158 Vaginismus (306.51)

DSM-IV-TR criteria

• A. Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.
• B. The disturbance causes marked distress or interpersonal difficulty.
• C. The disturbance is not better accounted for by another Axis I disorder (e.g., Somatization Disorder) and is not due exclusively to the direct physiological effects of a general medical condition.
• Specify type:
  • Lifelong Type
  • Acquired Type
• Specify type:
  • Generalized Type
  • Situational Type
• Specify:
  • Due to Psychological Factors
  • Due to Combined Factors

Associated Features

• Vaginismus, or spasm of the muscle surrounding the vagina often occurs in response to attempted intercourse, but can also occur in response to penetration by a finger, tampon, or speculum. Although this disorder is listed as a pain disorder, pain is not a necessary condition for the diagnosis. Vaginismus may be best defined as a phobic/aversive response to vaginal penetration.
• There are two types of vaginismus: Primary and Secondary. Primary vaginismus occurs in women who have never been able to have pain-free intercourse. Secondary vaginismus is due to a medical condition, surgery, traumatic event, childbirth, or menopause.
• Individuals suffering from Vaginismus disorder display symptoms such as trouble or impossibilities with sexual penetration and pelvic examination.

Child vs. adult presentation

Vaginismus is a disorder that occurs in women. Children do not have to worry about it, although, Vaginismus could be linked to sexual trauma as a child, or teen.

Gender and cultural differences in presentation

• Vaginismus is only present in females.
• Research shows that 0.17% of women in the United Kingdom have this disorder. Also, 5 out of 1000 marriages in Ireland reported having this problem.
• The problem occurs in 1% to 6% of women and is highly comorbid with dyspareunia.

Epidemiology

• A study in 1993 by Rosen and colleagues estimate that the rates of vaginismus range from 5% to 17%.
• 2 out of 1000 women have this. However, it could be higher, because women are embarrassed and it is not commonly known about and often misdiagnosed.
• In the United States, 47% of women with this disorder are single or dating, while 53% are married.
• The majority (53%) are ages 26 to 35. Next, women aged 36-50 make up 26% of those with the disorder. 18% are 25 or younger and 9% are 51 or older.

Etiology

• Non-physical causes are fears, anxiety, stress, traumatic event, childhood experiences, and partner issues. Sometimes, there is no known cause at all. Physical causes are medical conditions, childbirth, abuse, menopause, pelvic trauma, and temporary discomfort.
• Most common causes are fears and anxiety about intercourse and pain. Anxiety due to performance pressures and negativity towards sex can also cause a woman to experience this. Partner issues such as abuse, distrust, and fear of commitment are causes as well. Childhood experiences like overly rigid parenting, inadequate sex education, and exposure to shocking sexual imagery can lead to vaginismus.

Empirically supported treatments

• It is very treatable and most cases do not require medications. It includes a combination of pelvic floor control exercises, training for insertion or dilation, and learning techniques for pain elimination. These treatments can be done from home, however, it is helpful to have the support of a partner in a therapy-like setting.
• Vaginismus is generally treated with behavioral exercises in which plastic vaginal dilators of increasing size are inserted to help relax the vaginal musculature. A gynecologist usually demonstrates by inserting the narrowest dilator. The woman then increases the size of dilator as she becomes capable of tolerating insertion and containment (for 10 or 15 minutes) without pain or discomfort. Psychological treatment may also be necessary if the woman has a history of sexual trauma.
• According to the behavioral view, treatment of vaginismus involves a reconditioning of the bodies response to feared objects such as the penis, a speculum, or a tampon, much like the treatment approach for other specific phobias. Using a systhematic desensitization approach, the woman is asked to create a hierarchy of feared objects that she will then progressively work through to insert vaginally over the course of treatment.