Vaginismus is a reflex convulsive spasm of the muscles of the genital tract that prevents sexual intercourse and gynecological manipulations. Vaginismus refers to systemic neuroses and is manifested by involuntary contraction of the muscles compressing the vagina and lifting the anus. Diagnosis is based on the presentation of characteristic complaints and gynecological examination data. Treatment requires the efforts of a gynecologist, psychotherapist, sexologist.
Vaginismus (colpospasm, vulvism, sexual neurosis) develops in 2-3% of women, can occur at any age and be expressed to varying degrees. In sexual relations, vaginismus has a protective reflex character associated with the expected sexual intercourse, fear of defloration. This leads to a reflex contraction of the hips, contraction of the muscles of the perineum, vagina, abdominal wall, and other protective movements of the body. Sometimes a woman retains or gradually develops libido and the ability to achieve orgasm. In some cases, disease can lead to virgogamy (virgin marriage), which sometimes lasts for years.
Primary vaginismus is understood as the difficulties that arise when trying to conduct the first sexual intercourse; secondary – disorders that have developed after the beginning of sexual life. There is a pre-coital form of vaginismus that occurs exclusively during attempts at sexual intercourse and a generalized form that occurs reflexively, including during the introduction of tampons, gynecological examination, etc. situations.
There are 3 degrees of vaginismus severity. A mild degree is characterized by muscle spasm that occurs in response to the insertion of an instrument, a doctor’s finger, or a penis into the vagina. With an average degree of this disease, a reflex reaction follows when touching the genitals. Severe vaginismus corresponds to a spasm that occurs when thinking about gynecological examination or intimacy.
True vaginismus should be distinguished from pseudovaginism – muscle spasm that develops in response to a painful stimulus during injuries, structural abnormalities (vaginal atresia or hymen), diseases of the female genital tract (colpitis, bartholinitis, genital herpes, mucosal dryness, anal fissures, scarring of the entrance to the vagina, etc.). Also, disease is not worth it to be confused with coitophobia – fear of sexual intercourse, not accompanied by spastic muscle contraction.
It is proved that the causes of vaginismus are psychogenic in nature and are often associated with neurasthenia, obsessive-compulsive disorder, hysteria. Vaginismus in neurasthenia is caused by a general increased nervous excitability and is caused by an unconditional protective reaction, and not by fear of sexual intimacy. Such a symptom complex is often found in some somatic diseases – thyrotoxicosis, traumatic cerebrasthenia.
Vaginismus in psychasthenia (obsessive-compulsive disorder) has the character of phobias, i.e. it is associated with an obsessive fear of sexual relations or gynecological examination. Vaginismus often develops in suspicious, anxious women under the influence of ideas or their own negative experience of painful defloration or sexual acts (due to the rigidity of the hymen, vulvovaginitis, insufficient stimulation, cracks and tears of the vaginal mucosa).
With hysteria, vaginismus is regarded as an escape into the disease – a conscious or unconscious unwillingness of a woman to enter into an intimate relationship with a specific man. The causes of vaginismus in hysterical types may lie in forced marriage, antipathy to a partner, rudeness of his behavior, violence, erectile dysfunction in men, etc. Vaginismus is more common in non-perforated patients, although it can develop in women in marriage, even after the birth of children.
Manifestations of vaginismus
Manifestations of vaginismus are usually associated with the onset of sexual activity. Convulsive muscle spasm develops against the background of fear and expectation of painful defloration, but it can also occur suddenly, completely unexpectedly for a woman. With vaginismus, a sharp contraction of the muscles of the vagina, perineum, hips, pelvic floor, abdominal wall develops in response to touching the genitals, an attempt to insert the penis, or even thoughts of intimacy. Similar reactions may occur with the introduction of a hygienic tampon, vaginal examination or an attempt to conduct it.
If a spasm develops when touching the genitals, then coitus becomes impossible. When a spasm occurs after the insertion of the penis, its infringement may occur with the inability to extract it from the vagina, which is accompanied by severe pain and swelling of the penis. In the anamnesis of many patients with vaginismus, various kinds of childhood fears, dysmorphic phobias, sleep disorders, depression are noted.
With neurasthenic disorders, vaginismus of mild or moderate degree is usually noted, with phobic neuroses – of moderate or severe severity, with hysteria – of moderate severity. Pseudovaginism is characteristic of mentally healthy women and is associated with a pain syndrome that forms a persistent reflex connection when pain is repeated. Many women suffering from vaginismus retain the ability to achieve sexual arousal and orgasm, and their seeking medical help is associated with a feeling of inferiority or a desire to have a child.
To diagnose vaginismus, complaints and anamnesis are collected, an objective study is carried out. The woman finds out the peculiarities of physical and sexual development, attitude to sex, previous sexual experience, details of sexual life at the moment. In addition, the method of contraception used, pregnancy plans, and the nature of pain when an object is inserted into the vagina are being clarified.
During gynecological examination, an involuntary spasm of the muscles surrounding the entrance to the vagina is detected on the chair. In severe cases of vaginismus, a vaginal examination by a gynecologist is possible only under anesthesia. To determine the causes of pseudovaginism, smears are taken for bacteriological and microscopic examination, PCR diagnostics.
Gynecologists, psychotherapists, psychologists, sexologists, proctologists are involved in the treatment of vaginismus. Complex therapy of vaginismus is carried out taking into account etiological factors. Gynecology considers the elimination of the causes that cause the soreness of sexual intercourse to be the first priority in the treatment of pseudovaginism. With vulvitis, colpitis, bartholinitis, anti-inflammatory therapy is carried out taking into account the pathogen, with anal fissures – local treatment and presacral blockades.
Therapy requires psychotherapy sessions, hypnosis, explanatory conversations, treatment of erectile dysfunction in a partner, sexual education. Patients with vaginismus benefit from training exercises aimed at relaxing the muscles of the pelvis and thighs, breathing exercises, reflexology. During the sessions, the patient is convinced of the painlessness of gynecological procedures, a gradual expansion of the entrance to the vagina is performed, first with one and then with two fingers and dilators of various sizes. At the same time, tranquilizers, antidepressants, muscle relaxants, valerian, bromine preparations and local lubrication of the entrance to the vagina with 2% dicaine are prescribed to reduce the manifestations of vaginismus.
In some cases, with a preserved hymen and pronounced manifestations of vaginismus, surgical defloration can be performed. In the treatment of vaginismus, the simultaneous assistance of a psychotherapist or a sexologist is required by the patient’s sexual partner. Therapy of hysterical vaginismus dictates the need to eliminate psychotraumatic moments.
The prognosis in patients in terms of restoring a normal sexual life is more often favorable. In the future, women can plan pregnancy.