II. Definitions

  1. Vaginismus
    1. Involuntary contraction of the pelvic floor Muscles, inhibiting vaginal entry
  2. Genito-Pelvic Pain Penetration Disorder
    1. Term that combines Dyspareunia with Vaginismus

III. Pathophysiology

  1. Involuntary Muscle spasm of outer third of vagina
    1. Bulbocavernous Muscles
  2. Associated with negative attitudes toward sex
    1. Fear or anxiety about vaginal penetration
    2. May be triggered by prior sexual Trauma or medical conditions
      1. However, not all women with Vaginismus have predisposing factors
  3. Results
    1. Dyspareunia
    2. Prevents vaginal penetration

IV. Symptoms

  1. Painful Intercourse
  2. Triggered by penis, finger or tampon insertion

V. Associated Conditions

  1. Chronic Pain
  2. Concurrent mood disturbance
    1. Anxiety
    2. Major Depression

VI. Diagnosis

  1. DSM 5 now combines Vaginismus with Dyspareunia (Genito-Pelvic Pain Penetration Disorder)
  2. Vaginismus diagnosis (and Dyspareunia diagnosis) per DSM 5
    1. Pelvic Pain, anxiety or vaginal penetration problems for at least 6 months
    2. Primary Vaginismus is diagnosed in those who have never had painless vaginal penetration
    3. Secondary Vaginismus is diagnosed with prior painless vaginal penetration

VII. Differential Diagnosis

  1. See Dyspareunia
  2. Differentiate from entry Dyspareunia causes
    1. Vaginal infection or Vaginitis
    2. Vulvodynia
    3. Pelvic Floor Dysfunction

VIII. Evaluation

  1. Rule-out other causes of Vulvodynia

IX. Management

  1. Biofeedback
  2. Pelvic Floor Exercises
  3. Cognitive Behavioral Therapy Counseling
  4. Relationship and sexual counseling
  5. Vaginal Lubricants
  6. Sequential Vaginal dilation
  7. Avoid perineoplasty (only indicated for Vestibulitis)
  8. Onabotulinumtoxin A (Botox) injections (by Gynecology or Chronic Pain Management)
    1. Bertolasi (2009) Obstet Gynecol 114(5): 1008-16 [PubMed]

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Related Studies

Ontology: Psychologic vaginismus (C0042266)

Definition (MSH) Recurrent or persistent involuntary SPASM of the outer muscles of the VAGINA, occurring during vaginal penetration.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D052065
ICD9 306.51
ICD10 F52.5
SnomedCT 268773000, 192469003, 154924008, 71787009
DSM4 306.51
English Psychogenic vaginismus, Vaginismus (Not Due to a General Medical Condition), Psychologic vaginismus, Non-organic vaginismus, Nonorganic vaginismus, vaginismus not due to physical condition (diagnosis), vaginismus not due to physical condition, Vaginismus psychogenic, Vaginismus [Disease/Finding], Vaginismus;psychogenic, vaginismus, Non-organic vaginismus (disorder), Psychologic vaginismus (disorder), nonorganic origin; vaginismus, vaginismus; nonorganic, Psychogenic Vaginismus, Functional vaginismus, Vaginismus, psychogenic vaginismus
Dutch psychogeen vaginisme, vaginisme psychogeen, niet-organische oorsprong; vaginisme, vaginisme; niet-organisch, Niet-organisch vaginisme
French Vaginisme psychogène, Vaginisme
German Vaginismus psychogen, psychogener Vaginismus, Scheidenkrampf, Nichtorganischer Vaginismus, Vaginismus
Italian Vaginismo psicogeno, Vaginismo
Portuguese Vaginismo psicogénico, Vaginismo
Spanish Vaginismo psicógeno, vaginismo psicológico (trastorno), vaginismo psicológico, Vaginismo
Japanese 心因性腟痙, シンインセイチツケイ
Swedish Vaginism
Czech vaginismus, Psychogenní vaginismus, vaginizmus
Finnish Vaginismi
Korean 비기질성 질경련증
Polish Pochwica
Hungarian psychogen vaginismus, Psychogen vaginismus
Norwegian Ikke-organisk vaginisme, Skjedekrampe, Psykogen vaginisme