Vaginismus is reflexive tightening around the vagina when vaginal entry is attempted or completed (eg, using a penis, finger, or dildo) despite women's expressed desire for penetration and despite the absence of any structural or other physical abnormalities.
Vaginismus usually results from fear that intercourse will be painful; it usually begins with the first attempt at sexual intercourse but may develop later after periods of stress. Women may develop a phobia-like avoidance of penetration. Most women with vaginismus thus cannot tolerate full or often even partial penetration. Some cannot tolerate insertion of a tampon or have never wanted to try. However, most women with vaginismus enjoy nonpenetrative sexual activity.
Reflex muscle tightening can also accompany dyspareunia of any cause, thereby adding to the pain and difficulty with entry. Women anticipate a recurrence of pain when intercourse is initiated, and muscles tighten, making attempts at sexual intercourse even more painful.
Diagnosis is suspected based on symptoms. Physical abnormalities that cause pain, such as those that cause dyspareunia should be excluded by physical examination. However, the condition itself makes examination difficult. One strategy is to initiate treatment as described below and defer the confirmatory examination. When the examination is done, the physician can give the patient a sense of control by having her sit up and view her genitals using a mirror. The woman then spreads her labia and inserts her or the examiner's gloved finger past the hymen as she bears down. This simple digital examination can simultaneously confirm a normal vagina and the presumed diagnosis of vaginismus.
In progressive desensitization, women progressively accustom themselves to self-touch near, on, and then through the introitus.
Some men experience situational erectile dysfunction in this process and may benefit from a phosphodiesterase inhibitor.
Last full review/revision April 2013 by Rosemary Basson, MD, FRCP (UK)
Content last modified September 2013