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Vaginismus

Vaginismus is defined as involuntary spasms of the muscles of the outer third of the vagina. Vaginal spasms interfere with sexual intercourse (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000). Vaginismus can occur at any point during the sexual response cycle. Vaginal muscle reflex may make sexual intercourse painful or impossible. Vaginismus must result in interpersonal difficulty or distress in order to be a diagnosable disorder. To diagnose vaginismus, clinicians must rule out other disorders including somatization disorder. Somatization is defined as medical symptoms with no discernible organic cause; often time somatization disorders have psychological causes. It is also critical to ensure that vaginal spasms are not the direct physiological effects of a general medical condition.

Vaginismus can be either lifelong or acquired. Lifelong vaginismus is defined as never having been able to have penetrative sex without pain. Acquired vaginismus is defined as the loss of ability to achieve penetration without pain.

Vaginismus can occur in two contexts; generalized or situational.
Generalized vaginismus occurs regardless of types of stimulation, situations, or partners. Situational vaginismus appears to be limited to certain types of stimulation, situations, or partners.

According to past research, vaginismus is a psychosomatic contraction of the vaginal muscles. Vaginismus may be caused by fear of penetration and is often a situation-specific disorder (LoPiccolo & Stock, 1986). In order to rule out physical causes, it is the responsibility of a professional sex therapist to recommend that clients consult with a gynecologist. A gynecological consultation is needed to determine the balance of psychological and physical causes relating to vaginismus. Women with a history of childhood or adolescent molestation, rape, incest or sexual trauma are likely to present physical symptoms of vaginismus.

Treatment:

  • Relaxation training
  • Dilation of the vagina
  • Eye movement desensitization and reprocessing (EMDR)
  • Sex therapy as effective treatment for vaginismus
  • LoPiccolo (1986) cited previous research indicating the above methods were effective.

CASE STUDY (Chakrabarti, N., & Sinha, V. K., 2002).:

Mr. and Mrs. D had never consummated their 22-year marriage at the time they began therapy. Mrs. D revealed that the initial anxiety began the day before her wedding night. At this time, Mrs. D’s aunt told her that penile penetration was extremely painful for the female and therefore, the couple did not have sex on their wedding night due to Mrs. D’s anxiety. Prior to beginning therapy, Mr. and Mrs. D were physically evaluated by a medical doctor and both deemed as healthy. Therefore, there was no physical cause to Mrs. D’s hesitation for penetration. Mrs. D also had other symptoms when beginning therapy including panic attacks, feeling low, crying spells, guilt, and avoiding social situations where children may be present as the couple wanted a child.
The first session of therapy was directed at exploring Mr. and Mrs. D’s ideas about the human reproductive anatomy and sexual physiology. Mrs. D revealed that she had learned from her family that talking about sex was considered taboo and she had never received any form of sex education. The therapist provided sex education to the couple explaining the sexual cycle. Within four sessions with a therapist, Mr. and Mrs. D consummated their marriage and Mrs. D felt confident enough to initiate physical intimacy with her husband.

CASE STUDY (Torun, F., 2010):
Vaginismus can be a result of past sexual trauma that has not been processed. Mr. and Mrs. U were a married couple who didn’t have sexual intercourse for 5 years prior to doing EMDR. Mrs. U began experiencing symptoms of vaginismus, including spasms, since their wedding night. The couple had felt pressure to conceive a child and were on the brink of divorce due to their inability to consummate. Mrs. U confided to the therapist that she had not told her husband of past attempted sexual abuse by a family member. In order to fight off sexual penetration, Mrs. U managed to keep her legs together tight enough for her Uncle to give up. The therapist decided to use EMDR to help Mrs. U reprocess the attempted sexual trauma rapidly and reprogram the negative cognition that coincided with the trauma; “I cannot take care of myself”. Following one session of EMDR, Mr. and Mrs. U reported having pain-free sexual intercourse.

Reference:
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Chakrabarti, N., & Sinha, V. K. (2002). Marriage consummated after 22 years: A case report. Journal Of Sex & Marital Therapy, 28(4), 301-304. doi:10.1080/00926230290001420

LoPiccolo J., & Stock, W.E. (1986). Treatment of sexual dysfunction. Journal of Consulting and Clinical Psychology, 54(2), 158-167. Doi:10.1037/0022-006X.54.2.158

Torun, F. (2010). [Treatment of vaginismus with EMDR: a report of two cases]. Türk Psikiyatri Dergisi = Turkish Journal Of Psychiatry, 21(3), 243-248.

 



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