Although it was first described over 150 years ago, vaginismus or as it now known as according to the DSM-V- genito pelvic pain penetration disorder (GPPPD), is rarely taught in medical schools and residencies or discussed at medical conferences. Despite hypotheses on possible causes, its etiology is unknown. Vaginismus affects 5% to 17% of women […]
Although it was first described over 150 years ago, vaginismus or as it now known as according to the DSM-V- genito pelvic pain penetration disorder (GPPPD), is rarely taught in medical schools and residencies or discussed at medical conferences.
Despite hypotheses on possible causes, its etiology is unknown. Vaginismus affects 5% to 17% of women seen in a clinical setting. However, its true incidence is unknown, because many women remain silent about this problem. It is often only when women decide that they would like to start a family that they share their “secret”. Some cases being more sever than others where insertion of anything bigger than a Q-tip is impossible, let alone a finger or penis.
Women with primary vaginismus have never experienced pain-free intercourse, whereas those with secondary vaginismus are comfortable with intercourse at one time in their lives prior to progression to painful intercourse. Carefully constructed medical and psychosexual histories are the tools used to diagnose this disorder.
There is opportunity for high rates of treatment success in patients with vaginismus unlike other sexual pain disorders. Vaginismus, GPPPD is a physical and psychological condition, and both modules must be treated. Treatments that have been used to help women overcome vaginismus include dilators, sex counselling, hypnotherapy, and a multimodal program using botulinum toxin A (onabotulinum toxin A).
Recent research has shown that Kegel exercises, hymenectomy, lubricants, topical anaesthetics, antidepressants, anti-anxiety medication, sedatives, alcohol, hallucinogenic drugs, and muscle relaxants are not helpful. Rather a good diagnosis of the condition and sex therapy sessions where the woman feels that she can discuss her anxiety is the most effective.
The emotional needs of patients have to be considered whatever treatment is used, and some women respond better to more intensive therapy than others . Some recent studies have looked at exposure therapy. This is where the women and often partners commit to therapy on a daily basis for a fixed time. It is usually between 7 and 10 days and exposure therapy, often involving dilators, is practiced daily. In a recent study up to 90% of participants reported success within two weeks. Post-treatment counselling and follow-up are essential for success regardless of the treatment program used. It is still a condition that isn’t talked about or discussed often; sadly many women learn to live with this unnecessarily.