general examination in vaginismus

Last reviewed 01/2018

genital examination in vaginismus

Genital examination of a patient with vaginismus is usually carried out after several consultations.

  • a patient may elucidate various degrees of anxiety - from verbal expressions of discomfort to refusal, pulling away, or screaming
  • pain is commonly reported in the absence of abnormal physical findings

Before the examination:

  • make the patient comfortable by reassuring that the examination will stop immediately if she wishes
  •  explain about the examination and what will be done during the examination
  • tell her that she can ask questions at any point
  • let  the patient hold the smallest Cusco’s speculum to reduce her fear
  • explain that the vagina has the potential to expand. However penetration becomes difficult due to muscle contraction caused by anxiety
  • press your finger on her hand and in order to demonstrate the pressure you will be using during the examination

During the examination:

  • be gentle, encourage the patient to relax her legs, do not force them apart
  • place one finger on the external genitalia and get permission again to inspect the vulva
  • check for vestibulodynia by using cotton wool swabs to elicit any point tenderness
  • obtain permission again before inserting one finger into the vagina
  • generous use of lubricants may be useful
  • assess how well the patient tolerate this process
  • if finger penetration is possible, feel the tightness  in the levator ani
  • try to identify the painful areas
  • instruct the patient to squeeze and release her pelvic floor muscles.
    • observe whether this increase the pain
    • can the patient consciously relax the levator ani?
  • discuss the possibility of speculum examination

Information gathered from the examination can be used to discuss regarding her experience of sexual intercourse.