Vaginismus

An international consensus committee has defined vaginismus as “The persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger, and or any object, despite the woman’s expressed wish to do so” (1).

• the definition further describes that the affected women often avoid intercourse; experience involuntary pelvic muscle contraction; and anticipate, fear, or experience pain
• women with vaginismus may experience either sexual or non sexual (gynaecological examination, tampon, dilator) aversion to vaginal
• complete vaginismus describes a situation of inability to tolerate any vaginal penetration and is commonly seen in the more severe forms of vaginismus accompanied by considerable fear and anxiety

Vaginismus and dyspareunia is considered to be part of the spectrum of painful intercourse.

• the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) categorises the both vaginismus and dyspareunia under "GenitoPelvic Pain/Penetration Disorder"
  • one of the following should occur persistently or recurrently to establish a diagnosis -
    • difficulty in vaginal penetration
    • marked vulvovaginal or pelvic pain during penetration or attempt at penetration
    • fear or anxiety about pain in anticipation of , during or after penetration
    • tightening or tensing of pelvic floor muscles during attempted penetration (3)

Vaginismus can be:

• primary (lifelong) - have never had pain-free intercourse

or
secondary - comfortable with intercourse at some time in their lives and then progressed to painful intercourse

• situational - occurring only with certain partners or in particular circumstances

or
global - occurring independent of partner or circumstances

True incidence of the condition is unknown. It is thought to affect 5-17% of women in a clinical setting (2)

Reference:

• (1) Crowley T, Goldmeier D, Hiller J. Diagnosing and managing vaginismus. BMJ. 2009;338:b2284
• (2) Pacik PT et al. Understanding and treating vaginismus: a multimodal approach. Int Urogynecol J. 2014;25(12):1613-20.
• (3) IsHak WW , Tobia G. DSM-5 Changes in Diagnostic Criteria of Sexual Dysfunctions. Reprod Sys Sexual Disorders. 2013;2:122