VAGINISMUS

VAGINISMUS


Vaginismus [vaj-uh-niz-muh s] is considered a disorder of sexual dysfunction.The disorders is an involuntary spasm of the muscles surrounding the vagina. The spasms close the vagina. Vaginismus can cause vaginal penetration during sex is difficult or impossible, and vaginal pain is common during sexual intercourse or an attempted pelvic exam. Vaginismus is also closely related to any of the other forms of dyspareunia in that any type of general sex pain may trigger vaginismus. Most women with vaginismus cannot tolerate sexual intercourse, and some cannot tolerate using tampons. It has several possible causes, including past sexual trauma or abuse, psychological factors, or a history of discomfort with sexual intercourse. Sometimes no cause can be found. 

Vaginismus Involuntary Tightness - In the diagram [1] on the left, the effects of vaginismus are illustrated with the tightening of the pelvic floor muscles and the resulting tightness of the vagina. On the right, the pelvic floor is relaxed and intercourse is possible without pain.

There are two types of vaginismus; primary (i.e. lifelong) and secondary (occurring after a period of normal sexual function). When a woman has never at any time been able to have pain-free intercourse due to vaginismus tightness, her condition is known as primary vaginismus. Vaginismus can also develop later in life, even after many years of pleasurable intercourse.

This type of condition, known as secondary vaginismus, is usually precipitated by a medical condition, traumatic event, childbirth, surgery, or life-change (menopause). Although these women will remember that penetrations used to be fine, they are now faced with painful/impossible intercourse and gynecologic exams. The cause for their secondary vaginismus is the loss of lubrication and elasticity in the vagina, making them feel just as isolated and hopeless as those with primary vaginismus.

Although a woman can easily diagnose her vaginismus, medical evaluation is recommended as the following information is not intended to be used in lieu of proper medical care. Doctors base the diagnosis on symptoms and a subsequent pelvic examination, done as gently as possible. Women are taught how to touch her genital area, gradually moving closer to her vagina and becoming used to touching it without causing pain, and then to insert progressively larger cones. These exercises may enable women to have sexual intercourse without pain.

There are a variety of factors that can contribute to vaginismus. These may be psychological or physiological, and the treatment required can depend on the reason that the woman has developed the condition. As each case is different, an individualized approach to treatment is useful. Treatment involves extensive therapy that combines education, counseling, and behavioral exercises.

Typically, treatment includes relaxation, Kegel exercises (pelvic floor muscle contraction and relaxation) and individual and partner involvement in a series of at-home exercises, including repeated practice with insertion (dilation) training. Each woman moves at her own pace and decides when she is ready for the next step. Pain and discomfort are avoided throughout the treatment.

The other treatment of vaginismus is treating with hypnosis. In general, hypnotherapy tends to focus on overcoming the vaginismus itself, as opposed to resolving any causes or conflicts behind it. Hypnosis is unsurpassed at dealing with unconscious processes. This is why is useful to help sports people excel - their brain can be trained to control their muscles in precisely the right way. Similarly, hypnosis can be used to treat high blood pressure because it relaxes the body like no other method can.

A good news for patient with vaginismus that reported new treatment to use botolinum toxin (botox). Botox is a relatively new treatment for vaginismus, first described in 1997. Ghazizadeh and Nikzad reported on the use of botulinum toxin in the treatment of refractory vaginismus in 24 patients. In this study, Dysport (a type of Botox) 150-400 mIU (Ipsen Ltd, United Kingdom) was used. 23 patients were able to have vaginal examinations one week post procedure showing little or no vaginismus.

If you have pain associated with intercourse or difficulties with successful vaginal penetration, contact your health care provider. When a physician or gynecologist is consulted, involuntary spasm during pelvic examination can confirm the diagnosis of vaginismus, and the physician will rule out any physiological causes for the condition. When psychological causes are suspected, referral should be made to a psychologist or psychiatrist.

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FEMALE DYSPAREUNIA

FEMALE DYSPAREUNIA


Other name : Painful sexual intercourse

Dyspareunia (dis-puh-ROO-ne-uh) is the medical term for painful intercourse — which is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse and that causes you personal distress. The pain can be in the genital area or deep inside the pelvis. The pain is often described as sharp, burning or similar to menstrual cramps. It can have many causes.

Symptoms of dyspareunia include : Pain with every penetration; even while putting in a tampon, Pain with certain partners or just under certain circumstances, New pain after previously pain-free intercourse, Superficial (entry) pain, Deep pain during thrusting, which is often described as "something being bumped", Burning pain or aching pain. [1]

Diagnosis

The diagnosis is based on the woman's description of the problem, including when and where the pain is felt, and on the results of a physical examination. The genital area is gently but thoroughly examined for possible causes, such as signs of inflammation or abnormalities. A doctor may touch the area gently with a cotton swab to determine where the pain occurs. The doctor checks the tightness of the pelvic muscles around the vagina by inserting one or two gloved fingers into the vagina. To check the uterus and ovaries, the doctor then places the other hand on the lower abdomen. A rectal examination may also be done. [2]

Clinical Features of dyspareunia

Dyspareunia needs to be addressed from an integrated patient-centered perspective. This review analyzes the organic causes of pain during intercourse. Factors that are often under evaluated in the clinical setting include hormonal, inflammatory, muscular, iatrogenic, neurologic, vascular, connective, and immunitary causes. Psychosexual factors, such as vaginismus, loss of libido, arousal disorders and sexual pain-related disorders, often overlap. A preliminary clinical approach aimed at integrating different biological and psychosexual etiologies in a comprehensive manner is discussed in this article. [Graziottin A, 2001, J Sex Marital Ther;27(5):489-501]

Young women complaining of dyspareunia usually have a history of OC (oral contraception) use, recurrent thrush and adverse reactions to common foods or chemicals. Correctable laboratory findings include zinc, magnesium, copper, B vitamin, essential fatty acid deficiencies, positive gut fermentation tests and decreased pancreatic exocrine secretion and often a variety of cervical or vaginal infections. The Royal College of General Practitioners Oral Contraception Study found that stopping to co-habit was twice as common among users as among control women.3 Much disruption to family life could have been, and still could be, prevented by a more realistic awareness of the adverse effects of progesterones on women’s health. [Grant, E C G; in Biochemical and microbiological investigations needed for female dyspareunia, June 5, 2004]

Causes

Physical causes of dyspareunia include [3]:

Because there are numerous physical conditions that can contribute to pain during sexual encounters, a careful physical examination and medical history are always indicated with such complaints. In women, common physical causes for coital discomfort include infections of the vagina, lower urinary tract, cervix, or fallopian tubes (e.g., mycotic organisms (esp. candidiasis), chlamydia, trichomonas, coliform bacteria); endometriosis; surgical scar tissue (following episiotomy); and ovarian cysts and tumors.

In addition to infections and chemical causes of dyspareunia such as monilial organisms and herpes, anatomic conditions, such as hymenal remnants, can contribute to coital discomfort (Sarrell and Sarrell 1989). Estrogen deficiency is a particularly common cause of sexual pain complaints among postmenopausal women, although vaginal dryness is often reported by lactating women as well. Women undergoing radiation therapy for pelvic malignancy often experience severe dyspareunia due to the atrophy of the vaginal walls and their susceptibility to trauma. Vaginal dryness is sometimes seen in Sjögren's syndrome, an autoimmune disorder which characteristically attacks the exocrine glands that produce saliva and tears.

Dyspareunia is now believed to be one of the first symptoms of a disease called Interstitial Cystitis (IC). Patients may struggle with bladder pain and discomfort during or after sex. For men with IC, pain occurs at the moment of ejaculation and is focused at the tip of the penis. For women with IC, pain usually occurs the following day, the result of painful, spasming pelvic floor muscles. Interstitial cystitis patients also struggle with urinary frequency and/or urinary urgency.

Psychosocial causes of dyspareunia include [4]:

1. Prior sexual trauma. Many women who have been raped or sexually abused as children have dyspareunia. Even when a woman wishes to have sex with someone later, the act of intercourse may trigger memories of the trauma and interfere with her enjoyment of the act. Vaginismus also often occurs in such women.
2. Guilt, anxiety, or tension about sex. Any of these can cause tense vaginal muscles and also prevent arousal from occurring. People who were raised with the idea that sex is bad may be more prone to have this problem. Fear of pregnancy may make arousal difficult.
3. Prior physical trauma to the vaginal area. Women who have had an accidental injury or surgery in the vaginal area may become sensitive to penetration. Vaginismus is common in these cases, as well.
4. Depression or anxiety in general. Either of these can lead to loss of interest in sex. This can be experienced by either sex.
5. Problems in a relationship. Dyspareunia may occur when a woman feels her sexual partner is abusive or emotionally distant, she is no longer attracted to her partner, or she fears her partner is no longer attracted to her. Men, too, can lose interest in sex because of prior emotional trauma in a relationship; however, the result is usually impotence, rather than dyspareunia.
6. Vasocongestion. Vasocongestion can occur when either partner frequently becomes aroused but does not reach orgasm. Vasocongestion is a pooling of blood in dilated blood vessels. Normally, the pelvic area becomes congested with blood when a person becomes sexually aroused. This congestion goes away quickly after orgasm. If there is no orgasm, the congestion takes much longer to resolve.

Prevention [5] :

1. Good hygiene and routine medical care will help to some degree.
2. Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
3. The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant because it is not compatible with latex condoms (it causes them to break), it is not water soluble, and it may encourage vaginal infections.
4. Practicing safe sex can help prevent sexually transmitted diseases.

Treatment of Dyspareunia

Treatment is aimed at identifying and properly treating the underlying disorder. Medications are prescribed to treat infections, if they exist. If an allergy to latex is suspected, alternative methods of contraception should be considered. If the spermicide is causing discomfort, try a different brand or consider using alternate methods of birth control. A water-based lubricant may help ease discomfort and friction. However, avoid oil-based lubricants, such as petroleum jelly, since they dissolve the latex in condoms and may actually promote infection. Insertion of a graduated set of dilators into the vagina may be used to treat vaginismus. Pain during intercourse due to an episiotomy generally subsides over time. Psychological counseling may be advised if no underlying physical abnormalities can be identified. [6]

More specific treatment depends on the cause, as in the following [7] :

1. Thinning and drying of the vagina after menopause: Estrogen applied as cream, inserted into the vagina as a pill or in a ring, or taken by mouth (as part of hormone therapy)
2. Infections: Antibiotics, antifungal drugs, or other drugs as appropriate
3. Cysts or abscesses: Surgical removal
4. A rigid hymen or another congenital abnormality: Surgical correction
5. Prolapse of the uterus: Insertion of a pessary, which resembles a diaphragm, into the vagina to support and reposition the uterus. Sometimes surgery is needed.

Because this disorder involves chronic pain, treatments are becoming more comprehensive, including management of stress and emotional reactions to the pain.