Vaginismus: Categories, reasons, indications, and remedies
Vaginismus, a condition characterised by involuntary muscle spasms in the pelvic floor, can make vaginal penetration painful or impossible. This condition, which affects roughly 1% to 7% of females worldwide, can be categorised into primary and secondary types, each with different underlying causes and treatment approaches.
**Primary Vaginismus** often results from a lack of sexual education, fear of intercourse, or psychological factors such as anxiety or past trauma. It is present since the first attempt at penetration.
**Secondary Vaginismus** typically occurs after experiencing pain during intercourse due to conditions like vaginal infections, pelvic injuries, recent surgeries, menopause-related vaginal dryness, or other physical changes.
Treatment for vaginismus often involves a combination of physical therapies, psychological interventions, and sometimes medical interventions. For primary vaginismus, sex therapy and cognitive behavioural therapy (CBT) can help address psychological aspects and fear related to sexual activity. Pelvic floor physical therapy involves techniques like massage and muscle retraining to relax the pelvic floor muscles.
In the case of secondary vaginismus, pelvic floor physical therapy may also include addressing physical issues like tissue scarring or dryness. Dilator therapy gradually increases comfort with penetration using a series of dilators, while relaxation techniques such as deep breathing and meditation can reduce muscle tension and anxiety.
Additional treatments may include topical numbing creams to reduce pain during treatment and surgery in rare cases where physical obstruction is present and other treatments fail.
It is important to note that treatment should be tailored to the individual's specific condition and may involve collaboration between healthcare professionals. Early diagnosis and treatment can significantly improve outcomes for both primary and secondary vaginismus.
Anyone who is concerned about symptoms relating to vaginismus should speak with a healthcare professional for evaluation. Conditions that may mimic vaginismus include atrophic vaginitis, vulvar vestibulitis, a vaginal infection, lichen sclerosis or another condition that can create vaginal scar tissue, physical trauma to the vaginal area, and long periods of time without penetrative sexual intercourse.
To diagnose vaginismus, a doctor will take a medical history and carry out a pelvic examination, and may need to rule out possible underlying causes such as infections. Vaginismus is a condition classified under "genito-pelvic pain/penetration disorder (GPPPD)" in the DSM-5.
Vaginismus can make it painful, difficult, or impossible for a person to have sexual intercourse, undergo a gynecological exam, or insert a tampon. Treatment for vaginismus should focus on both physical and psychological factors, and a person may need to work with a therapist or psychiatrist, who may recommend medications that can treat underlying mental health conditions.
Vaginismus can be associated with physical risk factors such as childbirth, poor health, the presence of similar conditions in family members, a history of UTIs or yeast infections, chronic pain syndromes, endometriosis, mental health conditions, stress or anxiety. Psychological and social risk factors can include trauma from sexual assault or childhood sexual abuse, trauma from a gynecological examination or another medical procedure involving vaginal insertion, trauma resulting from different economic or social factors, negative perceptions of sex or belief in myths about sexuality, sexual or physical abuse, including by a romantic partner or family member, other problems in one's romantic relationship, and emotional difficulties.
Other treatments for vaginismus include pelvic floor control exercises, education and counseling, Botox, pulsed radiofrequency, and surgery (rare and typically necessary only if there is a problem with the vagina that mimics the symptoms of vaginismus).
A small study suggests that people with vaginismus might be more resistant to treatment if they blame themselves for the condition and that treatment may be more difficult if vaginismus runs in a person's family. Secondary vaginismus occurs after previous pain-free penetration and may be caused by specific events such as infections, menopause, surgery, or childbirth. The results of this study underscore the importance of early intervention and addressing any underlying psychological factors to improve treatment outcomes.
- Some cases of primary vaginismus can be linked to a lack of sexual education, psychological factors such as anxiety or past trauma, or fear of intercourse.
- Secondary vaginismus may be caused by conditions like vaginal infections, pelvic injuries, recent surgeries, menopause-related vaginal dryness, or other physical changes.
- In instances of secondary vaginismus, pelvic floor physical therapy may involve addressing physical issues like tissue scarring or dryness.
- Conditions that may mimic vaginismus include atrophic vaginitis, vulvar vestibulitis, a vaginal infection, lichen sclerosis, physical trauma to the vaginal area, and other conditions that can create vaginal scar tissue.
- Vaginismus is a condition classified under "genito-pelvic pain/penetration disorder (GPPPD)" in the DSM-5 and is associated with physical risk factors such as childbirth, poor health, the presence of similar conditions in family members, a history of UTIs or yeast infections, chronic pain syndromes, endometriosis, mental health conditions, stress or anxiety.
- Treatment for vaginismus should focus on both physical and psychological factors, and a person may need to work with a therapist or psychiatrist, who may recommend medications that can treat underlying mental health conditions.
- Other treatments for vaginismus include pelvic floor control exercises, education and counseling, Botox, pulsed radiofrequency, and surgery (rare and typically necessary only if there is a problem with the vagina that mimics the symptoms of vaginismus).
- A small study suggests that people with vaginismus might be more resistant to treatment if they blame themselves for the condition, and treatment may be more difficult if vaginismus runs in a person's family.
- Treatment for vaginismus should be tailored to the individual's specific condition and may involve collaboration between healthcare professionals, and early diagnosis and treatment can significantly improve outcomes.
