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Updated: Feb 6 2017


  • 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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