Dyspareunia and other psychosexual problems
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Vaginismus is the involuntary spasm of the pubococcygeal and associated muscles causing painful and difficult penetration of the vagina, during sex, tampon insertion or clinical examination. Primary vaginismus occurs when a woman has never experienced vaginal penetration; secondary vaginismus is diagnosed when the problem occurs after previous successful vaginal penetration. Usually at the root of vaginismus is a combination of physical or non-physical triggers that cause the body to anticipate pain. The body reacts to this by automatically tightening the vaginal muscles, which makes sex more painful and this response becomes the ‘cycle of pain’. The patient may present with a painful vulva at intercourse. The differential diagnosis is then of organic vulval disorders, such as vulval vestibulitis. However, there is likely to be some degree of vaginismus in all women with organic vulval disease. The skill is in trying to work out whether the vaginismus is the primary problem or is a result of organic disease. The ‘Q-tip’ test can be helpful to elucidate the exact site of pain and whether it is in the contracted muscles or in the tender epithelium of the vestibule. (The ‘Q-tip’ test involves the use of a moistened cotton bud to elicit the exact site and degree of discomfort or vulval pain.)The other main form of presentation is admission of non-consummation of a relationship in the fertility clinic setting.
Conditions
Sarah Bekaert in Women's Health, 2018
Vaginismus occurs when the muscles around the vagina tighten involuntarily, causing the vagina to spasm and possibly causing pain. It is a psychological problem that is manifested in a physical way, and is fairly common. The vaginal muscles go into spasm, usually in response to the vagina or vulva being touched before sexual intercourse. It can also occur if penetration of the vagina by the penis is attempted, or during a gynaecological examination. Vaginismus can cause emotional distress and relationship problems. Women who have vaginismus are able to achieve orgasm during mutual masturbation, foreplay and oral sex. It is only when sexual intercourse is suggested or attempted that the vagina tightens to prevent penetration. There are many factors that can cause vaginismus.Some women may have had the condition all their adult life and may never have had sexual intercourse because of it.In other cases, vaginismus may be due to other causes, such as the following:a physical cause, such as an injury, or inflammation of the vagina, pelvis or bladder
Hysteria
Francis X. Dercum in Rest, Suggestion, 2019
When possible, the endeavor should be made to bring about in the patient an autosuggestion favoring the dietary it is desirable to prescribe. This must, of course, be accomplished by indirect means. Thus, the article of food, most often milk, is emphatically forbidden in the presence of the nurse, or the matter of the milk is treated as of no consequence or its mention ignored by a shrug of the shoulders. Not infrequently the patient, finding that milk is not being forced upon her, or not even being mentioned in her presence, will ask the physician whether he never prescribes milk, and whether a trial in her case might not prove beneficial. Especially is this likely to come to pass if the amount of other food has been so limited as to be grossly insufficient. The advantage gained is exceedingly great, and if followed up in the proper manner, will prove of enormous utility In the final determination of a successful issue. Very much must, of course, be left to the tact of the physician and his comprehension of the mental make-up of the patient. In Intestinal distress and hysteric distention, general or limited (phantom tumors), the methods already detailed—massage and the suggestive use of electricity—are of value. We have already alluded to the local areas of painful hyperesthesia, at times developed ia the rectum. If very persistent, such areas may be dispersed by rectal massage. Vaginismus, a condition similar in character, is often very difficult to treat. For obvious reasons, massage cannot here be employed, while such measures as injections, the use of vaginal electrodes—the anode with very mild galvanic current—tampons, and glass plugs, etc., are of little use. The symptom does, however, yield when the hysteria as a whole is relieved, and every energy should be directed to the general measures coupled with properly made suggestion. Retention of urine is not, as a rule, a serious complication. The physician can rest assured that rupture of the bladder will never take place in hysteric retention; nor is even disastrous distention likely to result. The placing of the patient upon the vessel at regular but not too frequent intervals, with the suggestive sound of running water and the withdrawal of the nurse from the room at the time, are among the expedients to be employed. Occasionally, when the distention of the bladder becomes exceedingly uncomfortable to the patient, she may suddenly leave the bed and evacuate the bladder upon the floor. Patients will rarely go to the extent of wetting the bed. The catheter is to be used only as a last resort, and then not regularly. The physician should, of course, be cautioned against the possibility of mistaking a case of organic retention for one of hysteric retention, and if there be any doubt regarding this point, the catheter should be used promptly. A physical examination will, it need hardly be said, at any time reveal whether the distention of the bladder has reached a serious point.
Vaginismus - iatrogenic precipitation and maintenance
Published in Acta Obstetricia et Gynecologica Scandinavica, 1992
Four cases of vaginismus are presented. Two of them illustrate an iatrogenic precipitation of vaginismus, one misdiagnosis of vaginismus, and one shows the use of unnecessary hymenectomy as the first choice of treatment of vaginismus. The etiology of vaginismus and the indications of first pelvic examinations are discussed.
Combined Vulvar Vestibulitis Syndrome with Vaginismus: Which to Treat First?
Published in Journal of Sex & Marital Therapy, 2001
Joseph Har-Toov, Idan Militscher, Joseph B. Lessing, Liora Abramov, Juza Chen
The common approach to vulvar vestibulitis syndrome (VVS) combined with vaginismus is to treat the VVS before the vaginismus. Our study initially ignored the VVS and instead treated the vaginismus first.
Vaginismus as an independent risk factor for cesarean delivery
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2009
Tomer Goldsmith, Amalia Levy, Eyal Sheiner, Tomer Goldsmith, Amalia Levy, Eyal Sheiner
Objective. The present study was aimed to investigate pregnancy outcome of patients with vaginismus, and specifically the relationship between vaginismus and cesarean delivery. Methods. A population based study comparing all pregnancies in patients with and without vaginismus was conducted. Patients lacking prenatal care were excluded from the analysis. Deliveries occurred during the years 1988–2007. A multivariate logistic regression model, with backward elimination, was constructed to find independent risk factors associated with vaginismus. Results. During the study period there were 192,954 deliveries, of which 118 occurred in patients with vaginismus. Patients with vaginismus tended to be younger (26.04±4.89 vs. 28.61±5.83; p < 0.001) and delivered smaller children (3024.2±517 g vs. 3160.9±576 g; p = 0.01) when compared with patients without vaginismus. Patients with vaginismus had higher rates of infertility treatments (5.9%vs. 2.7%, odds ratio [OR] 2.3; 95% confidence interval [CI] 1.1–4.9; p = 0.04) and labor induction (37.3%vs. 27.4%, OR 1.6; 95% CI 1.1–2.3; p = 0.02), vacuum extraction (9.3%vs. 2.8%, OR 3.6, 95% CI 1.9–6.7; p < 0.001), and cesarean delivery (39.0%vs. 14.5%, OR 3.8; 95% CI 2.6–5.5; p < 0.001) when compared with the comparison group. Even after controlling for possible confounders associated with cesarean delivery such as previous cesarean delivery, pathological presentations, and fetal distress, vaginismus remained as an independent risk factor for cesarean delivery (OR 7.1; 95% CI 4.5–11.1; p < 0.001). Conclusion. Vaginismus is an independent risk factor for cesarean delivery.
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