Vaginismus

Vaginismus is a psychophysiological syndrome affecting women’s freedom of sexual response by severely, if not totally, impeding coital function. Anatomically this clinical entity involves all components of the pelvic musculature investing the perineum and outer third of the vagina.

Physiologically, these muscle groups contract spastically as opposed to their rhythmic contractual response to orgasmic experience. This spastic contraction of the vaginal outlet is a completely involuntary reflex stimulated by imagined, anticipated, or real attempts at vaginal penetration. Thus, vaginismus is a classic example of a psychosomatic illness.

Vaginismus and Female Sexual Dysfunction

Vaginismus is one of the few elements in the wide pattern of female sexual dysfunctions that cannot be unreservedly diagnosed by any established interrogative technique. Regardless of the psychotherapist’s high level of clinical suspicion, a secure diagnosis of vaginismus cannot be established without the specific clinical support that only a direct pelvic examination can provide.
Without confirmatory pelvic examination, women have been treated for vaginismus when the syndrome has not been present.

Conversely, there have been cases of vaginismus diagnosed by pelvic examination when the clinical existence of the syndrome had not been anticipated by therapists. The clinical existence of vaginismus is delineated when vaginal examination constitutes a routine part of the required complete physical examination. The presence of involuntary muscular spasm in the outer third of the vaginal barrel, with the resultant severe constriction of the vaginal orifice, is obvious.

The literature has remarked on an unusual physical response pattern of a woman afflicted with vaginismus. She reacts in an established pattern to psychological stress during a routine pelvic examination that includes observation of the external genitalia and manual vaginal exploration.

The patient usually attempts to escape the examiner’s approach by withdrawing toward the head of the table, even raising her legs from the stirrups, and/or constricting her thighs in the midline to avoid the implied threat of the impending vaginal examination. Frequently this reaction pattern can be elicited by the woman’s mere anticipation of the examiner’s physical approach to pelvic examination rather than the actual act of manual pelvic investigation.

When vaginismus is a fully developed clinical entity, constriction of the vaginal outlet is so severe that penile penetration is impossible. Frequently, manual examination can be accomplished only by employing severe force, an approach to be decried, for little is accomplished from such a forced pelvic investigation, and the resultant psychosexual trauma can make the therapeutic reversal of the syndrome more difficult.

The diagnosis of vaginismus can easily be established by a one-finger pelvic examination. If a nontraumatic pelvic exploration is conducted, and a markedly apprehensive woman is somewhat reassured in the process, the first step has been taken in a therapeutic reversal of the involuntary spasm of the vaginal outlet.