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{{DiseaseDisorder infobox |
  
{{DiseaseDisorder infobox |
 
Name = Vaginismus |
  
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ICD9 = 625.1 |
  
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'''Vaginismus''' is a condition which affects a woman's ability to have [[sexual intercourse]], insert [[tampon]]s and undergo gynaecological examinations. This is due to a conditioned muscle reflex in the [[PC muscle]], they clamp shut making penetration either extremely painful or in many cases, impossible. The woman does not choose for this to happen; it is a learned [[reflex reaction]]. A comparison which is often made, is that of the eye shutting when an object comes towards it. This, like vaginismus is a reflex reaction designed to protect our bodies from pain. A woman with vaginismus expects pain to come with penetration and so her mind automatically sends a signal to her PC muscles to clamp shut, thus making penetration either impossible or very painful. The severity of vaginismus varies from woman to woman.
 
  +
'''Vaginismus''' (the German equivalent of the word '''Vaginism''') is a condition which affects a woman's ability to engage in any form of vaginal penetration, including [[sexual penetration]], insertion of tampons, and the penetration involved in gynecological examinations. This is the result of a conditioned reflex of the [[pubococcygeus muscle]], which is sometimes referred to as the 'PC muscle'. The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration -- including [[sexual penetration]] -- either painful or impossible.
   
  +
A vaginismic woman does not consciously control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The severity of vaginismus varies from woman to woman.
−
The conditioned reflex creates a vicious circle for vaginismic women. For example, if a teenage girl is told that the first time she has sex it will be very painful, she may develop vaginismus because she expects pain. If she then attempts to have sexual intercourse, her muscles will [[spasm]] and clamp shut which will make sex painful. This then confirms her fear of pain as does each further attempt at intercourse. Every time the fear is confirmed, the brain is being "shown" that sex does hurt and that the reflex reaction of the PC muscles is needed. This is why it is important that if a woman suspects she has vaginismus, she stops attempting to have sexual intercourse. This does not mean women with vaginismus can not partake in other sexual activities, as long as penetration is avoided. It is a common misconception that these women do not want to have sex as a lot of the time, they desperately do.
 
   
  +
{{Sex problems}}
−
There is no one reason that a woman may have vaginismus and in fact, there are a variety of factors that can contribute. These may be [[psychological]] or [[physiological]] and the treatment required will usually depend on the reason why the woman has the condition. Some examples of causes of vaginimus include [[sexual abuse]], strict religious upbringing, being taught that sex is dirty or wrong or simply the fear of pain associated with penetration, and in particular, losing your [[virginity]]. These are just some of the reported reasons behind vaginismus and there are many, many more. It is a very personal condition and so each case must be looked at individually as causes and treatment can not be generalised to all women with vaginismus.
  
   
  ⚫
==Experience of vaginismus==
−
Most women who suffer from vaginismus do not realise they have it until they try to insert a tampon or have sex for the first time and so it may come as quite a shock to them. Whether they choose to treat the problem or not is entirely their choice and they should never be led to believe that vaginismus must be treated. It is not an illness or a [[dysfunction]] and therefore the only physical effect it will have on a woman is making penetration painful or impossible. It will ''not'' get worse or more serious if left untreated unless the woman is continuing to have sex/use tampons despite feeling pain on penetration.
  
  +
The conditioned reflex can create a [[vicious circle]] for vaginismic women. One example: if a teenage female learns that the first time she engages in penetrative sex that it will be painful, she may develop vaginismus because she expects pain. If she then attempts to engage in penetrative sex, the muscle spasm will make penetrative sex painful. This and each further attempt at sexual penetration confirms her fear of pain and may worsen the condition. Naturally, penetration may be extremely painful without vaginismus or psychological prerequisite as well.
   
−
== Primary vaginismus ==
 +
===Primary vaginismus===
  ⚫
Primary vaginismus occurs when a woman has never been able to have penetrative sex or achieve any kind of vaginal penetration. It is commonly discovered in [[teenagers]] and women in their early twenties, as this is when many young women in the Western world will initially attempt to use [[tampons]], have penetrative sex, or undergo a [[pap smear]]. Women who have vaginismus may not be aware of their condition until they attempt vaginal penetration. It may be confusing for a woman to discover she has vaginismus. She may believe that vaginal penetration should be naturally easy, or she may be unaware as to the reason for her condition.
   
  +
Some of the things that may cause primary vaginismus are:
⚫
Primary vaginismus occurs when a woman has never been able to have sexual intercourse or achieve any other kind of penetration. It is commonly discovered in teenagers and women in their early twenties as this is when the majority of women will attempt to use tampons, have sexual intercourse or complete a [[pap smear]] for the first time. It can often be very confusing for a woman when she discovers she has vaginismus as we are led to believe that sex is something that comes naturally to us. It can be even more confusing if the woman does not know why she has the condition, as is true for many women.
  
   
  +
*[[sexual abuse]]
⚫
== Secondary vaginismus ==
 
  +
*having been taught that sex is immoral or vulgar
  +
*the fear of pain associated with penetration, particularly that of breaking the [[hymen]] upon the first attempt at sexual penetration
   
  +
=== Secondary vaginismus ===
−
Secondary vaginismus occurs when a woman who has previously been able to achieve penetration, acquires vaginismus for one reason or another. This is often due to physical causes such as a [[yeast infection]] or trauma during childbirth, however it can also be down to psychological causes. The treatment for secondary vaginismus is the same as for primary vaginismus but in many cases the knowledge that you can have sex and have previously achieved penetration can aid treatment and speed the process up a little.
 +
Secondary vaginismus occurs when a woman who has previously been able to achieve penetration develops vaginismus. This may be due to physical causes such as a [[yeast infection]] or trauma during [[childbirth]], or it may be due to psychological causes. The treatment for secondary vaginismus is the same as for primary vaginismus, although, in these cases, previous experience with successful penetration can assist in a more rapid resolution of the condition.
   
 
== Treatment ==
  
== Treatment ==
  +
There are a variety of factors that can contribute to vaginismus. These may be [[psychological]] or [[physiological]], and the treatment required can depend on the reason that the woman has developed the condition. As each case is different, an individualized approach to treatment is useful.
   
  +
The condition will not necessarily become more severe if left untreated, unless the woman is continuing to attempt penetration, despite feeling pain. Some women may choose to refrain from seeking treatment for their condition.
−
If a woman suffering from vaginismus desires to treat the problem then she can do so in many different ways. It does not have to be expensive and in fact, many women achieve relief from vaginismus without the help of any health professionals at all (although it is recommended that a proper diagnosis is sought).
  
   
  +
According to the [[Cochrane Collaboration]] review of the scientific literature, "In spite of encouraging results reported from uncontrolled case series there is very limited evidence from controlled trials concerning the effectiveness of treatments for vaginismus. Further trials are needed to compare therapies with waiting list control and with other therapies." <ref>Interventions for vaginismus, The Cochrane Database of Systematic Reviews 2007[http://www.cochrane.org/reviews/en/ab001760.html]</ref>
−
If the cause of vaginismus is psychological then it is usually important to treat those aspects of the problem as well as the actual muscle spasm. This will usually require help from a therapist or psychologist as it is very important to get to the root of the problem.
  
   
  +
Although few controlled trials have been carried out, many serious scientific studies have tested and proved the efficacy of the treatment of vaginismus. In all cases where the systematic desensitization method was used, success rates were close to 90-95% and even 100%. For an example of one of these studies, see Nasab, M., & Farnoosh, Z., or for a basic review, see Reissing's literature review. (links below)
⚫
If the vaginismus does not have any psychological grounds then physical treatment alone may be enough to fix the problem. This includes sensate focus exercises, exploring the vagina and [[desensitization]] involving vaginal dilators. Dilating involves inserting objects (usually mildly resembling a penis in shape), into the vagina. Whatever objects the woman chooses to use for dilation, they should gradually increase in size as she progresses. Medical dilators can be obtained from online resources but are often quite expensive. There are many other options though, some women use vegetables and candles covered with a condom, q-tips or simply their own fingers. It is very important to use [[personal lubricant]] whilst dilating as it makes insertion a lot easier and less painful.
  
  +
  +
  +
===Psychological treatment===
  +
  +
According to Ward and Ogden's qualitative study on the experience of vaginismus for women (1994), the three highest ranked causes for vaginismus are usually:
  +
  +
1. Fear of painful sex, fear of pain at insertion
  +
2. Strict religious upbringing where sex was viewed as wrong or not discussed
  +
3. Early childhood traumatic experiences (not necessarily sexual in nature)
  +
  +
It is important to address the psychological aspects of the problem as well as the actual muscle spasm. A woman may choose to address the issue on her own terms, or she may avail the help of a therapist.
  +
  +
Many people -- even some professionals -- are not aware of the emotional difficulties associated with vaginismus, which can include low self-esteem, fears, and [[clinical depression|depression]]. Women with this condition may wish to seek an understanding professional who has previous experience with women who experience vaginismus. A therapist who has a positive attitude towards [[Sexual intercourse|sex]] and the [[Human anatomy|human body]] may be beneficial.
  +
  +
===Physical treatment===
  ⚫
Physical treatment of the internal spasms may include sensate focus exercises, exploring the [[vagina]] through touch, and [[desensitization]] with vaginal dilators. Dilating involves inserting objects, usually [[phallus|phallic]] in shape, into the vagina. In treating the spasms through dilation, the objects used gradually increase in size as the woman progresses. Medical dilators may be obtained online, though they may be expensive. Other options include sex toys (such as dildos or vibrators), peeled cucumber, or simply her own fingers. The addition of [[personal lubricant]] can ease insertion.
  +
  +
==Sexuality==
  +
If a woman suspects she has vaginismus, sexual penetration is likely to remain painful or impossible until her vaginismus is addressed. Women with vaginismus may be able to engage in other sexual activities, as long as penetration is avoided. Sexual partners of vaginismic women may come to believe that vaginismic women do not want to engage in penetrative sex at all, though this may not be true. Many vaginismic women do wish to engage in penetrative sex, but are deterred by the pain and emotional distress that comes with each attempt.
  +
  +
===Masturbation===
  +
Women with vaginismus may not realize that most women who do ''not'' have vaginismus usually do experience pain or discomfort if they attempt sexual penetration without prior [[sexual arousal]]. Most women acknowledge sexual arousal as integral to painless sexual penetration so self-exploration of the vaginal area through [[masturbation]] can be beneficial in addressing vaginismus.
  +
  +
One of the problems that can come with vaginismus is that a woman may be fearful to engage in sexual activity, due to the fear of pain with any kind of vaginal penetration. Solo masturbation, with or without penetration, can alleviate this fear, as well as the psychological pressure to 'perform' sexually or become aroused quickly, with a partner.
  +
  +
Despite popular belief, [[orgasm]] need not be the goal of masturbation. The reason may be to simply increase comfort with the genital area, to explore various sensations through genital and clitoral touch, and to become aware of those sensations which are relaxing and pleasurable. Sexual arousal causes changes in the shape and color of the [[vulva]], as well as in the [[vaginal lubrication]] produced. As a woman becomes more aware of her individual sexual response, she can learn which sensations are best for bringing her to a state of arousal. She will then be better equipped to teach her partner(s) which sensations feel best for her.
  +
  +
===Emotional experiences===
  +
A wide range of emotions may surface during masturbation and other forms of genital exploration. Some women have negative associations with their genitals, including fears that their genitals are dirty, smelly, oddly shaped, or ugly. These associations can lead to negative emotions arising during any kind of sexual expression, including masturbation, and these emotions can take time to process. Especially in the case of a vaginismic woman, feelings of shame, inadequacy or of being 'defective' can be deeply troubling. Relaxation, patience and self-acceptance are vital to a pleasurable experience.
  +
  +
The process of addressing vaginismus requires time, patience, and a focused personal intention to heal. In almost all cases it can be successfully treated.
  +
  +
==See also==
  +
* [[Dyspareunia]]
  +
* [[Frigidity]]
  +
  +
==References==
  +
  +
<!-- ----------------------------------------------------------
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See Psychology wiki:Footnotes for a
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discussion of different citation methods and how to generate
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footnotes using the <ref>, </ref> and <reference /> tags
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<div class="references-small">
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<references />
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*{{cite journal |author=van der Velde J, Everaerd W |title=The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus |journal=Behaviour research and therapy |volume=39 |issue=4 |pages=395-408 |year=2001 |pmid=11280339 |doi=}}
  +
  +
* Crowley, Tessa et al. (the BASHH Special Interest Group for Sexual Dysfunction) Recommendations for the management of vaginismus. International Journal of STD & AIDS. 17(1):14-18, January 2006. Available in PDF format at: http://www.bashh.org/committees/sig/dys_sig/bashh_vag_recomm_050106.pdf
  +
  +
* Nasab, M., & Farnoosh, Z. (2003). Management of vaginismus with cognitive-behavioral therapy, self-finger approach: A study of 70 cases. IJMS, 28(2).
  +
Available on PDF at http://ijms.sums.ac.ir/28_2/69-71_Mosavi.pdf
  +
  +
* Reissing E. et al. (1999) Does vaginismus exist? A critical review of the literature The Journal of Nervous and Mental Disease 187 (5): 261-271
  +
  +
* WARD E, OGDEN J. (1994) Experiencing Vaginismus: sufferers beliefs about causes and effects - Sexual and Marital Therapy - Vol. 9, No. 1, pp: 33-45
  +
  +
</div>
  +
  +
== External links ==
  +
===Support and treatment===
  +
*[http://www.vaginismus-awareness-network.org Vaginismus] A non-profit site to raise awareness of vaginismus, self-treat it and offer facts, advice and opinions to women, their partners and gynecologists.
  +
*{{dmoz|Health/Women's_Health/Conditions_and_Diseases/Vagina/Vaginismus|Vaginismus}}
  +
  +
===Clinical resources===
  +
* [http://www.nlm.nih.gov/medlineplus/ency/article/001487.htm Vaginismus] entry in the [[Medical Dictionary]] at NIH
  +
* [http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=386 Vaginismus – Causes, Diagnosis, Treatment & Self Help] entry in NHS Direct Health Encyclopaedia (UK)
  +
  +
{{Diseases of the pelvis, genitals and breasts}}
   
−
The process of curing vaginismus is usually a long one and will require patience, will power and determination. However, it is important to know that in 99% of cases, it can be successfully treated. Many people don't take into account the emotional problems associated with vaginismus such as low self esteem, insecurities and often even [[clinical depression|depression]], so it is very important that if women choose to seek the help of professionals, they should try to find someone who is very understanding and who has previous experience with vaginismus.
  
   
 
[[Category:Sexual and gender identity disorders]]
  
[[Category:Sexual and gender identity disorders]]
  +
[[Category:Sexual function disturbances]]
  +
[[Category:Sexual health]]
  +
   
  +
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Revision as of 09:25, 6 March 2010

Vaginismus
ICD-10 N94.2
ICD-9 625.1
OMIM {{{OMIM}}}
DiseasesDB {{{DiseasesDB}}}
MedlinePlus {{{MedlinePlus}}}
eMedicine {{{eMedicineSubj}}}/{{{eMedicineTopic}}}
MeSH {{{MeshNumber}}}

Vaginismus (the German equivalent of the word Vaginism) is a condition which affects a woman's ability to engage in any form of vaginal penetration, including sexual penetration, insertion of tampons, and the penetration involved in gynecological examinations. This is the result of a conditioned reflex of the pubococcygeus muscle, which is sometimes referred to as the 'PC muscle'. The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration -- including sexual penetration -- either painful or impossible.

A vaginismic woman does not consciously control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The severity of vaginismus varies from woman to woman.

Experience of vaginismus

The conditioned reflex can create a vicious circle for vaginismic women. One example: if a teenage female learns that the first time she engages in penetrative sex that it will be painful, she may develop vaginismus because she expects pain. If she then attempts to engage in penetrative sex, the muscle spasm will make penetrative sex painful. This and each further attempt at sexual penetration confirms her fear of pain and may worsen the condition. Naturally, penetration may be extremely painful without vaginismus or psychological prerequisite as well.

Primary vaginismus

Primary vaginismus occurs when a woman has never been able to have penetrative sex or achieve any kind of vaginal penetration. It is commonly discovered in teenagers and women in their early twenties, as this is when many young women in the Western world will initially attempt to use tampons, have penetrative sex, or undergo a pap smear. Women who have vaginismus may not be aware of their condition until they attempt vaginal penetration. It may be confusing for a woman to discover she has vaginismus. She may believe that vaginal penetration should be naturally easy, or she may be unaware as to the reason for her condition.

Some of the things that may cause primary vaginismus are:

  • sexual abuse
  • having been taught that sex is immoral or vulgar
  • the fear of pain associated with penetration, particularly that of breaking the hymen upon the first attempt at sexual penetration

Secondary vaginismus

Secondary vaginismus occurs when a woman who has previously been able to achieve penetration develops vaginismus. This may be due to physical causes such as a yeast infection or trauma during childbirth, or it may be due to psychological causes. The treatment for secondary vaginismus is the same as for primary vaginismus, although, in these cases, previous experience with successful penetration can assist in a more rapid resolution of the condition.

Treatment

There are a variety of factors that can contribute to vaginismus. These may be psychological or physiological, and the treatment required can depend on the reason that the woman has developed the condition. As each case is different, an individualized approach to treatment is useful.

The condition will not necessarily become more severe if left untreated, unless the woman is continuing to attempt penetration, despite feeling pain. Some women may choose to refrain from seeking treatment for their condition.

According to the Cochrane Collaboration review of the scientific literature, "In spite of encouraging results reported from uncontrolled case series there is very limited evidence from controlled trials concerning the effectiveness of treatments for vaginismus. Further trials are needed to compare therapies with waiting list control and with other therapies." [1]

Although few controlled trials have been carried out, many serious scientific studies have tested and proved the efficacy of the treatment of vaginismus. In all cases where the systematic desensitization method was used, success rates were close to 90-95% and even 100%. For an example of one of these studies, see Nasab, M., & Farnoosh, Z., or for a basic review, see Reissing's literature review. (links below)


Psychological treatment

According to Ward and Ogden's qualitative study on the experience of vaginismus for women (1994), the three highest ranked causes for vaginismus are usually:

1. Fear of painful sex, fear of pain at insertion 2. Strict religious upbringing where sex was viewed as wrong or not discussed 3. Early childhood traumatic experiences (not necessarily sexual in nature)

It is important to address the psychological aspects of the problem as well as the actual muscle spasm. A woman may choose to address the issue on her own terms, or she may avail the help of a therapist.

Many people -- even some professionals -- are not aware of the emotional difficulties associated with vaginismus, which can include low self-esteem, fears, and depression. Women with this condition may wish to seek an understanding professional who has previous experience with women who experience vaginismus. A therapist who has a positive attitude towards sex and the human body may be beneficial.

Physical treatment

Physical treatment of the internal spasms may include sensate focus exercises, exploring the vagina through touch, and desensitization with vaginal dilators. Dilating involves inserting objects, usually phallic in shape, into the vagina. In treating the spasms through dilation, the objects used gradually increase in size as the woman progresses. Medical dilators may be obtained online, though they may be expensive. Other options include sex toys (such as dildos or vibrators), peeled cucumber, or simply her own fingers. The addition of personal lubricant can ease insertion.

Sexuality

If a woman suspects she has vaginismus, sexual penetration is likely to remain painful or impossible until her vaginismus is addressed. Women with vaginismus may be able to engage in other sexual activities, as long as penetration is avoided. Sexual partners of vaginismic women may come to believe that vaginismic women do not want to engage in penetrative sex at all, though this may not be true. Many vaginismic women do wish to engage in penetrative sex, but are deterred by the pain and emotional distress that comes with each attempt.

Masturbation

Women with vaginismus may not realize that most women who do not have vaginismus usually do experience pain or discomfort if they attempt sexual penetration without prior sexual arousal. Most women acknowledge sexual arousal as integral to painless sexual penetration so self-exploration of the vaginal area through masturbation can be beneficial in addressing vaginismus.

One of the problems that can come with vaginismus is that a woman may be fearful to engage in sexual activity, due to the fear of pain with any kind of vaginal penetration. Solo masturbation, with or without penetration, can alleviate this fear, as well as the psychological pressure to 'perform' sexually or become aroused quickly, with a partner.

Despite popular belief, orgasm need not be the goal of masturbation. The reason may be to simply increase comfort with the genital area, to explore various sensations through genital and clitoral touch, and to become aware of those sensations which are relaxing and pleasurable. Sexual arousal causes changes in the shape and color of the vulva, as well as in the vaginal lubrication produced. As a woman becomes more aware of her individual sexual response, she can learn which sensations are best for bringing her to a state of arousal. She will then be better equipped to teach her partner(s) which sensations feel best for her.

Emotional experiences

A wide range of emotions may surface during masturbation and other forms of genital exploration. Some women have negative associations with their genitals, including fears that their genitals are dirty, smelly, oddly shaped, or ugly. These associations can lead to negative emotions arising during any kind of sexual expression, including masturbation, and these emotions can take time to process. Especially in the case of a vaginismic woman, feelings of shame, inadequacy or of being 'defective' can be deeply troubling. Relaxation, patience and self-acceptance are vital to a pleasurable experience.

The process of addressing vaginismus requires time, patience, and a focused personal intention to heal. In almost all cases it can be successfully treated.

See also

References

  1. ↑ Interventions for vaginismus, The Cochrane Database of Systematic Reviews 2007[1]
  • van der Velde J, Everaerd W (2001). The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behaviour research and therapy 39 (4): 395-408.
  • Nasab, M., & Farnoosh, Z. (2003). Management of vaginismus with cognitive-behavioral therapy, self-finger approach: A study of 70 cases. IJMS, 28(2).

Available on PDF at http://ijms.sums.ac.ir/28_2/69-71_Mosavi.pdf

  • Reissing E. et al. (1999) Does vaginismus exist? A critical review of the literature The Journal of Nervous and Mental Disease 187 (5): 261-271
  • WARD E, OGDEN J. (1994) Experiencing Vaginismus: sufferers beliefs about causes and effects - Sexual and Marital Therapy - Vol. 9, No. 1, pp: 33-45

External links

Support and treatment

Clinical resources


v·d·e
Diseases of the pelvis, genitals and breasts (N40-N99, 600-629)
Diseases of male genital organs

prostate (Benign prostatic hyperplasia, Prostatitis)

testicle/epididymis (Hydrocele testis, Spermatocele, Testicular torsion, Orchitis, Epididymitis, Azoospermia, Oligospermia)

penis (Phimosis, Balanoposthitis, Balanitis, Priapism, Erectile dysfunction, Peyronie's disease)

Disorders of breast

Chronic cystic mastitis - Mastitis - Gynecomastia - Galactorrhea - Mastodynia - Nipple discharge - Galactocele

Inflammatory diseases
of female pelvic organs

Pelvic inflammatory disease: Salpingitis - Oophoritis - Hydrosalpinx - Parametritis - Vaginitis - Vulvitis

Noninflammatory disorders
of female genital tract

Endometriosis (Adenomyosis) - Vaginal prolapse (Cystocele, Rectocele) - obstetric fistulae (Vesicovaginal fistula, Rectovaginal fistula) - Ovarian cyst - Endometrial polyp - Retroverted uterus - Hematometra - Leukorrhea - menstruation (Amenorrhoea, Oligomenorrhea, Menorrhagia, Menometrorrhagia, Metrorrhagia, Dysmenorrhea) - intercourse (Dyspareunia, Vaginismus) - Mittelschmerz

See also congenital conditions (Q50-Q56, 752)


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