and Paula Briggs2
(1)
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
(2)
Sexual and Reproductive Health, Southport and Ormskirk Hospital, Southport, UK
Sexual Pain Disorders: Vaginismus and Dyspareunia
Theses two symptoms are often interrelated, as dyspareunia can cause vaginismus.
Definition
The inability to have penetrative sex due to spasm of the vaginal muscles. Primary is when it has been present from coitarche, secondary is when it develops where sex has previously been pain free.
Incidence
It is a relatively uncommon problem, but is a relatively frequent presentation.
Aetilogy and Pathogenesis
The vagina is a fibro-muscular structure lined by epithelium. The surface area is composed of ridges called rugae. The walls of the vagina are usually in apposition, but have the ability to be distended during sex and childbirth. The lower third of the vagina is under control of voluntary muscles – these muscles can be contracted consciously.
Possible causes of vaginismus include:
Congenital- an anatomical abnormality such vaginal stenosis.
Traumatic- a previous bad experience can result in contraction of the voluntary muscles as a defense mechanism.
Inflammatory/Infective – Any cause of vaginitis, such as chronic thrush can cause painful sexual intercourse and consequent vaginismus.
Denegenerative – lack of oestrogen during the menopause can cause atrophic changes in the vagina. The mucosa becomes less elastic.
Neoplastic
Benign –Precancerous changes of the vulva and/or vagina can result in dyspareunia and possible vaginismus.
Psychogenic – This is usually primary, and should be considered if no physical cause is identified.
Iatrogenic – Vaginal atrophy as a result of radiotherapy
Clinical Asessment
History
Women who have avoided using tampons or having sex may have vaginismus.
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