Vaginismus (colpospism, vulvism, sexual neurosis) develops in 2-3% of women, can occur at any age and be expressed in varying degrees. In sexual relations, vaginism is defensive-reflex, associated with the expected sexual intercourse, fear of defloration. This leads to a reflex note of the thighs, contraction of the muscles of the perineum, vagina, abdominal wall, and other defensive movements of the body. Sometimes a woman retains or gradually develops libido and the ability to achieve orgasm. In some cases, vaginismus can lead to virgamia (virgin marriage), which sometimes lasts for years.
Classification of vaginismus.
By primary vaginismus understand the difficulties arising when trying to conduct the first sexual intercourse; under the secondary – violations that developed after the onset of sexual life. There is a precoital form of vaginismus that occurs solely when attempts are made to have sexual intercourse and a generalized form reflexively arising, including when inserting tampons, gynecological examinations, and other situations.
There are 3 degrees of severity of vaginismus. An easy degree is characterized by spasm of the muscles arising in response to the introduction of the instrument into the vagina, the finger of the doctor, the penis. With an average degree of vaginismus, the reflex reaction follows when you touch the genital organs. Severe vaginismus corresponds to a spasm that occurs when thinking about gynecological examination or intimacy.
True vaginismus should be distinguished from pseudo-vaginism – spasm of muscles developing in response to a pain stimulus in traumas, abnormalities of the structure (atresia of the vagina or hymen), diseases of the genital tract of the woman (colpitis bartolinitis, genital herpes mucosa, cracks anus, cicatricial narrowing of the entrance in the vagina, etc.). Also vaginismus should not be confused with koitofobiey – fear of sexual intercourse, not accompanied by spastic muscle contraction.
The causes of vaginismus.
It is proved that the causes of vaginism are psychogenic and are often associated with neurasthenia. the neurosis of compulsive states. hysteria. Vaginismus in neurasthenia is due to the general increased nervous excitability and is caused by an unconditional protective reaction, and not by fear of sexual intimacy. A similar symptom complex is often found in some somatic diseases – thyrotoxicosis. traumatic cerebrasthenia.
Vaginismus in psychasthenia (obsessive-compulsive disorder) has the character of phobias. that is, it is associated with obsessive fear of sexual relations or gynecological examination. Vaginismus often develops in hypochondriacs, anxious women under the influence of their own negative experience of painful defloration or sexual acts (due to the rigidity of the hymen, vulvovaginitis, insufficient stimulation, cracks and ruptures of the vaginal mucosa.
In hysteria, vaginism is regarded as a flight into a disease – a conscious or unconscious unwillingness of a woman to enter into an intimate relationship with a particular man. The causes of vaginismus in hysterical types can be covered in forced marriage, antipathy towards a partner, rudeness of his behavior, violence, erectile dysfunction in a man, etc. More often, vaginismus occurs in non-florated patients, although it can also develop in women in marriage, even after the birth of children .
Manifestations of vaginismus.
Manifestations of vaginismus are usually associated with the onset of sexual activity. Spasmodic muscle spasm develops against the background of fear and expectation of painful defloration, but can occur suddenly, quite unexpectedly for a woman. With vaginismus, a sharp contraction of the muscles of the vagina, perineum, hips, pelvic floor, abdominal wall develops in response to touching the genitals, attempting to introduce a penis or even thoughts of intimacy. Similar reactions may occur when a hygienic tampon, a vaginal test, or an attempt is made.
If the spasm develops by touching the genitals, the coitus becomes impossible. At the onset of a spasm after the introduction of the penis, it can be infringed with the impossibility of extraction from the vagina, which is accompanied by severe pain and edema of the penis. In the anamnesis of many patients with vaginism, there are various kinds of childhood fears, dysmorphophobia, sleep disorders. depression.
With neurasthenic disorders, vaginismus is usually mild or moderate, with phobic neuroses – medium or severe, with hysteria – moderate severity. Pseudovaginism is characteristic of women who are psychologically healthy and is associated with a pain syndrome that forms a strong reflex connection in the repetition of pain. Many women with vaginism retain the ability to achieve sexual arousal and orgasm, and their recourse to a doctor is associated with feelings of inferiority or a desire to have a child.
Diagnosis of vaginismus.
For the diagnosis of vaginismus is collected complaints and anamnesis, an objective study. The woman reveals the features of physical and sexual development, attitude to sex, previous sexual experience, the details of sexual life at the moment. In addition, the method of contraception used is being specified. plans for pregnancy, the nature of pain when you insert a vagina into an object.
With a gynecological examination, an involuntary spasm of muscles surrounding the vaginal opening is found on the armchair. In severe cases of vaginismus, a vaginal examination by a gynecologist is possible only under conditions of anesthesia. To determine the causes of pseudo-inguity, smears are collected for bacteriological and microscopic examination. PCR-diagnostics.
Treatment of vaginismus.
To treatment of vaginismus are involved gynecologists, psychotherapists. psychologists. sexologists. proctologists. Complex therapy of vaginismus is carried out taking into account etiological factors. Prior to the treatment of pseudo-gynecology, gynecology considers the elimination of the causes causing painful sexual intercourse. With the vulvites. colpitis, bartholinitis, anti-inflammatory therapy is performed taking into account the pathogen, with anus fractures – local treatment and presacral blockades.
Therapy of true vaginismus requires the holding of psychotherapy sessions. hypnosis. explanatory conversations, treatment of erectile dysfunction in a partner, sexual education. Patients with vaginismus are useful training exercises aimed at relaxing the muscles of the pelvis and thighs, breathing exercises, reflexotherapy. During the sessions the patient is convicted of painlessness of gynecological procedures, gradually expanding the entrance to the vagina first one and then two fingers and expanders of various sizes. In order to reduce the manifestations of vaginismus, tranquilizers, antidepressants, muscle relaxants, valerian preparations, bromine and local lubrication of the entrance to the vagina of 2% r-rum of dicaine are prescribed.
In a number of cases, with a preserved hymen and pronounced manifestations of vaginismus, surgical defloration can be performed. In the treatment of Vaginismus, the simultaneous help of a psychotherapist or sexologist is required by the patient’s sexual partner. The therapy of hysterical vaginismum dictates the need to eliminate the psychotraumatic moments.
Prognosis with vaginismus.
The prognosis in patients with vaginismus in order to restore normal sexual life is often favorable. In the future, women can plan pregnancy.