Vaginismus

Vaginismus is an involuntary spasm of the muscles surrounding the vagina. The spasms close the vagina.

Vaginismus is considered a disorder of sexual dysfunction. It has several possible causes, including past sexual trauma or abuse, psychological factors, or a history of discomfort with sexual intercourse. Sometimes no cause can be found.

Vaginismus is an uncommon condition. The exact number of women who have this problem is unknown.

Women with varying degrees of vaginismus often develop anxiety regarding sexual intercourse. The condition causes penetration to be difficult and painful, or even impossible. However, this does not mean the woman cannot become sexually aroused. Many women may have orgasms when the clitoris is stimulated.

• Vaginal penetration during sex is difficult or impossible.
• Vaginal pain is common during sexual intercourse or an attempted pelvic exam.

A pelvic exam can confirm the diagnosis of vaginismus. A medical history and complete physical exam is important to rule out other causes of pain with sexual intercourse (dyspareunia).

Treatment involves extensive therapy that combines education, counseling, and behavioral exercises. Such exercises include pelvic floor muscle contraction and relaxation (Kegel exercises).

Vaginal dilation exercises are recommended using plastic dilators. This should be done under the direction of a sex therapist or other health care provider. Such therapy should involve the partner, and can gradually include more intimate contact, ultimately resulting in intercourse.

Educational resources should be provided. This includes information about sexual anatomy, physiology, the sexual response cycle, and common myths about sex.

When treated by a specialist in sex therapy, success rates are generally very high.

Vaginismus may lead to unsatisfying sex activity and tension in intimate relationships.

If you have pain associated with intercourse or difficulties with successful vaginal penetration, contact your health care provider.

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Lentz GM. Emotional aspects of gynecology: sexual dysfunction, eating disorders, substance abuse, depression, grief, loss. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 9.

Moore DP, Jefferson JW. Vaginismus. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2004:chap 105.