Vaginismus

Question 1

Definition

Answer 1

Psychologically conditioned relflex causing spasm of the pelvic floor musculature that prevents any attempt at vaginal entry

Question 2

Aetiology

Answer 2

• Sexual abuse
• Painful first sexual encounter
• Traumatic experience (Vaginal birth, STOP)
• Associatd vulvodynia

Question 3

Relevant history

Answer 3

• Presents with avoidance of cervical smears, dyspaurenia or infertility
• NB to see patient ALONE and with partner
• Discuss previous tampon use and sexual intercourse
• Depression screening

Question 4

Examination

Answer 4

o Sensitive, reassuring approach – ensure patient aware than examination will cease if discomfort occurs, and speculum examination will not be attempted
o Assess external genitalia
o Cotton-tip test for vulvodynia
o Attempt insertion of single lubricated gloved finger
o Contraction of bulbocavernosum, pubococcygeus or puborectalis may be identified

Question 5

Investigations

Answer 5

o Usually nil required
o Consider urine MCS, vaginal swab MCS to exclude contributing causes