II. Definitions
- Vaginismus
- Involuntary contraction of the pelvic floor Muscles, inhibiting vaginal entry
- Genito-Pelvic Pain Penetration Disorder
- Term that combines Dyspareunia with Vaginismus
III. Pathophysiology
- Involuntary Muscle spasm of outer third of vagina
- Bulbocavernous Muscles
- Associated with negative attitudes toward sex
- Fear or anxiety about vaginal penetration
- May be triggered by prior sexual Trauma or medical conditions
- However, not all women with Vaginismus have predisposing factors
- Results
- Dyspareunia
- Prevents vaginal penetration
IV. Symptoms
- Painful Intercourse
- Triggered by penis, finger or tampon insertion
V. Associated Conditions
- Chronic Pain
- Concurrent mood disturbance
- Anxiety
- Major Depression
VI. Diagnosis
- DSM 5 now combines Vaginismus with Dyspareunia (Genito-Pelvic Pain Penetration Disorder)
- Vaginismus diagnosis (and Dyspareunia diagnosis) per DSM 5
- Pelvic Pain, anxiety or vaginal penetration problems for at least 6 months
- Primary Vaginismus is diagnosed in those who have never had painless vaginal penetration
- Secondary Vaginismus is diagnosed with prior painless vaginal penetration
VII. Differential Diagnosis
- See Dyspareunia
- Differentiate from entry Dyspareunia causes
- Vaginal infection or Vaginitis
- Vulvodynia
- Pelvic Floor Dysfunction
VIII. Evaluation
- Rule-out other causes of Vulvodynia
IX. Management
- Biofeedback
- Pelvic Floor Exercises
- Cognitive Behavioral Therapy Counseling
- Relationship and sexual counseling
- Vaginal Lubricants
- Sequential Vaginal dilation
- Avoid perineoplasty (only indicated for Vestibulitis)
- Onabotulinumtoxin A (Botox) injections (by Gynecology or Chronic Pain Management)