Overview
Psychologic vaginismus is a condition characterized by involuntary muscle spasms of the pelvic floor muscles, specifically the pubococcygeus muscles, that prevent vaginal penetration 1. This can occur during attempted intercourse, tampon insertion, or gynecologic examination 1. It is often associated with significant distress and avoidance of sexual activity 1.Diagnosis
Diagnosis is primarily clinical, based on a history of inability to achieve vaginal penetration despite adequate desire and arousal 1.
Physical examination may reveal visible or palpable involuntary contractions of the pelvic floor muscles upon attempted penetration 1.
Exclusion of other medical conditions, such as vulvodynia, pelvic inflammatory disease, or anatomical abnormalities, is important 1.Management
Treatment typically involves a multidisciplinary approach, including psychosexual therapy, pelvic floor physical therapy, and education 1.
Cognitive behavioral therapy (CBT) and sex therapy can help address underlying psychological factors, anxiety, and fear associated with penetration 1.
Pelvic floor physical therapy may include relaxation techniques, biofeedback, and graduated dilator use 1.
Topical anesthetic agents may be used cautiously to reduce discomfort during initial therapy sessions 1.Special Populations
Pregnancy: While not directly addressed for vaginismus, pregnant women with vasa previa have increased risks of adverse outcomes, necessitating optimized diagnostic and management protocols 1.Key Recommendations
Treatment should involve a multidisciplinary approach including psychosexual therapy, pelvic floor physical therapy, and education 1. (Evidence: Expert opinion)
Cognitive behavioral therapy and sex therapy are recommended to address psychological factors, anxiety, and fear related to penetration 1. (Evidence: Expert opinion)
Pelvic floor physical therapy may incorporate relaxation techniques, biofeedback, and graduated dilator use 1. (Evidence: Expert opinion)References
1 Jain V, Gagnon R. Guideline No. 439: Diagnosis and Management of Vasa Previa. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2023. link