Self-Evaluation for Vaginismus

Levels of severity and self evaluation can be done by most women with vaginismus. I have found from evaluating 555 women with vaginismus, of which 391 women were treated using the Pacik Botox multimodal program, that not all vaginismus is the same [1,2,3]. A woman with severe vaginismus has so much fear and anxiety to penetration that it is difficult to follow treatment recommendations. This is very different than a woman with mild vaginismus who is willing to follow dilation recommendations and progression to intercourse. Self evaluation can save a lot of time in getting the right treatment.

Self-evaluation: Levels of anxiety and pain

Start by creating a simple chart listing the various types of penetration such as tampon, cotton tipped applicator, finger, GYN exam, dilators and intercourse. Assign anxiety levels from 1-10 with 10 being the most severe anxiety. Now use the same chart to record pain with penetration also 1-10.

Interpretation: Less severe vaginismus to severe vaginismus

Women with less severe vaginismus have lower anxiety levels for some of the different types of penetration yet are unable to achieve intercourse because of pain. In contrast a woman who scores herself as 10's for all forms of penetration and pain has the more severe type of vaginismus.

Vaginismus Treatment options:

Less Severe Vaginismus

Women can often treat themselves by using progressively larger dilators until they are able to advance to intercourse and GYN exams whereas women with moderate to severe vaginismus often need professional help. 

Moderately Severe Vaginismus

  • Physical therapy especially a therapist who specializes in pelvic floor dysfunction.
  • Sex Counseling, psychotherapy, hypnotherapy and cognitive behavior therapy (CBT) 
  • Consider a multidisciplinary approach to treatment to help treat BOTH the physical and the emotional aspects of vaginismus.

Severe Vaginismus

Severe Vaginismus is noted in women who score themselves as 10 for all types of penetration. I have found that there is a high level of failure with most treatments and often a patient is treated best by using the Pacik Botox multimodal program [1,2,3].

Lamont-Pacik classification of vaginismus

An alternative method for determining the severity of vaginismus relates to a woman's behavior during a GYN exam using the Lamont-Pacik classification [1-4]. The various levels of vaginismus severity are noted in the table below. When combined with the levels of fear and anxiety for the various forms of penetration such as tampon, finger, GYN exam, use of vaginal dilators and intercourse, it is possible to make an accurate assessment of the severity of your vaginismus and to determine ahead of time which types of treatment may be suitable for you.


Classification of vaginismus based on GYN exam

Lamont Grade 1: Patient is able to relax for pelvic exam

Lamont Grade 2: Patient is unable to relax for pelvic exam

Lamont Grade 3: Buttocks lift off table. Early retreat

Lamont Grade 4: Generalized retreat: Buttocks lift up, thighs close, patient retreats

Pacik Grade 5: Generalized retreat as in level 4 plus visceral reaction which may result in any one or more of the following: palpitations, hyperventilation, sweating, severe trembling, uncontrollable shaking, screaming, hysteria, wanting to jump off the table, a feeling of going unconscious, nausea, vomiting and even a desire to attack the doctor.


References:

1. Pacik, PT When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy. (Ch. 6 p. 40-47 "How Bad is Bad. The Five Levels of Vaginismus) Odyne Publishing (2010)

2. Pacik PT. Vaginismus: review of current concepts and treatment using Botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia. Aesthetic Plast Surg. 35:1160-1164 (2011)

3. Pacik PT. Understanding and treating vaginismus: A multimodal approach. International Urogynecology Journal  2014; 25 (12), DOI: 10.1007/s00192-014-2421-y

4. Lamont JA. Vaginismus. Am J Obstet Gynecol. 1978;131:633-636.