Vaginismus

Content written by Irwin Goldstein MD

OVERVIEW:

For almost 150 years the term “Vaginismus” has been used to refer to a “vaginal muscles spasm” at the entrance of the vagina which causes a “persistent or recurrent difficulties of the woman to allow vaginal entry of the penis, finger, or any object, despite her expressed wish to do so.”

CAUSES:

Traditionally, “Vaginismus” has been felt to be the result of fear of pain or a phobia about sex. It has often attributed to difficulties with upbringing and attributed to discomfort with sexuality in general. Sexual abuse was often implicated as the cause of the vaginismus. However, it is the opinion of this author and such noted sexual medicine researchers such as Dr. Irv Binik of McGill University that there is no empiric evidence that vaginismus (as defined above) exist.

Certainly, increased tone (spasm) of the muscles that surround the entrance of the vagina (the pubococcygeus and transverse perinea muscles) does exist and is a common cause of dyspareunia (sexual pain.) (We refer to this condition at “hypertonic pelvic floor muscle dysfunction. ”) However, there is no evidence that these spasm occur only “when there is a threat” of penetration and that the muscles are relaxed at other times. Lastly, there is no evidence that hypertonic pelvic floor muscles are cause by of psychological reasons or a history of sexual abuse.

Lastly, it is very likely that the majority of women who are diagnosed with vaginismus do not have a spasm of these muscles but have vestibulodynia (vulvar vestibulitis syndrome.) As most physicians are not trained in the diagnosis and causes of vestibulodynia, it is very likely that they are attributing pain upon penetration to vaginismus instead of the other causes of vestibulodynia (too many nerve ending, hormonal causes, etc)

DIAGNOSTIC TESTS:

Traditionally, almost all women who complained of pain upon penetration were labeled as having vaginismus. The treatment they were offered was sex therapy and vaginal dilators. However, the author emphatically advises that any women with pain upon penetration be evaluated by a specialist in sexual pain disorders so as to not be incorrectly labeled as having vaginismus.

TREATMENTS:

If a diagnosis of hypertonic pelvic floor muscle dysfunction is made then treatment can consist of pelvic floor physical therapy (by trained womens’ health physical therapists,), muscle relaxants, biofeedback, and Botox injections.

Sex therapy and/or cognitive behavior therapy can be useful in women who feel that anxiety or other psychological issues play a significant role in their dyspareunia.

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