The spasm surrounding the vagina muscles, causing occlusion of its opening. The introduction of the penis is either impossible or painful. Vaginismus may be a secondary reaction to locally caused pain, in which case this rubric should not be used.
Diagnostic criteria. Vaginismus, i.e., spasm of the perivaginal musculature, is manifested in one of the following options:
1) the normal reaction was always absent;
2) the disorder appeared after a period of relatively normal sexual functioning.
a) sexual reactions can proceed normally in the absence of vaginal penetration attempts;
b) every attempt at sexual intercourse leads to a generalized anxiety and attempts to prevent the introduction of a member, including through the reduction and contraction of the hips.
– psychogenic vaginismus.
– Vaginismus (organic).
In the literature, it is usually emphasized that women suffering from vaginismus often had negative early sexual experiences. For example, for those who were told that first sexual intercourse can cause severe pain and bleeding in the presence of an intact hymen, it can be a painful ordeal (G. Kelly, 2000). Among the causes of vaginism are sexual abuse in the past, rude behavior of a partner when trying to defloration, fear of a possible pregnancy, strict religious education, etc., notes that vaginism often occurs with indecisive, timid and incompetent behavior of a partner and certain features of a woman’s character (suspiciousness , emotional instability, touchiness, anxiety). Often such women have a history of various phobias, including the fear of pain or the appearance of blood.
Vaginismus usually occurs with the onset of sexual activity. Convulsive contraction of the muscles of the vagina and pelvic floor is often preceded by the fear of pain during defloration, but in some cases it appears suddenly and unexpectedly at the time of defloration. Soft, tactful, sensitive to the experiences of young spouses husbands do not insist on coitus, postponing defloration in the morning, the next day. But in the next attempt to commit sexual intercourse, everything repeats again and again. In some cases, vaginismus can progress, therefore, there are three degrees of its severity:
1) spastic reaction occurs with the introduction of the penis, finger or instrument during a pelvic exam;
2) the reaction occurs when touching the genitals or waiting for contact with them;
3) the reaction occurs with one idea of sexual intercourse or gynecological examination.
Vaginismus is the most common cause of virgogamy (virgin marriage). Interestingly, even the long-term absence of defloration and sexual intercourse in marriage in some cases does not impair interpersonal relations of the spouses. At the same time, sexual adaptation of the couple is achieved through the use of various variants of petting and oral-genital contacts. Women with vaginismus may experience an orgasm, and a feeling of inferiority or a desire to have a child makes them go to a doctor (I.L. Botneva, 1990). Occasionally, the phenomenon of vaginism occurs after a period of normal sexual life, if sexual violence has been committed against a woman or she has strong negative feelings towards her partner. Without appropriate treatment, the phenomenon of vaginism in women can lead to serious marital conflicts, the emergence of sexual problems with the spouse and the rupture of marriage.
Psychogenic vaginism should be differentiated from organic vaginism, when pain when trying to introitus, convulsive spasm and defensive reaction of a woman is caused by various gynecological diseases (colpitis, endometriosis, adhesions in the pelvis, etc.) that cause severe pain in coitus.
– standard sexological examination;
– gynecological examination (to exclude organic soil algii), which should include vaginal examination, ultrasound of the pelvic organs, changing the main dimensions of obstetric pelvis, preferably – the study of the hormonal background of the patient (estrogen, progesterone, LH, FSH, prolactin, testosterone) ; – study of the patient’s mental status (clinical and psychopathological research, psychological testing – tests by Luscher, MMPI, Liri, Kettel, etc.); – urological, sexological and psychological research of the patient’s permanent partner. The treatment is aimed at eliminating the spasm of the muscles surrounding the vagina and the acquisition of a woman’s ability to have sex. Vaginism therapy is paired and complex. If the patient has a psychopathological disorder, antidepressants, tranquilizers or antipsychotics are used.
Infantry therapy: gynnosuggestia to eliminate fear of sexual intercourse, neutralize negative memories of previous painful attempts to coitus and enhance erotic experiences; progressive desensitization, based on the use of special vaginal dilators of increasing size (when it becomes possible to painlessly introduce a dilator that mimics the male erect sexual organ, the doctor authorizes the transition to coital activity). Sexual rehabilitation of the couple takes an important place with the involvement of a partner in the final stages as a co-therapist.
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