Vaginismus

http://en.wikipedia.org/wiki/Vaginismus

Vaginismus (the Latin equivalent of the word Vaginism) is a condition which affects a woman's
ability to engage in any form of vaginal penetration, including sexual penetration, insertion of
tampons, and the penetration involved in gynecological examinations. This is the result of a
conditioned reflex of the pubococcygeus muscle, which is sometimes referred to as the "PC
muscle". The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of
vaginal penetration—including sexual penetration—either painful or impossible.
A vaginismic woman does not consciously control the spasm. The vaginismic reflex can be
compared to the response of the eye shutting when an object comes towards it. The severity of
vaginismus and the pain during penetration, including sexual penetration, varies from woman to
woman.

Contents
[hide]
• 1 Experience of vaginismus
○ 1.1 Primary vaginismus
○ 1.2 Secondary vaginismus
• 2 Prevalence
• 3 Treatment
○ 3.1 Psychological treatment
○ 3.2 Physical treatment
• 4 Sexuality
○ 4.1 Masturbation
○ 4.2 Emotional experiences
• 5 References
• 6 External links
○ 6.1 Support and treatment
○ 6.2 Clinical resources

[edit] Experience of vaginismus

The conditioned reflex can create a vicious circle for vaginismic women. One example: if a
female is lead to believe that the first time she engages in penetrative sex that it will be painful,
she may develop vaginismus because she expects pain. If she then attempts to engage in
penetrative sex, the muscle spasm will make penetrative sex painful. This and each further
attempt at sexual penetration confirms her fear of pain and may worsen the condition. Naturally,
penetration may be painful without vaginismus or psychological prerequisite as well.[citation needed]
[edit] Primary vaginismus
Primary vaginismus occurs when a woman has never been able to have penetrative sex or
experience any kind of vaginal penetration without pain. It is commonly discovered in teenagers
and women in their early twenties, as this is when many young women in the Western world will
initially attempt to use tampons, have penetrative sex, or undergo a Pap smear. Women who have
vaginismus may not be aware of their condition until they attempt vaginal penetration. It may be
confusing for a woman to discover she has vaginismus. She may believe that vaginal penetration
should be naturally easy, or she may be unaware of reasons for her condition.[citation needed]
A few of the many things which may cause primary vaginismus include:
• sexual abuse, rape, or attempted sexual abuse
• domestic violence or conflict in the early home environment
• having been taught that sex is immoral, vulgar, or demoralising
• fear of pain associated with penetration, particularly the popular
misconception of 'breaking' the hymen upon the first attempt at penetration
• knowledge of (or witnessing) sexual or physical abuse of others, without
being personally abused
• being sexualized or told about sex in violent or inappropriately graphic terms
before an age at which one is comfortable with such information
• any physically invasive trauma

[edit] Secondary vaginismus

Secondary vaginismus occurs when a woman who has previously been able to achieve
penetration develops vaginismus. This may be due to physical causes such as a yeast infection or
trauma during childbirth, or it may be due to psychological causes. The treatment for secondary
vaginismus is the same as for primary vaginismus, although, in these cases, previous experience
with successful penetration can assist in a more rapid resolution of the condition.[citation needed]

[edit] Prevalence
The prevalence of vaginismus has been reported to be 6% in two widely divergent cultures,
Morocco and Sweden. The prevalence of manifest dyspareunia has been reported as low as 2%
in elderly British women, yet as high as 18–20% in British and Australian studies.[1]
By another study vaginismus rates of between 12% and 17% have been reported in women
presenting to sex therapy clinics (Spector and Carey 1990). National Health and Sexual Life
Survey, which used random sampling and structured interviewing, report that between 10% and
15% of women reported having experienced pain during intercourse during the last 6 months
(Laumann et al. 1994).[2]
The most recent study estimates of vaginismus range from 5% to 47% of people presenting for
sex therapy or complaining of sexual problems, with significant differences across cultures (see
Reissing et al. 1999; Nusbaum 2000; Oktay 2003). It seems likely that society's expectations of
women's sexuality may particularly impact on these sufferers.[3]
[edit] Treatment
There are a variety of factors that can contribute to vaginismus. These may be psychological or
physiological, and the treatment required can depend on the reason that the woman has
developed the condition. As each case is different, an individualized approach to treatment is
useful.
The condition will not necessarily become more severe if left untreated, unless the woman is
continuing to attempt penetration, despite feeling pain. Some women may choose to refrain from
seeking treatment for their condition.
According to the Cochrane Collaboration review of the scientific literature, "In spite of
encouraging results reported from uncontrolled case series there is very limited evidence from
controlled trials concerning the effectiveness of treatments for vaginismus. Further trials are
needed to compare therapies with waiting list control and with other therapies."[4]
Although few controlled trials have been carried out, many serious scientific studies have tested
and proved the efficacy of the treatment of vaginismus. In all cases where the systematic
desensitization method was used, success rates were close to 90–95% and even 100%. For an
example of one of these studies, see Nasab, M., & Farnoosh, Z., or for a basic review, see
Reissing's literature review (links below).
[edit] Psychological treatment
According to Ward and Ogden's qualitative study on the experience of vaginismus for women
(1994), the three most common contributing factors to vaginismus are fear of painful sex; the
belief that sex is wrong or shameful (often the case with patients who had a strict religious
upbringing); and traumatic early childhood experiences (not necessarily sexual in nature).
Vaginismus patients are twice as likely to have a history of childhood sexual interference and
held less positive attitudes about their sexuality whereas no correlation was noted for lack of
sexual knowledge or physical abuse. [5]
For some women, especially those with primary vaginismus, it is important to address the
psychological aspects of the problem as well as the actual muscle spasm. A woman may choose
to address the issue on her own terms, or she may avail the help of a therapist. Some women,
especially those with secondary vaginismus, may rely on a physical rather than psychological
treatment and also be successful.
There are emotional difficulties associated with vaginismus, which can include low self-esteem,
fears, and depression.
[edit] Physical treatment
Physical treatment of the internal spasms may include sensate focus exercises, exploring the
vagina through touch, and desensitization with vaginal dilators. Dilating involves inserting
objects, usually phallic in shape, into the vagina. In treating the spasms through dilation, the
objects used gradually increase in size as the woman progresses. Medical dilators may be
obtained online, though they may be expensive.
Botox is a relatively new treatment for vaginismus first desrcribed in 1997 [6]. Ghazizadeh and
Nikzad reported on the use of botulinum toxin in the treatment of refractory vaginismus in 24
patients. In this study, Dysport (a type of Botox) 150-400 mIU (Ipsen Ltd, United Kingdom) was
used. 23 patients were able to have vaginal examinations one week post procedure showing little
or no vaginismus. One patient refused vaginal examination and did not attempt coitus. Of the 23
patients, 18 (75%) achieved satisfactory intercourse, 4 (17%) had mild pain and one patient was
unable to have intercourse because of her husband’s impotence. A second dose of Dysport was
needed on one patient. There were no recurrences during the 2-24 month follow-up period. [7]
A controlled study using Botox for one group of patients was compared to saline in another. 8
women having the botox were able to achieve satisfactory intercourse whereas 5 women who
were injected with saline controls showed no response. None of the 8 women who had Botox
required any further treatment. The procedure is simple, easy, cost-effective, not time-consuming
and can be achieved on an outpatient basis. No complications were reported. [8]

[edit] Sexuality
If a woman suspects she has vaginismus, sexual penetration is likely to remain painful or
impossible until her vaginismus is addressed. Women with vaginismus may be able to engage in
other sexual activities, as long as penetration is avoided. Sexual partners of vaginismic women
may come to believe that vaginismic women do not want to engage in penetrative sex at all,
though this may not be true. Many vaginismic women do wish to engage in penetrative sex, but
are deterred by the pain and emotional distress that comes with each attempt.
[edit] Masturbation
Many women do not realize that it is normal, even in patients who do not suffer from
vaginismus, for a woman to experience pain or discomfort if she attempts sexual penetration
without first being sufficiently aroused. Most women acknowledge sexual arousal as vital to
achieving comfortable penetration, so self-exploration of the vaginal area through masturbation
can be beneficial in addressing vaginismus.
One of the problems that can come with vaginismus is that a woman may be fearful to engage in
sexual activity, due to the fear of pain with any kind of vaginal penetration. Solo masturbation,
with or without penetration, can alleviate this fear, as well as the psychological pressure to
"perform" sexually or become aroused quickly, with a partner.
Despite popular belief, orgasm need not be the goal of masturbation. The reason may be to
simply increase comfort with the genital area, to explore various sensations through genital and
clitoral touch, and to become aware of those sensations which are relaxing and pleasurable.
Sexual arousal causes changes in the shape and color of the vulva, as well as in the vaginal
lubrication produced. As a woman becomes more aware of her individual sexual response, she
can learn which sensations are best for bringing her to a state of arousal. She will then be better
equipped to teach her partner which sensations feel best for her.
Vaginismus does not prevent a woman from achieving orgasm.
[edit] Emotional experiences
A wide range of emotions may surface during masturbation and other forms of genital
exploration. Some women have negative associations with their genitals, including fears that
their genitals are dirty, smelly, oddly shaped, or ugly. These associations can lead to negative
emotions arising during any kind of sexual expression, including masturbation, and these
emotions can take time to process. Especially in the case of a vaginismic woman, feelings of
shame, inadequacy or of being "defective" can be deeply troubling. If multiple attempts to
penetrate are made before treating vaginismus, it may lead to fear of sexual intercourse.
Relaxation, patience and self-acceptance are vital to a pleasurable experience.
[edit] References
This article needs additional citations for verification. Please help
improve this article by adding reliable references (ideally, using inline
citations). Unsourced material may be challenged and removed. (May 2007)
1. ^ Ronald W. Lewis, MD, Kersten S. Fugl-Meyer, PhD. "Epidemiology/Risk
Factors of Sexual Dysfunction". Epidemiology/Risk Factors of Sexual
Dysfunction. http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1743-
6109.2004.10106.x. Retrieved on 2008-01-08.
2. ^ "Vaginismus". Sexual Pain Disorders - Vaginismus. 2006.
http://www.health.am/sex/more/sexual_pain_disorders_vaginismus/. Retrieved
on 2008-01-07.
3. ^ "Critical literature Review on Vaginismus". Critical literature Review on
Vaginismus. http://www.vaginismus-awareness-network.org/lit_review.html.
Retrieved on 2008-01-08.
4. ^ Interventions for vaginismus, The Cochrane Database of Systematic
Reviews 2007[1]
5. ^ Reissing ED, Binik YM, Khalifé S, Cohen D, Amsel R.( 2003) Etiological
correlates of vaginismus: sexual and physical abuse, sexual knowledge,
sexual self-schema, and relationship adjustment. J Sex Marital Ther.29:47-59.
6. ^ Brin MF, Vapnek JM. Treatment of vaginismus with botulinum toxin
injections. (1997). Lancet. 349: 252-253
7. ^ Shirin Ghazizadeh, MD, and Masoomeh Nikzad, MD. (2004). Botulinum Toxin
in the Treatment of Refractory Vaginismus. Obstet Gynecol 104, 922-925.
8. ^ Shafik A.; El-Sibai O.Journal of Obstetrics & Gynaecology, Volume 20,
Number 3, 1 May 2000 , pp. 300-302(3)
• van der Velde J, Everaerd W (2001). "The relationship between involuntary
pelvic floor muscle activity, muscle awareness and experienced threat in
women with and without vaginismus". Behaviour research and therapy 39
(4): 395–408. doi:10.1016/S0005-7967(00)00007-3. PMID 11280339.
• Crowley, Tessa; et al. (January 2006). "Recommendations for the
management of vaginismus". International Journal of STD & AIDS 17 (1): 14–
18. doi:10.1258/095646206775220586. PMID 16409672.
http://ijsa.rsmjournals.com/cgi/content/abstract/17/1/14.
• Nasab, M.; Farnoosh, Z. (2003). "Management of vaginismus with cognitive-
behavioral therapy, self-finger approach: A study of 70 cases." ([dead link] – Scholar
search
). IJMS 28 (2). http://ijms.sums.ac.ir/28_2/69-71_Mosavi.pdf.[dead link]
• Reissing E, E.; et al. (1999). "Does vaginismus exist? A critical review of the
literature". The Journal of Nervous and Mental Disease 187 (5): 261–271.
PMID 10348080.
• Ward, E.; Ogden, J. (1994). "Experiencing Vaginismus: sufferers beliefs about
causes and effects". The Journal of Nervous and Mental Disease 9 (1): 33–45.
[edit] External links
• Vaginismus Awareness NetworkA non-profit site to raise awareness of
vaginismus, self-treat it and offer facts, studies and tips to women, their
partners and gynecologists.

[edit] Support and treatment

• Vaginismus at the Open Directory Project
• Online Forum on Vaginismus (An open forum to discuss any topic related to
Vaginismus)
• Sh! Women's Erotic Emporium (supplies training kits designed for women
with vaginismus)
• Women's Therapy Center
• Vaginimus.com/treatment - 10 step resolution process

[edit] Clinical resources

• Vaginismus – Causes, Diagnosis, Treatment & Self Help entry in NHS Direct
Health Encyclopaedia (UK)