Vaginismus is the inability to have sexual intercourse due to painful involuntary spasm of muscles surrounding the vagina. In some patients vaginal penetration may be possible but extremely painful. Painful sexual intercourse is known as dyspareunia. Vaginismus is diagnosed when this problem is persistant for at least 6 months.
Before diagnosis, a gynecological examination is necessary to exclude anatomical structural abnormalities of the hymen.very rarely the hymen may be closed from birth or they may be very little opening on the hymen that makes penetration impossible. These patients need surgery such as ‘hymenectomy’ or hymenal septum resection’.
Gynecologists specialised in sexual therapy may treat vaginismus. Sometimes psychiatric consultation may be necessary.
In some patients the only symptom may be involuntary spasm and contraction of vaginal muscles. In other patients palpitations, tremor, mouth dryness, tonic clonic contractions of whole body muscles, syncope or panic attack symptoms may accompany the condition.
12-17 % of patients applying for sexual therapy are diagnosed with vaginismus according to international publications.
Vaginismus is usually diagnosed at the first attempt of penetrative sexual intercourse. Most patients are embarrased and feel guilty about the situation, so they do not seek medical help. Therefore the problem may worsen in time, as they continue to force themselves to make intercourse possible despite the pain they feel.
Most patients describe the feeling as ‘having a wall at the vaginal enterance that makes penetration impossible’. Actually the spasm of muscles feels like a wall that closes the vagina.
Once the patient visits a gynecologist, she will be releaved by learning that vaginismus is a very common problem among women, irrelevant to the socioeconomical condition of the patient and it can be treated very easily.
Vaginismus is a treatable condition. When it is properly treated, the symptoms never come back.
Cognitive behavioural therapy methods are commonly used for the treatment of vaginismus. During therapy process, office and home exercises are given to patients. The number of therapeutic sessions necessary for solution of the problem may change from one patient to the other.
First of all, patients are given education about genital anatomy and sexual functions. They will be asked to examine their external genital organs with a mirror. They should know their own genital anatomy and overcome the fear of touching their own vulva. They should also explore their own sensory areas to find out which points can stimulate them most, which is known as sexual arousal.
In the gynecoplogists’s office, different sized dilators may be used gradually for the relaxation of vaginal muscles.
Kegel exercises are reommended so that the patient can learn how to contract and relax vaginal muscles voluntarily. These exercises are also effective in the treatment of sress urinary incontinence and fecal incontinence.
At home patients are adviced to make ‘finger exercises’ in the same manner as vaginal dilators are used at the office.
The result of treatment is permanent solution of the problem, if therapy and exercises can be properly conducted.
They are also known as pelvic floor exercises. Kegel exercises are designed to contract and relax the pubococcygeous muscle voluntarily. When the exercises are repeated regularly, they help to strengthen the pelvic floor.
You can feel this muscle while you are urinating and try to stop the flow by contracting the PC muscle. Once you feel the muscle, you can contract it for 5 seconds and relax it for 5 seconds in a row of 10 repetitions, in 3 sets. You can increase the time of contraction and number of repetitions gradually in time.
Home exercises are given to patients with vaginismus, but the therapy should be guided with a sexual therapist only after a thorough gynecological examination is made.