Vaginismus
Einstein Health Glossary
ICD 10 - N942
What is vaginismus?
Vaginismus is a sexual dysfunction in women that causes pain during vaginal penetration. It can affect both physical and mental health, leading to personal, interpersonal, and even marital difficulties, ultimately reducing quality of life.
It involves an involuntary contraction of the pelvic floor muscles when vaginal penetration is attempted—for example, with a penis, finger, tampon, or speculum. The contraction occurs in the perineal muscles and may extend to the anus and, in some cases, also to the inner thigh and abdominal muscles. The intensity can range from mild, allowing some form of penetration, to severe, making any penetration impossible.
Types
Vaginismus can be primary or secondary. Primary vaginismus is defined when a woman is unable to have penetrative sexual intercourse due to involuntary vaginal muscle contractions from the very first attempt in her life. Secondary vaginismus occurs when a woman who previously had penetrative intercourse can no longer do so.
Causes
Pelvic floor muscle contraction occurs in a cycle: pain during intercourse leads to more contraction, which leads to more pain and further avoidance of intercourse. Eventually, just the thought of having sex can cause the woman to contract her muscles and feel pain.
One of the causes of vaginismus is phobic anxiety before vaginal penetration. Contributing factors are often linked to embarrassing, punitive, and/or religious sexual education, as well as traumatic sexual experiences. There are also physical causes, such as hymenal abnormalities, congenital anomalies, vaginal atrophy, endometriosis, infections, vaginal injuries, tumors, sexually transmitted diseases, and pelvic congestion.
Diagnosis and Treatment
Evaluation and treatment by a multidisciplinary team are extremely important. This usually involves a gynecologist specialized in sexuality, a psychologist, and a pelvic floor physical therapist. Some physical therapy resources include manual therapy techniques, desensitization combined with the use of dilators, diaphragmatic breathing, pelvic floor exercises, various types of electrical stimulation, and thermotherapy.