What is vaginismus?
Vaginismus is a condition involving spasm in the muscles of the pelvic floor. Vaginismus makes sexual intercourse, vaginal examination and inserting a tampon extremely painful and difficult. It is an involuntary contraction seen in the pelvic muscles when an object is inserted which tightens it up. This, in turn, leads to muscle spasm, pain, and temporary cessation of breathing. The commonly affected muscle group in Vaginismus is the pubococcygeus group, the muscle which is responsible for urination, intercourse, orgasm, bowel movements, and childbirth.
Types
There are different types of vaginismus that can affect women at different ages.
Primary vaginismus
This is a lifetime condition in which the pain has always been present. It will be difficult to use a tampon and to undergo a gynecological exam.
It is often experienced by women during their first attempt at intercourse. The male partner is unable to insert his penis into the vagina. He may describe a sensation like “hitting a wall” at the vaginal opening.
There may be pain, generalized muscle spasms, and the woman may temporarily stop breathing. The symptoms are reversed when the attempt at vaginal entry is stopped.
Secondary vaginismus
This develops after a woman has already experienced normal sexual function. It has not always been present. It can occur at any stage of life, and it may not have happened before.
It usually stems from a specific event, such as an infection, menopause, a traumatic event, development of a medical condition, relationship issues, surgery, or childbirth.
Even after any underlying medical condition is corrected, pain can continue if the body has become conditioned to respond in this way.
Global vaginismus
Vaginismus is always present, and any object will trigger it.
Situational vaginismus
This occurs only in certain situations. It may happen during sex but not during gynecological exams or tampon insertion.
Causes of vaginismus
There are several possible causes of vaginismus. These include physical and psychological factors, like:
- Trauma during childbirth
- Medical conditions like recurrent UTIs, yeast infections (thrush), chronic pain syndromes, endometriosis
- Rape, sexual abuse or assault in the past
- A painful examination in the past
- Unpleasant sexual intercourse
- Fear of getting pregnant
- Fear the vagina may be too small for penetration
Risk Factors
Factors that may increase your chance of vaginismus include:
- History of sexual abuse or trauma
- A frightening childhood medical procedure
- Painful first intercourse
- Relationship problems
- Sexual inhibition
- Fear of pregnancy
- Memory of previous pain due to infection, surgery, or other gynecologic conditions
Symptoms
The symptoms vary between individuals.
They may include:
- Painful intercourse (dyspareunia), with tightness and pain that may be burning or stinging
- Penetration being difficult or impossible
- Long-term sexual pain with or without a known cause
- Pain during tampon insertion
- Pain during a gynecological examination
- Generalized muscle spasm or breathing cessation during attempted intercourse
Pain can range from mild to severe in nature and from discomfort to burning in sensation.
Vaginismus does not prevent people from becoming sexually aroused, but they may become anxious about sexual intercourse, so that they try to avoid sex or vaginal penetration.
Complications of vaginismus
Vaginismus can cause a lot of complications in women who are diagnosed with it. It can lead to physical and emotional distress in women, since they are either sexually unsatisfied or might experience difficulty in getting pregnant. Following are the commonly known complications caused by vaginismus:
- Emotional and psychological distress: Often, the inability to support vaginal penetration makes a woman emotionally and psychologically drained out. This leads to poor self-esteem and insecurity among women.
- Dyspareunia: It is a condition of painful or difficult sexual intercourse experienced by a woman. Lack of arousal or poor lubrication caused by pelvic inflammatory disease or endometriosis can be one reason, and vaginismus can be another major reason for dyspareunia.
- Stress: Vaginismus can make a woman completely stressed out because she constantly feels guilty about not being able to have a fulfilling sexual life. The stress further causes hormonal imbalance (for example, a drop in estrogen levels) and may also affect vaginal lubrication due to which vaginal penetration becomes difficult.
- Depression and relationship issues: Vaginismus makes it difficult for women to enjoy sexual intercourse with her partner. Also, the man is not sexually satisfied as he is not able to penetrate enough. This leads to depression and issues in the relationship since both partners are unable to feel physically intimate and often abstain from intercourse.
- Infertility: Vaginismus can also lead to infertility which is a condition where women are unable to bear a child. If diagnosed with infertility, women can consult reproductive consultant for further options.
The complications caused by vaginismus can be avoided by taking appropriate treatment for the same. Consulting doctors and counselors for treatment and therapy can help women lead a normal life like their peers.
Diagnosis and Test
The clinician should take a careful gynaecological, obstetric, sexual and urological history to determine if there is any obvious likely cause.
Diagnosis of vaginismus firsts begins with the gynecologist asking you about your symptoms including:
- When did you first notice the problem?
- What makes you feel uncomfortable?
- How often does the problem occur?
- Instances when it occurs
- Have you experienced any form of sexual abuse or trauma?
- Your medical history, if you have had any form of gynecological surgeries
Examination of the external genitalia and vagina is essential, looking for any congenital urogenital anomalies, scarring, lichenification, ulceration or inflammation.
Pelvic examination may be difficult with vaginismus and require patience and maybe a second visit. Time should be taken to explain examination and to obtain consent at each step. Reassure the woman that you will stop examining at any point if she wishes or if it is too painful to continue. During examination try to ascertain at what point there is pain or muscular contraction and what the trigger for this is. Establish if she is able to voluntarily relax the musculature and whether penetration is possible.
How is vaginismus managed or treated?
Vaginismus treatments focus on reducing the reflex of your muscles that causes them to tense up. Treatments also address anxieties or fears that contribute to vaginismus.
Your healthcare provider may recommend one or more of these treatments:
- Topical therapy: Topical lidocaine or compounded creams may help with the pain associated with this condition.
- Pelvic floor physical therapy: A physical therapist will teach you how to relax your pelvic floor muscles.
- Vaginal dilator therapy: Vaginal dilators are tube-shaped devices that come in various sizes. Their primary purpose is to stretch the vagina. People with vaginismus use dilators to become more comfortable with, and less sensitive to, vaginal penetration. Your provider may recommend first applying a topical numbing cream to the outside of the vagina to make insertion easier.
- Kegel Exercises: Kegel exercises cause the repeated contraction and relaxation of the pelvic muscles. The exercises can help improve control over the vaginal muscles.
- Cognitive behavioral therapy (CBT): CBT helps you understand how your thoughts affect your emotions and behaviors. It’s an effective treatment for anxiety, depression and post-traumatic stress disorder (PTSD).
- Education and counseling: Providing information about the sexual anatomy and sexual response cycle can help the individual understand their pain and the processes their body is going through.
- Sex therapy: Trained sex therapists work with individuals and couples to help them find pleasure again in their sexual relationships.
- Surgery: in some cases, where there may have been previous surgical trauma, or an obstruction which narrows the vagina, surgery may be necessary. The patient will undergo an anaesthetic and a small amount of tissue is removed.
Prevention of vaginismus
This condition cannot be prevented as the cause of the disease can be a past traumatic incident or a fear. Also, you will only get to know about the condition while attempting vaginal penetration.