Vagina

Vaginismus

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Vaginismus, Genito-Pelvic Pain Penetration Disorder

  • 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
  • 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
  • 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 (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
  • Differential Diagnosis
  1. See Dyspareunia
  2. Differentiate from entry Dyspareunia causes
    1. Vaginal infection or Vaginitis
    2. Vulvodynia
    3. Pelvic Floor Dysfunction
  • Evaluation
  1. Rule-out other causes of Vulvodynia
  • 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]