muscles, which many consider to be potentially counter productive but may actually improve things by enhancing control of these muscles.
For more on treatment options