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Snapshot
  • A 21-year-old woman presents tearfully to her gynecologist. She has a new partner but is having difficulty with intercourse. She has a lot of anxiety surrounding sexual contact. On pelvic exam, her vaginal muscles contract involuntarily. Her physician recommends therapy and treatment with gradual dilators.
Introduction
  • Vaginismus is a sexual pain disorder
    • vaginismus results in difficulty allowing vaginal penetration, despite willingness
  • Pathogenesis
    • involuntary, painful reflex spasm of the paravaginal thigh adductor muscles
    • results from anxiety about sex or pelvic exam
      • results from a bad experience with either in the past
  • Vaginismus is the only type of sexual dysfunction that can be diagnosed with physical exam
  • Risk factors
    • generalized anxiety disorder
    • depression
    • history of sexual trauma
Presentation
  • Symptoms
    • pain during intercourse
    • difficulty with vaginal penetration
  • Physical exam
    • pain with pelvic exam
    • involuntary vaginal spasm during pelvic examination
Evaluation
  • Diagnosis confirmed if vaginal muscles contract involuntarily with pelvic exam
Treatment
  • Gradual vaginal dilators
  • Physical therapy to relax the tight muscles
  • Counseling
Prognosis, Prevention, and Complications
  • Prognosis
    • vaginal dilators are typically very successful
 

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