Vaginisumus

Question 1

Definition

Answer 1

ICD: Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening. Penile entry is either impossible or painful.

DSM: Genito-Pelvic Pain/Penetration Disorder, persistent or recurrent difficulties with one or more of the following:
• Vaginal penetration during intercourse
• Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
• Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
• Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration

Question 2

Presentation

Answer 2

Primary = woman has never been able to have penetrative intercourse without pain or never been able to achieve penetrative intercourse.

Secondary = symptoms develop in a woman who has previously been able to allow penetration

Question 3

Physiological causes

Answer 3

Medical conditions where the vulva is sore to touch e.g. thrush
Other pain conditions or where pain is anticipated
Female genital mutilation
Congenital abnormality

Question 4

Psychological causes

Answer 4

Misinformation and mistaken beliefs

- vagina too small
- no opening 
- first intercourse will be painful 

Religious or cultural issues

Fear of pregnancy

Previous sexual abuse/trauma,
or unpleasant first sexual
experience or gynaecological examination

Fear or dislike of partner
Relationship dissatisfaction
Situational

Question 5

Ix

Answer 5

Full sexual history
Full physical examination
Full pelvic examination

Question 6

Medical Tx

Answer 6

Lidocaine if pain is the primary problem

Question 7

Psychological Tx

Answer 7

Individual psychosexual therapy; explore family of origin, childhood, social history, relationships, sexual messages, cultural beliefs and sexual abuse.

Integrated CBT, deconstruct and eventually control phobic reaction

Question 8

Behavioural Tx

Answer 8

Breathing control and relaxation

Self exploration and examination with mirror, cultural issues?

Personal sexual growth programme, cultural issues?

Kegel exercises

Vaginal trainers

Question 9

Pathophysiology

Answer 9

• Spasm of pelvic floor muscles => tightening/occlusion of vagina => penetration is painful or impossible