What Are the Diagnosis and Treatment Methods for Vaginismus?

What Are the Diagnosis and Treatment Methods for Vaginismus?

Vaginismus is a sexually related disorder that has been commonly seen in women for a very long time. Despite this, its definition dates back to the 1800s. Surgeon James Marion Sims, known as the father of gynecology, both described vaginismus and gave the disease its currently known name. Vaginismus is a condition in which the vagina essentially closes and does not permit penetration due to muscle contractions that occur during sexual intercourse.

Vaginismus is classified into 2 types according to how and when it appears. Primary vaginismus is a condition that manifests with the first sexual intercourse experience and continues persistently thereafter. In the medical literature, primary vaginismus is cited as the most common cause of unconsummated marriages. Secondary vaginismus is a condition characterized by pain, muscle contraction, and fear that can emerge at any time after a painless and successful first sexual experience. In our country, the most common type of vaginismus is primary vaginismus.

What Is Vaginismus?

Vaginismus is a psychophysiological syndrome of psychological, physiological or anatomical origin seen in women, which severely or completely restricts sexual function and causes the woman to fear sexuality. During vaginal entry, the pelvic muscle structures surrounding approximately one third of the vagina continuously and repeatedly contract, leading to spasm. These muscles, whose normal function is to produce rhythmic responses during orgasm, work for the exact opposite purpose in individuals with vaginismus. Depending on the severity and degree of vaginismus, this spasm state occurs during the initial approach or only at the moment of vaginal entry, through reflex mechanisms. Muscle spasm does not occur only through contact with the penis during sexual intercourse. In situations such as vaginal examination, tampon use, or insertion of any foreign object into the vagina, the muscles also contract abnormally. A study conducted on the partners of women with vaginismus revealed that men describe the situation as follows: "During sexual intercourse, the movement of the penis is restricted as if it were hitting a wall."

Vaginismus has different names as well. The most commonly used of these is unconsummated marriage. Unconsummated marriage is the failure of all vaginal intercourse attempts by a couple for at least 3 months, regardless of whether they are married.

Vaginismus has been divided into groups based on its severity, the patient's history, and her reactions during gynecological examination. In this classification ranging from 1 to 4, grade 1 vaginismus is the mildest form and does not excessively restrict life. Grade 4 vaginismus is the most severe grade of vaginismus, and sexual intercourse can almost never be achieved. Grade 4 vaginismus, accompanied by severe pain and discomfort, leads to unconsummated marriage.

What Are the Symptoms of Vaginismus?

The symptoms of vaginismus vary depending on the severity of the disease and the way it manifests. Among the most commonly seen symptoms are the following:

Severe muscle spasm occurring during intercourse: In individuals with vaginismus, during intercourse the muscles show high tension and low muscle strength, leading to spasms and, as a result of the spasms, pain. Due to these spasms, intercourse cannot take place.

Fear of pain and bleeding: One of the most common causes of vaginismus is having fear of experiencing pain or of feeling pain. In fact, among the causes of the disease, fears related to pain are more determinative than spasms. Studies conducted on individuals with vaginismus show that about half of patients do not feel pain during intercourse; however, psychological factors may lead the person to disregard this reality. The pain experienced during vaginismus arises from involuntary, severe contraction of the pubococcygeal region in the lower part of the vagina and the surrounding muscles. In this case, the person avoids sexual intercourse and may develop it into a phobia. Vaginismus may also develop due to fear of bleeding. This thought generally emerges based on incorrect sexual information the person has.

Fear and anxiety: Patients with vaginismus feel anxiety and fear about sexual intercourse and any situation that reminds them of sexuality. This fear progresses over time to avoidance and even rejection of the partner.

Aversion to sexual intercourse: In individuals with vaginismus, although it is very difficult to confess, there is a state of disgust and revulsion toward sexual intercourse. These feelings prevent individuals from living together as a couple.

How Is Vaginismus Diagnosed?

DSM-IV-TR diagnostic criteria are used in the diagnosis of vaginismus. According to DSM-IV-TR criteria, vaginismus is found under the "Sexual and Gender Identity Disorders" section, in the subcategory "Sexual Pain Disorders". These diagnostic criteria are as follows:

Recurrent or persistent involuntary spasms in the one-third part of the vagina that make sexual intercourse difficult,

Vaginismus causing marked distress or interpersonal difficulties,

Vaginismus not better explained by another disorder such as somatization disorder, and not due solely to the direct physiological effects of a medical condition.

The clinical feature that distinguishes vaginismus from other similar sexual disorders is the muscle spasms that occur, and this is of great importance in diagnosis.

How Is Vaginismus Treated?

Because the factors involved in the emergence of vaginismus are very diverse, quite varied and multidimensional methods are used in treatment. Both psychological therapy methods and medical treatment methods are utilized in vaginismus, and sometimes these methods are used simultaneously. Methods used in vaginismus treatment include the following:

Psychotherapy: Psychotherapy is a fairly broad field encompassing sexual therapy, education and cognitive behavioral therapy. Vaginismus can be treated quite successfully by applying psychotherapy. The most preferred psychotherapy method is cognitive behavioral therapy. In cognitive behavioral therapy, an attempt is made to replace the person's negative emotions with positive ones through therapy.

Medical intervention: A kind of botox procedure performed by injecting botulinum toxin into the entrance of the vagina produces an effect that prevents muscle spasms by relaxing the vagina for a prolonged period.

Pharmacological treatment: Although pharmacological treatment is not frequently preferred in vaginismus treatment, it may sometimes be used as an adjunct to other treatment methods. Ointments, gels, creams and sprays containing local anesthetic substances are preferred for treatment purposes. Also, the use of local or oral muscle relaxants may suppress symptoms.

Sexuality education: One of the most fundamental causes leading to the emergence of vaginismus is having insufficient or incorrect information related to sexuality. For this reason, sexuality education provided to couples holds an important place in the prevention of vaginismus.

What Is the Process After Vaginismus Treatment?

Individuals undergoing vaginismus treatment have a healthy sex life after successfully applied treatment. However, couples generally feel apprehension about whether the symptoms experienced before treatment will recur during the first few intercourse experiences following treatment. Women in particular feel a need to receive confirmation from their partners that intercourse has taken place. Later, the reduced anxiety and worry gradually turn into pleasure and desire. This is a process and occurs step by step. During this process, the male partner should be as understanding and supportive as possible. He should not act hastily.

After vaginismus treatment, it is recommended that couples do not have a child immediately. The occurrence of vaginismus and pregnancy in succession reduces the success rate of treatment in women. It is recommended that the right conditions be provided so that the woman can adapt to her new life after treatment.

Frequently Asked Questions about Vaginismus

How long vaginismus treatment will take varies depending on the method applied, the patient's psychological and physiological factors, and adherence to treatment. Particularly since sexual therapies proceed through an assignment system, the recovery time varies according to how early and correctly the patient completes these assignments. Meanwhile, in women receiving botulinum treatment, the procedure takes approximately 15-20 minutes, while the recurrence of symptoms after treatment may take up to 6 months. Sexual therapies are carried out in sessions, and generally three or more sessions are recommended. Women with vaginismus experience increased anxiety and decreased positive feelings toward stimuli related to sexual intercourse compared to healthy women. For this reason, they avoid sexual intercourse as much as possible. In patients with severe vaginismus, penetration is nearly impossible and the woman develops very severe pain and contraction. At the moment of contraction, not only the vaginal muscles but all muscles in the body contract; even the legs close with fear and the urge to avoid. Multiple factors contribute to the development of vaginismus. Treating or controlling these factors before they progress helps prevent the development of vaginismus. These factors are:

Urinary tract infections and fungal infections,

Anxiety disorders,

Vaginal injuries and wounds,

Having had vaginal surgery,

Vaginal atrophy and atrophy-related symptoms,

Uterine prolapse,

Vulvar vestibulitis syndrome (VVS)

Having chocolate cysts,

Having vaginal tumors or sexually transmitted diseases,

Holding incorrect beliefs about sexual intercourse.

How partners cope with vaginismus is an important factor in determining how the relationship will be affected. Pressuring and insisting on sexual intercourse, failing to communicate, punishing the partner, feeling anger, and using violence can negatively affect relationship dynamics. Vaginismus symptoms tend to increase further. The situation may even progress to the spouses rejecting each other. For this reason, women with vaginismus should not be pressured into sexual intercourse, and both partners should seek professional help. Vaginismus can be easily treated with the help of treatments carried out under physician supervision, and both the emotional and physical difficulties between couples can be overcome. Women experiencing vaginismus may receive help from gynecologists, sexual therapists and physiotherapists, depending on the severity of their symptoms and underlying causes. Couples may also request support by applying to places such as vaginismus therapy centers. Application of muscle-relaxing creams, ointments, sprays and gels to the vagina before intercourse may prevent muscle spasm and help relieve the pain experienced. However, although this method is not a definitive solution, it may sometimes delay the actual treatment because it masks the psychological aspect of vaginismus. Expert psychologist, psychiatrist or physiotherapist support may be needed to prevent the obstacles that vaginismus may cause in sexual intercourse and to establish balance and a healthy relationship between partners.