Diagnosis

diagnosis

Differentiating superficial dyspareunia and vaginismus from clinical presentation is a challenging task.

A carefully constructed medical and psycho-sexual history is necessary to make a diagnosis of vaginismus.

• some of the questions which can be enquired from the patient include:
  • is she in a relationship?
  • is she sexually active with her partner?
  • is penetration possible? if so, is it painful?
  • is it painful only at penetration?
  • how anxious does she feel at the thought of penetration?
  • can she insert tampons or fingers?
  • how long has this been a problem?
  • how anxious does she feel about the thought of a genital examination?
  • has she ever had a traumatic sexual experience?
• obtain a clear description of the pain, fear, and avoidance responses
• for psychological assessment find out about sexual knowledge and family attitudes to sexual behaviour
• find out about the ability to tolerate genital exploration by herself or another
• exclude other causes for sexual pain e.g. - herpes virus, lichen sclerosis, vulvodynia etc

Genital examination may be necessary to exclude organic pathology (1).

Reference:

• (1) Crowley T, Goldmeier D, Hiller J. Diagnosing and managing vaginismus. BMJ. 2009;338:b2284