Vaginismus

Vaginismus is a condition in which involuntary muscle spasm interferes with vaginal intercourse or other penetration of the vagina. This often results in pain with attempts at sex. Often it begins when vaginal intercourse is first attempted.

Vaginismus
Other namesVaginism, genito-pelvic pain disorder
Muscles included
SpecialtyGynecology
SymptomsPain with sex
Usual onsetWith first sexual intercourse
CausesFear of pain
Risk factorsHistory of sexual assault, endometriosis, vaginitis, prior episiotomy
Diagnostic methodBased on the symptoms and examination
Differential diagnosisDyspareunia
TreatmentBehavior therapy, gradual vaginal dilatation
PrognosisGenerally good with treatment
Frequency0.5% of women

The formal diagnostic criteria specifically requires interference during vaginal intercourse and a desire for intercourse. However, the term vaginismus is sometimes used more broadly to refer to any muscle spasm occurring during the insertion of some or all types of objects into the vagina, sexually motivated or otherwise, including the usage of speculums and tampons.

The underlying cause is generally a fear that penetration will hurt. Risk factors include a history of sexual assault, endometriosis, vaginitis, or a prior episiotomy. Diagnosis is based on the symptoms and examination. It requires there to be no anatomical or physical problems and a desire for penetration.

Treatment may include behavior therapy such as graduated exposure therapy and gradual vaginal dilatation. Surgery is not generally indicated. Botulinum toxin (botox), a muscle spasm treatment, is being studied. There are no epidemiological studies of the prevalence of vaginismus. Estimates of how common the condition is are varied. One textbook estimates that 0.5% of women are affected. However, rates in clinical settings indicate that between 5–17% of women experience vaginismus. Outcomes are generally good with treatment.

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