How Does Vaginismus Develop?
Vaginismus has been classified as a subgroup of sexual pain disorders. It was first defined by Sims in 1861. Its prevelance is not known and some rates such as -17 have been reported in the literature. Vaginismus is defined as ”repetitive and involuntary muscle spasms in the outer 1/3 muscles of the vagina that would prevent coitus” in the American Psychiatrists Association in DSM-IV. This definition is still debatable. Although it has been classified as sexual pain disorder, there is no mention of pain in the definition. What kind of a pain is the pain expressed by vaginismus patients? Is there a pain secondary to constant spasms of pelvic floor muscles, or is it a “psychological pain”? As you can see, these points are controversial.
The cause of vaginismus is not known. Many factors were blamed, though it had been suggested that it may be seen in societies in which sexuality is a sin or in oppressive societies, it is known that these hypotheses are invalid. I do not agree to some theories of psychologists that patients read online. Although I do ask detailed questions about these theories to my patients, %27 of my patients do not have any sexual trauma or traumatic history.
In order to understand vaginismus, patient’s characteristics must be known. Vaginismus patients are sensitive people who had their general defense mechanism reflexes increased. They are differentiated from other painful sexual intercourse patients by having the fear of something entering into the vagina and severity of pain. Phobic behavior is seen in patietns. In this view, vaginismus is a phobic fear reaction that is provoked by object or condition ( in this case something entering into vagina) which takes the person into panic state. Patient feels like her vagina will be torn or broken with penile penetration, provokes defense reflexes causing contraction of pelvic floor muscles, then this fear triggers panic and patient’s relation with reality is broken, thus control over pelvic muscles disappear completely and sexual contact becomes impossible.
In vaginismus cases, there is a state of serious contraction even during rest. In a study conducted by Shafik et al. (an Egyptian researcher) in 2002, 7 vaginismus patients and 7 controls were involved in the study, EMG probes were inserted on the muscles levator ani, puborectalis and bulbocaverosus (muscles areound the hip and vagina), and the way of contraction were measured during rest and awake status in the vaginal group muscles. As a result, it has been shown that muscle groups of vaginismus patients were excessively contracted compared to controls even in resting status. On the other hand, in spite of the fact that control group had no differences in EG values when invoked, vaginismus patients had an excessive reaction, excessive spasms in muscles and it was documented. Although the fact that muscle groups of these patients were contracted even in resting state was dependent on other causes, it was explained as excessively increased defense reflex as a result of the same type characteristics. Van der velde et al. suggested that vaginismus patients had generally increased defense reflex and not only the pelvic floor muscles but the whole body muscles are contracted at the same time. Findings of Van der velde was interpreted as vaginismus being a component of general defense reflex. In fact, woman somehow considers sexual intercourse, penile penetration as a threat. The problem when evaluating these patients is that every case responds a defense reflex in different severities. The study conducted by Lamont in 1978 and classifies vaginismus according to pelvic floor muscle contraction severity makes it easier for us to understand the condition.
In order to summarize what I wrote above:
1. I do not agree the thesis suggesting that vaginismus is more common in the eastern societies, and that it is more common in university graduates. The most important vaginismus studies were conducted in Canada and USa! I do not agree that it must be seen in a traumatized patient somehow. I do not believe that religion is related to the subject at all.
2. Actually, the most important character of these patients is that they are perfectionists who are very beneficial to their countries, who cannot stand the unfairness and who fight for their rights. Thus, women with vaginismus are woen with excessively increased defense reflexes. And they consider penile penetration (or anything such as tampon, finger etc.) as an attack or weakness.
3. I think treatment must be planned according to what I wrote above. You can see my suggestion of physiopatogenesis of vaginismus which I presented as a poster in San Diego ISSWSH congress in 2008 which is also present in chapters of various books.