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At least 19 recordsLinked to original sources

PubMed2001

Interventions for vaginismus.

BACKGROUND: Vaginismus is involuntary vaginal muscle contraction which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. Various therapeutic strategies for vaginismus, such as sex therapy and desensitization, have been considered in uncontrolled studies. OBJECTIVES: The aim of this review is to determine the clinical effectiveness of treatments for vaginismus and also to examine the role of partner participation in the effectiveness of the treatment. SEARCH STRATEGY: The Cochrane Collaboration Depression, Anxiety & Neurosis Controlled Trials Register (Issue 3, 2000), the Cochrane Controlled Trials Register (Cochrane Library, Issue 2, 2000), MEDLINE (1966 to Apr 2000), EMBASE (1980 to Apr 2000), PsycINFO (1967 to April 2000) and CINAHL (1982 to Mar 2000) were searched. The Journal of Sex Research (1974 to 1999), Sexual & Marital Therapy (1986 to 1999), Sexual Dysfunction (1998 to 1999) and the Journal of Sex and Marital Therapy (1974 to 1999) were handsearched. Reference lists and conference abstracts were searched. Experts in the field were contacted regarding unpublished material. SELECTION CRITERIA: Controlled trials comparing treatments for vaginismus with another treatment, a placebo treatment, treatment as usual or waiting list control. DATA COLLECTION AND ANALYSIS: The reviewers extracted data which were verified with the trial investigator. MAIN RESULTS: Two controlled trials were identified although data were only available from one trial. The second trial compared two forms of systematic desensitization and reported no discernible differences between them. REVIEWER'S CONCLUSIONS: In spite of encouraging results reported from uncontrolled series of patients there is very limited evidence from controlled trials concerning the effectiveness treatments for vaginismus. Further trials are need to compare therapies with waiting list control and with other therapies.

Desensitization, Psychologic↗

PubMed2001

Vaginismus, a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus.

This study investigates the mechanism underlying vaginismus, which may be part of a general defense mechanism. Exposure to a threatening situation will evoke an increase in muscle activity. This muscle reaction will not be restricted to the pelvic floor but will also occur in postural muscles, such as in the trapezius region. Women with and without vaginismus were exposed to four stimuli: excerpts from threatening, erotic, neutral and sexual-threatening films. Subjects were 45 physician- or self-referred patients with vaginismus and 32 controls with no sexual or pelvic floor complaints. The activity of the pelvic floor muscles and of the muscles in the trapezius region was recorded with surface electrodes. There were no differences between women with and without vaginistic reactions. EMG measurement of both the pelvic floor muscles and the trapezius muscle showed an increase in muscle activity during the threatening and sexual-threatening excerpts in women with and without vaginismus. This increase of involuntary pelvic floor muscle activity is part of a general defense mechanism that occurs during exposure to threatening situations. This reaction is not restricted to a situation with a sexual content. The results of this study shed new light on the concept of vaginismus as a primarily sexual dysfunction.

Adolescent↗

PubMed2004

Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus.

This study investigated the roles of vaginal spasm, pain, and behavior in vaginismus and the ability of psychologists, gynecologists, and physical therapists to agree on a diagnosis of vaginismus. Eighty-seven women, matched on age, relationship status, and parity, were assigned to one of three groups: vaginismus, dyspareunia resulting from vulvar vestibulitis syndrome (VVS), and no pain with intercourse. Diagnostic agreement was poor for vaginismus; vaginal spasm and pain measures did not differentiate between women in the vaginismus and dyspareunia/VVS groups; however, women in the vaginismus group demonstrated significantly higher vaginal/pelvic muscle tone and lower muscle strength. Women in the vaginismus group also displayed a significantly higher frequency of defensive/avoidant distress behaviors during pelvic examinations and recalled past attempts at intercourse with more affective distress. These data suggest that the spasm-based definition of vaginismus is not adequate as a diagnostic marker for vaginismus. Pain and fear of pain, pelvic floor dysfunction, and behavioral avoidance need to be included in a multidimensional reconceptualization of vaginismus.

Adult↗

PubMed2005

Efficacy of functional electrical stimulation-biofeedback with sexual cognitive-behavioral therapy as treatment of vaginismus.

OBJECTIVES: To report 12 cases of vaginismus that were successfully treated with functional electrical stimulation (FES)-biofeedback with sexual cognitive-behavioral therapy (SCBT) to determine the efficacy of FES-biofeedback with SCBT as a standard therapy for vaginismus. Vaginismus is an involuntary spasm of the musculature of the outer third of the vagina that leads to impossible vaginal penetration, causing personal distress. Various therapeutic approaches, both physiologic and psychological, have been considered. METHODS: Twelve women with vaginismus referred from a checkup outpatient clinic participated in this study. The patients enrolled in this study had vaginismus according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders. The patients were assessed before and after treatment with gynecologic examinations and structured interviews pertaining to sexual function and psychological adjustment. After the diagnosis of vaginismus, we conducted weekly pelvic floor muscle relaxation using FES-biofeedback. Once the patients became tolerable to vaginal manipulation, the eight-stage SCBT (eight-stage gradual desensitization described by Kaplan using vaginal self-dilation with fingers and vaginal probe insertion) was added for 8 weeks. RESULTS: After 8 weeks of treatment, all 12 couples had completed the program, had become tolerable to vaginal insertion of larger size probes, and could achieve satisfactory vaginal intercourse. CONCLUSIONS: FES-biofeedback with SCBT is an effective aid for patients with vaginismus to learn muscle control. Therefore, it may increase the success rate of treatment of vaginismus.

Adult↗

PubMed2004

Couple characteristics and outcome of therapy in vaginismus.

OBJECTIVE: To describe couple characteristics and outcome of therapy in vaginismus. DESIGN: A prospective before-after intervention descriptive study. SETTING: Department of Physiology, Faculty of Medicine, Colombo, Sri Lanka. METHODS: Fifty six couples with vaginismus, mostly self referrals and referrals from gynaecologists and general practitioners, were treated with a standard cognitive behaviour therapy protocol with before-after assessments of the degree of vaginismus and individual partner self-ratings of the relationship and psychological status (GHQ-30). OUTCOME MEASURES: Success at the end of the therapy was equated to the absence of or only mild vaginismus and, improvement in the couple relationship and psychological status scores. RESULTS: Twenty seven (48%) of the 52 (93%) couples with non-consummation reported failure of coitus following previous non-surgical and surgical interventions. Love marriages (70%), frequent attempts at sex (75%, 3 or 4 times/week) and sexual arousal (women = 86%, men = 89%) characterised couples. Ten men developed sexual problems, mostly erectile failure and premature ejaculation secondarily. Couple therapy enabled penetrative sex in 45 (80.3%). The single prognostic indicator of outcome was the degree of vaginismus at first visit, those with mild and moderate vaginismus (77%) being significantly more likely to establish coitus (p<0.001) and complete the therapy (p<0.001). The couple relationship improved marginally (women p<0.01, men 0.025 0.01) but the psychological status remained unchanged. Dropouts and referrals for psychiatric and marital counselling failed to complete therapy. INTERPRETATION: Couple sex therapy is effective in the management of vaginismus. Health professionals, especially gynaecologists and general practitioners, need to be aware of the problem and the satisfactory outcome of sex therapy.

Adult↗

PubMed2002

Study of the pelvic floor muscles in vaginismus: a concept of pathogenesis.

BACKGROUND: Neither the cause of vaginismus nor the muscles involved are precisely identified. AIM: To define the involved muscles and their role in the pathogenesis of vaginismus. METHODS: The EMG activity of the levator ani (LA), puborectalis (PR) and bulbocavernosus (BC) muscles was studied in seven female patients (age (years): 25.6(mean)+/-1.2(S.D.)) and seven healthy volunteers who matched the patients in age. Recordings were performed at rest and during induction of vaginismus by a vaginal dilator. MAIN RESULTS: Upon approximating the vaginal dilator to the vaginal introitus or introducing it into the vagina of the healthy volunteers, the EMG activity of the LA, PR and BC muscles showed no significant difference from the basal activity. In the patients, the basal EMG activity of the examined muscles was significantly higher than that of the healthy volunteers (P<0.05). Upon vaginismus induction, the muscles showed a significant increase of the EMG activity (P<0.01). The latency recorded a mean of 14.2+/-2.3, 13.9+/-2.3 and 14.1+/-2.2ms (P>0.05) in the LA, PR and BC muscles, respectively. The muscle response was momentary lasting a mean of 31.2+/-5.7s. It was reproducible provided an off-time of a mean of 13.2+/-2.3s was observed. CONCLUSION: The pelvic floor muscles of vaginismus patients exhibited increased EMG activity at rest and on vaginismus induction; the cause is unknown. The concept of a disordered sacral reflex arc is put forward but needs further studies to be verified.

Adult↗

PubMed2005

Vulvar vestibulitis syndrome: an important factor in the evaluation of lifelong vaginismus?

The aim of the study was to investigate the prevalence of vulvar vestibulitis syndrome (VVS) in a sample of women suffering from lifelong vaginismus (N=91). Lifelong vaginismus is defined as "having a history of never having been able to experience penile entry of the vagina". The results with respect to VVS are compared with the results of women who are suffering from pain during intercourse (superficial dyspareunia) (N=84). Both patients groups were recruited from two treatment outcome studies. Using a standard physical examination, erythema was found in 77%, pain "on touch" in 69% and erythema and pain on the same location was seen in 56% of the patients with lifelong vaginismus. Furthermore, it was found that erythema (94%), pain (98%) and erythema and pain on the same location (92%) were more frequently found in patients with dyspareunia compared to women with lifelong vaginismus. It is concluded that pain is an integral part of the experiences in the majority of women with lifelong vaginismus.

Adult↗

PubMedDate not supplied

Etiological correlates of vaginismus: sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment.

This study investigated the role of sexual and physical abuse, sexual self-schema, sexual functioning, sexual knowledge, relationship adjustment, and psychological distress in 87 women matched on age, relationship status, and parity and assigned to 3 groups--vaginismus, dyspareunia/vulvar vestibulitis syndrome (VVS), and no pain. More women with vaginismus reported a history of childhood sexual interference, and women in both the vaginismus and VVS groups reported lower levels of sexual functioning and a less positive sexual self-schema. Lack of support for traditionally held hypotheses concerning etiological correlates of vaginismus and the relationship between vaginismus and dyspareunia are discussed.

Adult↗

PubMed1992

Vaginismus--iatrogenic precipitation and maintenance.

Four cases of vaginismus are presented. Two of them illustrate an iatrogenic precipitation of vaginismus, one misdiagnosis of vaginismus, and one shows the use of unnecessary hymenectomy as the first choice of treatment of vaginismus. The etiology of vaginismus and the indications of first pelvic examinations are discussed.

Adolescent↗

PubMed2000

Vaginismus and dyspareunia: is there a difference in clinical presentation?

The purpose of this exploratory study was to identify clinical similarities and differences in patients with vaginismus and dyspareunia. Thirty patients who were referred to an outpatient clinic for psychosomatic gynecology and sexology, with either of these two diagnoses, were investigated by means of a standardized interview, physical examination and self-rating questionnaires. Based on the interview, no significant differences were demonstrated between patients with vaginismus and dyspareunia, in the ability to insert a finger into the vagina or to have a gynecological examination. No differences were found in the reported level of pain during coitus (or attempted coitus), inserting one finger into the vagina, or during gynecological examination. Patients with vaginismus, however, more often reported that coitus was impossible. The physical examination and self-rating questionnaires showed no differences at all between patients with vaginismus and dyspareunia in palpated vaginal muscular tension and reported anxiety or tension during the examination. Moreover, in both groups redness and painful areas on the vulva were equally common. Redness and pain on the same location were more frequently present in the dyspareunia group. Patients with dyspareunia reported higher levels of pain during the examination. In conclusion, neither the interview nor the physical examination produced useful criteria to distinguish vaginismus from dyspareunia. A multi-axial description of these syndromes is suggested, rather than viewing them as two separate disorders.

Adult↗

PubMed2006

Cognitive-behavioral therapy for women with lifelong vaginismus: process and prognostic factors.

Cognitive-behavioral therapy (CBT) seems an effective treatment of lifelong vaginismus, but mechanisms of action have not yet been established. The present study explored whether the effect of CBT for lifelong vaginismus is mediated by changes in fear of penetration and avoidance behavior, which CBT explicitly aims to alter. A second aim of this study was to predict treatment outcome on the basis of pre-treatment variables. Participants with lifelong vaginismus were allocated at random to a 3-months CBT (n=81) or a waiting-list control condition (n=36). Full vaginal penetration with the penis of the partner constituted the primary outcome measure. Change scores in successful 'non-coital penetrative-behavior' and 'fear of coitus' were used to measure the mediating variables. Treatment resulted in an increase of intercourse (outcome), a decrease in fear of coitus, and an enhancement of successful non-coital penetration behavior, compared with no treatment. Outcome (intercourse) was partly mediated by changes in fear of coitus and changes in avoidance behavior. No treatment predictors could be detected in this study sample. It is concluded that techniques such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear, constitute an important avenue of change in the treatment of lifelong vaginismus.

Adult↗

PubMed2006

Topical lignocaine for vaginismus: a case report.

Vaginismus is a sexual dysfunction in which spasm of vaginal musculature precludes penetrative intercourse. In many cases associated pain or fear of pain may contribute to the maintenance of vaginismus. We report a case of primary vaginismus with associated pain that benefited from topical application of lignocaine gel along with systematic desensitization resulting in successful consummation, and suggest that it may be a useful adjunct during finger dilatation in the treatment of vaginismus, specifically in patients who have associated pain or areas of hyperesthesia in the introitus.

Adult↗

PubMed2000

Vaginismus: results of treatment with botulin toxin.

In view of the long-term therapy necessary to cure vaginismus and specially persistent cases, we considered using botulin toxin (BT) injections for the treatment of such cases. Eight women (mean age 26.6 +/- 1.2 years) with vaginismus were treated with BT. Another five women with vaginismus, matching the eight patients in age, acted as controls. The patients in the study group were injected with BT (25 IU diluted in 1 ml saline) into each of the two bulbospongiosus muscles. Control patients were injected with saline. Mean follow-up was 10.2 +/- 3.3 months. All the patients injected with BT improved. The couples could achieve satisfactory intromission. No patient was in need of re-injection and there was no recurrence during the follow-up period. Control subjects did not improve with the saline injection into the bulbospongiosus muscle. In conclusion, BT injection effected cure in all of the vaginismus patients with no complications or recurrence. The technique is simple, easy, cost-effective, not time-consuming and can be achieved on an outpatient basis.

Journal Article↗

PubMed2004

Botulinum toxin in the treatment of refractory vaginismus.

OBJECTIVE: To investigate the efficacy of botulinum toxin injection to treat women with moderate and severe vaginismus. METHODS: Twenty-four women referred to our clinic from February 2002 to February 2004 (mean age 25 years; range 19-34 years) with third- to fourth-degree vaginismus were recruited for this study. These women had previous unsuccessful treatments. Botulinum toxin (150-400 mIU) was injected into the puborectalis muscles in 3 sites on each side of the vagina. RESULTS: Twenty-three patients (95.8%) had vaginal examinations 1 week postoperatively that showed little or no vaginismus, 18 (75%) achieved satisfactory intercourse after the first injection, 4 (16.7%) had mild pain, 1 was cured after a second injection, 1 patient refused vaginal examination and did not attempt to have coitus, and another had no coitus as a result of her husband's secondary impotence. The women were followed up for a mean of 12.3 months (range 2-24 months), and there were no cases of recurrence. CONCLUSION: In refractory cases of vaginismus when conventional therapies have failed, local injection of botulinum toxin can be considered. LEVEL OF EVIDENCE: III.

Adult↗

PubMed2000

Vulvar vestibulitis syndrome and vaginismus. A case report.

BACKGROUND: Recent reports have argued for a revision of the criteria used for the establishment of a diagnosis of vulvar vestibulitis syndrome (VVS). On theoretical grounds it might be hypothesized that women with VVS also suffer from vaginismus. CASE: A young woman presented with a history, symptoms and objective findings typical of vaginismus, yet she suffered from continuous, burning pain and itching in the vestibule. Earlier in the course of the problem she had received a diagnosis VVS. The patient was treated with behavioral therapy developed for vaginismus. Notations made during the course of therapy supported the assumption that the pain and itching were conditioned responses to penetration in the same way that a vaginal muscular reflex is. CONCLUSION: Differential diagnostic difficulties exist in the field of VVS and vaginismus. Psychophysiologic theories are needed as the basis for research to clarify the connections between different diagnostic entities associated with coital burning pain and itching in the vestibule.

Adolescent↗

PubMed2001

[Vaginismus--a psychiatric perspective, "secrets" and other psychodynamic causes].

Vaginismus is a disorder involving both psychiatry and gynecology. Psychiatric help is sought in only a small proportion of cases, although it is probable that the psychological etiology of the disorder is more frequent than generally recognized. This article deals with the causes and psychological circumstances of the disorder. Five cases are presented. In the first three cases, primary vaginismus caused unconsummated marriage in young women of religious or traditional background. In these cases a "secret" was revealed relating to a previous sexually related experience. This provides the basis for therapy. The other cases describe secondary vaginismus which appeared in older women who developed the symptom after a number of years of marriage. This article discusses the different psychotherapeutic approaches for the two types of cases. In the former cases, therapy may be brief and the prognosis is favorable. In the second case type, there is often more significant personality or marital pathology requiring prolonged and extensive psychotherapy. The authors stress the need for physicians to be mindful of cases of vaginismus requiring psychiatric intervention rather than gynecological treatment.

Adult↗

PubMed1982

The treatment of vaginismus by the gynecologist: an eclectic approach.

Thirteen of 14 patients with vaginismus have been successfully treated using systematic in vivo desensitization and other simple but individualized behavioral techniques. Resolution of symptoms was usually effected within 3 to 4 weekly sessions with important supplementary home assignments. All but 1 patient were seen without partners. Neither mechanical dilators nor hymenotomy was employed. Primary orgasmic dysfunction was associated wih vaginismus in a minority of patients and was treated concomitantly. Vaginismus appears to be more frequent than the literature indicates and can be situational or absolute. Presenting symptoms include an inability to tolerate pelvic examination, severe superficial dyspareunia, and a history of unconsummated coitus. Although gynecologic experience with vaginismus has been generally limited, the gynecologist is seen as a potentially ideal therapist for establishing or confirming the diagnosis at that time of pelvic examination.

Adolescent↗

PubMedDate not supplied

Management and outcome of primary vaginismus.

Our objective was to access the success rate, and the factors affecting it, of treatment based on Masters and Johnson's sex therapy. For this prospective study, we enrolled 120 couples with unconsummated coitus due to vaginismus. We made a clinical diagnosis after taking a detailed history taking and conducting a clinical examination. Participants completed a questionnaire regarding characteristics of vaginismus after participating in a face-to-face interview. Both of these were done prior to treatment, after 3 months, and after 12 months. We provided sex therapy based on Masters and Johnson's method. Treatment results were then analyzed. After therapy, 93.3% of vaginismic women were successfully penetrated, and 83.3% had regular intercourse with orgasm. The abilities to reach orgasm and sexual desire were not different than that among normal women. There was a correlation between duration of unconsummation and success rate and also between severity of vaginismus, treatment sessions, and success rate. Because of our high success rate, we encourage vaginismic women and their partners to accept aggressive management.

Adult↗