Vaginismus: Difference between revisions
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== Prevalence and Incidence == | == Prevalence and Incidence == | ||
It affects about 1-7% of the female population worldwide.<ref name=":0" /> In primary care settings the same rate goes | It affects about 1-7% of the female population worldwide.<ref name=":0" /> In primary care settings the same rate goes up to 30%<ref>Read S, King M, Watson J. [https://academic.oup.com/jpubhealth/article/19/4/387/1591432 Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner.] Journal of Public Health. 1997 Dec 1;19(4):387-91.</ref>further drastically increasing to 42% in specialized clinics for female sexual disorders.<ref>Oniz A, Keskinoglu P, Bezircioglu I. [https://www.sciencedirect.com/science/article/abs/pii/S1743609515316970 The prevalence and causes of sexual problems among premenopausal Turkish women.] The journal of sexual medicine. 2007 Nov 1;4(6):1575-81.</ref><ref>Nusbaum MR, Gamble G, Skinner B, Heiman J. [https://go.gale.com/ps/i.do?id=GALE%7CA61522767&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00943509&p=AONE&sw=w&userGroupName=anon%7Ef0e3f5d8 The high prevalence of sexual concerns among women seeking routine gynecological care.] Journal of Family practice. 2000 Mar 1;49(3):229-.</ref> | ||
== Etiology == | == Etiology == | ||
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* Trauma associated with childbirth | * Trauma associated with childbirth | ||
* Genital surgery or radiotherapy | * Genital surgery or radiotherapy | ||
* Vaginal lesions and | * Vaginal lesions and tumours <ref>Lahaie MA, Boyer SC, Amsel R, Khalifé S, Binik YM. [https://journals.sagepub.com/doi/full/10.2217/WHE.10.46 Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment.] Women’s Health. 2010 Sep;6(5):705-19.</ref><ref name=":2" /> | ||
===== Psychological factors ===== | ===== Psychological factors ===== | ||
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== Quality of life == | == Quality of life == | ||
This condition influences the quality of life, in the most serious form it can result in an unconsummated marriage, and sterility and thus further result in the couple leading a separate life. <ref name=":0" />It is correlated with poor sexual [[Quality of Life|quality of life]]<ref name=":1" /> and even the male partners may have important effects on the development, maintenance, and exacerbation of vaginismus ( in lifelong vaginismus -LLV).<ref>Turan Ş, Sağlam NG, Bakay H, Gökler ME. [https://www.sciencedirect.com/science/article/abs/pii/S1743609520308894 Levels of depression and anxiety, sexual functions, and affective temperaments in women with lifelong vaginismus and their male partners]. The Journal of Sexual Medicine. 2020 Dec 1;17(12):2434-45.</ref>Common psychological symptoms seen are depression, anxiety, low self esteem, insecure attachment styles, histrionic/hysterical traits, alexithymia.<ref name=":2" /> | This condition influences the quality of life, in the most serious form it can result in an unconsummated marriage, and sterility and thus further result in the couple leading a separate life. <ref name=":0" />It is correlated with poor sexual [[Quality of Life|quality of life]]<ref name=":1" /> and even the male partners may have important effects on the development, maintenance, and exacerbation of vaginismus ( in lifelong vaginismus -LLV).<ref>Turan Ş, Sağlam NG, Bakay H, Gökler ME. [https://www.sciencedirect.com/science/article/abs/pii/S1743609520308894 Levels of depression and anxiety, sexual functions, and affective temperaments in women with lifelong vaginismus and their male partners]. The Journal of Sexual Medicine. 2020 Dec 1;17(12):2434-45.</ref>Common psychological symptoms seen are depression, anxiety, low self-esteem, insecure attachment styles, histrionic/hysterical traits, and alexithymia.<ref name=":2" /> | ||
== Symptoms == | == Symptoms == | ||
Revision as of 18:01, 19 June 2022
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Definition[edit | edit source]
Vaginismus is a penetration disorder in which any form of vaginal penetration is painful or impossible. It has traditionally been referred to as an involuntary contraction of the pelvic floor muscles due to actual or anticipated pain associated with vaginal penetration. It causes women to feel pain, fear and anxiety with penetration attempts.[1]It is often associated with psychological problems, leading to poor sexual quality of life (SQOL).[2]
The debate around its definition[edit | edit source]
Anatomy[edit | edit source]
Prevalence and Incidence[edit | edit source]
It affects about 1-7% of the female population worldwide.[1] In primary care settings the same rate goes up to 30%[4]further drastically increasing to 42% in specialized clinics for female sexual disorders.[5][6]
Etiology[edit | edit source]
The etiological factors are- ( the given etiological factors are still not well established by the literature)
Organic pathologies[edit | edit source]
- Congenital abnormalities
- Local infections
- Trauma associated with childbirth
- Genital surgery or radiotherapy
- Vaginal lesions and tumours [7][3]
Psychological factors[edit | edit source]
- Sexual abuse
- A negative attitude toward sexuality
- Relationship difficulties
- Fear of first-time sex (pain, bleeding, tearing, ripping, penis too large, vagina too small, sexually transmitted diseases, fear of pregnancy)[8]
- Fear of gynecological examinations[8]
- A maternal influence involving grandmothers, mothers, twins, and sisters-The influence is due to merely hearing about the difficulties faced by them and the patient may manifest it as a subsequent fear of penetration.[8]
Quality of life[edit | edit source]
This condition influences the quality of life, in the most serious form it can result in an unconsummated marriage, and sterility and thus further result in the couple leading a separate life. [1]It is correlated with poor sexual quality of life[2] and even the male partners may have important effects on the development, maintenance, and exacerbation of vaginismus ( in lifelong vaginismus -LLV).[9]Common psychological symptoms seen are depression, anxiety, low self-esteem, insecure attachment styles, histrionic/hysterical traits, and alexithymia.[3]
Symptoms[edit | edit source]
These symptoms are defined accordingly given by the Diagnostic and Statistical Manual of Mental Disorders (DSM, the American Psychiatric Association), fifth edition(DSM-5)[10]-
- Difficulty having intercourse
- Genito-pelvic pain
- Fear of pain or vaginal penetration
- Tension of the pelvic floor muscles.
Other symptoms-
- Inability to use OR remove a tampon (often noted at a young age)
- Complaints that attempted coitus is like “hitting a wall”
- An inability to tolerate a gynaecological examination.
Types[edit | edit source]
- Primary Vaginismus
- Secondary Vaginismus
Grades[edit | edit source]
In 1978 Lamont[11] described the first four grades and a grade 5 was then later added by Pacik[8][12]. The Lamont grades were based on the patient's conduct during gynaecological examination and history taking whereas the Pacik grade 5 takes into account the severe fear and anxiety seen in the patient while performing the examination.
| GRADES | DESCRIPTION |
|---|---|
| Lamont grade 1 | Patient is able to relax for pelvic examination |
| Lamont grade 2 | Patient is unable to relax for pelvic examination |
| Lamont grade 3 | Buttocks lift off the table. Early retreat |
| Lamont grade 4 | Generalized retreat: buttocks lift up, thighs close, patient retreats |
| Pacik grade 5 | Generalized retreat as in level 4 plus visceral reaction, which may result in any one or more of the following: palpitations, hyperventilation, sweating, severe trembling, uncontrollable shaking, screaming, hysteria, wanting to jump off the table, a feeling of becoming unconscious, nausea, vomiting, and even a desire to attack the doctor |
Assessment[edit | edit source]
Checking the Degree of vaginal muscle hypertonus/spasm[12]
| Degree of spasm | Description |
|---|---|
| 1-2 | Minimal/mild degrees of vaginal hypertonus/spasm |
| 3 | Considerable vaginal hypertonus/spasm. Finger
penetration possible, but vaginal musculature is tight. The patient is uncomfortable with the examination. |
| 4 | Presence of vaginal muscle spasm. Bulbocavernosus
seems like a tightly closed fist and digital penetration is difficult to impossible without sedation. |
Diagnosis[edit | edit source]
Differential diagnosis[edit | edit source]
Management[edit | edit source]
Non-surgical management[edit | edit source]
Behavioral sex therapy[edit | edit source]
CBT[edit | edit source]
Pharmacological therapy[edit | edit source]
Pelvic floor physiotherapy[edit | edit source]
- Breathing
- Relaxation
- Local tissue desensitization
- Vaginal dilators
- Pelvic floor biofeedback
- Manual therapy techniques
Surgical management[edit | edit source]
Removal of hymenal remnants[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Laskowska A, Gronowski P. Vaginismus: An overview. The Journal of Sexual Medicine. 2022 May 1;19(5):S228-9.
- ↑ 2.0 2.1 Psychological predictors of sexual quality of life among women with vaginismus, Velayati A, Jahanian Sadatmahalleh S, Ziaei S, Kazemnejad A. Psychological predictors of sexual quality of life among Iranian women with vaginismus: A cross-sectional study. International Journal of Sexual Health. 2022 Jan 2;34(1):81-9.
- ↑ 3.0 3.1 3.2 Maseroli E, Scavello I, Rastrelli G, Limoncin E, Cipriani S, Corona G, Fambrini M, Magini A, Jannini EA, Maggi M, Vignozzi L. Outcome of medical and psychosexual interventions for vaginismus: a systematic review and meta-analysis. The journal of sexual medicine. 2018 Dec 1;15(12):1752-64.
- ↑ Read S, King M, Watson J. Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner. Journal of Public Health. 1997 Dec 1;19(4):387-91.
- ↑ Oniz A, Keskinoglu P, Bezircioglu I. The prevalence and causes of sexual problems among premenopausal Turkish women. The journal of sexual medicine. 2007 Nov 1;4(6):1575-81.
- ↑ Nusbaum MR, Gamble G, Skinner B, Heiman J. The high prevalence of sexual concerns among women seeking routine gynecological care. Journal of Family practice. 2000 Mar 1;49(3):229-.
- ↑ Lahaie MA, Boyer SC, Amsel R, Khalifé S, Binik YM. Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment. Women’s Health. 2010 Sep;6(5):705-19.
- ↑ 8.0 8.1 8.2 8.3 8.4 Pacik PT. Understanding and treating vaginismus: a multimodal approach. International urogynecology journal. 2014 Dec;25(12):1613-20.
- ↑ Turan Ş, Sağlam NG, Bakay H, Gökler ME. Levels of depression and anxiety, sexual functions, and affective temperaments in women with lifelong vaginismus and their male partners. The Journal of Sexual Medicine. 2020 Dec 1;17(12):2434-45.
- ↑ American Psychiatric Association DS, American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American psychiatric association; 2013 May.
- ↑ Lamont JA. Vaginismus. American Journal of Obstetrics and Gynecology. 1978 Jul 15;131(6):632-6.
- ↑ 12.0 12.1 Pacik PT, Babb CR, Polio A, Nelson CE, Goekeler CE, Holmes LN. Case series: redefining severe grade 5 vaginismus. Sexual Medicine. 2019 Dec 1;7(4):489-97.
