VAGINISMUS
Vaginismus is defined as “The persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, finger, and or any object, despite the woman’s expressed wish to do so” (1). Typically these women will avoid intercourse, pelvic exams, and have involuntary pelvic floor muscle contractions anticipating fear, anxiety, and pain. However, it is important to note that pain is not necessary for the diagnosis of vaginismus and the ability to experience pleasure through stimulation is not always impaired.
Vaginismus, Dyspareunia (painful intercourse), and Interstitial Cystitis (bladder inflammation) may have overlapping symptoms including voiding or defecation dysfunctions due to the increased tone or spasm of the pelvic floor muscles, however, the main difference with Vaginismus is the conditioned muscle spasm response to a real or perceived painful stimulation making penetration difficult or impossible.
TREATMENT OPTIONS
Physical therapy interventions are very successful in treating this condition. The main treatment will be skilled Manual Therapy techniques by a pelvic floor physical therapist as well as a home program using dilators.
Sensate touch is often incorporated in the home program of patients with vaginismus in order to retrain the brain to not anticipate fear or pain from the touch of their partner allowing the pelvic floor muscles to stay relaxed and not spasm in protection.
TARA’S TIDBIT
There are many reasons for Vaginismus to occur and despite popular belief it is not always associated with a sexual trauma (although it may be). In my practice I have successfully treated women with vaginismus with the goal achieved of consummating their marriage. The etiology of vaginismus from my experience has been from a stressful event dating back to childhood including a horse back riding accident, bicycle injury, and painful/bad experience with first gynecological exam. I’ve even seen Vaginismus date back to negative potty training experiences or with women who have received surgeries or procedures as young children involving their urethra (urethral dilations) and hymen removal. Any procedure performed on a young child will increase the risk of pelvic floor dysfunction that may lead to Vaginismus or other disorders due to muscle memory and the guarding/spasm of the pelvic floor muscles. Here is my case study on Vaginismus:
1. Crowley, T, Goldmeier, D, Wadsworth, J, Hiller, J. Clinical Review: Diagnosing and Managing Vaginismus. BMJ 2009;338:b2284