Vaginismus:

What is Vaginismus?

Vaginismus is defined as a pelvic pain/penetration disorder in which penetration with tampons, finger, gynecology (GYN) examination, intercourse and the use of vaginal dilators is either very painful or impossible [1] despite a woman's desire to do so. Vaginismus is differentiated from dyspareunia which means painful intercourse. Vaginismus and dyspareunia are part of a spectrum of penetration pain which ranges from less severe (dyspareunia) to more severe (vaginismus) [2].

Vaginismus is both physical (spastic muscle) and psychologic (fear and anxiety) [2]. It is normal for us to avoid being injured. A dangerous situation creates fear and anxiety. When a woman is concerned that vaginal penetration will cause pain this appears to set up a reflex spasm of the entry muscle which in effect creates a “no entry” situation. Attempted penetration then causes pain which may be more or less severe depending on the severity of vaginismus.

Vaginismus Symptoms:

Vaginismus is the most common cause of unconsummated marriages and is due to spasm of the vaginal entry muscle over which the woman has no control. This is why attempted intercourse often feels like penetration is “hitting a wall”. Women often do not speak about this problem, even to their doctors because of shame and embarrassment and therefore the incidence is unknown. It is thought that about 10% of the female world population suffers from vaginismus and can affect both rich and poor in any country. 

Vaginismus Diagnosis:

Vaginismus is diagnosed by a comprehensive history as outlined by Pacik [2]. The muscular spasm responsible for vaginismus disappears under anesthesia. This is the reason vaginismus cannot be diagnosed under anesthesia. because any spasm disappears and the exam is usually "normal". This is deflating to the woman who knows something is wrong but is unable to get the proper diagnosis. More information can be read in my book “When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy”, and by watching the one-hour film about vaginismus. 

Primary VAGINISMUS vs. secondary vaginismus

If attempted penetration has always been very painful or impossible this is known as primary vaginismus. When this occurs at a later age after having had comfortable penetration this is known as secondary vaginismus. Intercourse is very painful or impossible in both primary and secondary vaginismus [2]. 

Levels of severity, self-evaluation of vaginismus

Less severe vaginismus occurs when a woman is able to tolerate tampons or fingers, sometimes a GYN exam but intercourse is impossible or extremely painful. 

Moderate vaginismus is present when a woman is able to tolerate some penetration but most of the time there is considerable discomfort. This is associated with moderate fear and anxiety to penetration. Intercourse is usually impossible.

Severe vaginismus is noted in women in whom any penetration is impossible because of both severe pain and high anxiety and fear. These are the woman who have often failed many treatment attempts. Given the correct information about vaginismus women are capable of making their own diagnosis and are also able to determine the best course of treatment. 

References:

1.     American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. Washington D.C. (DSM 5. 2013)

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