Vagina

Vaginismus

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Vaginismus

  • Definitions
  1. Vaginismus
    1. Involuntary contraction of the pelvic floor muscles, inhibiting vaginal entry
  • Pathophysiology
  1. Involuntary muscle spasm of outer third of vagina
    1. Bulbocavernous Muscles
  2. Associated with negative attitudes toward sex
  3. Results
    1. Dyspareunia
    2. Prevents vaginal penetration
  • Symptoms
  1. Painful Intercourse
  2. Triggered by penis, finger or tampon insertion
  • Associated Conditions
  1. Chronic Pain
  2. Concurrent mood disturbance
    1. Anxiety
    2. Major Depression
  • Diagnosis
  1. DSM 5 now combines Vaginismus with Dyspareunia
  2. Vaginismus diagnosis (and Dyspareunia diagnosis) per DSM 5
    1. Pelvic Pain, anxiety or vaginal penetration problems for at least 6 months
  • Evaluation
  1. Rule-out other causes of Vulvodynia
  • Management
  1. Biofeedback
  2. Pelvic Floor Exercises
  3. Cognitive Behavioral Therapy Counseling
  4. Avoid perineoplasty (only indicated for Vestibulitis)
  5. Onabotulinumtoxin A (Botox) injections (by Gynecology or Chronic Pain Management)
    1. Bertolasi (2009) Obstet Gynecol 114(5): 1008-16 [PubMed]