| disease | Vaginismus |
Vaginismus refers to the muscular rigidity and spasm of the vagina during intercourse, leading to pain. Although patients often fear sexual activity and thus limit all sexual responses, they typically experience no difficulty with sexual arousal, maintain normal vaginal lubrication, and may feel satisfied and happy with non-intercourse activities, with normal orgasmic responses. Patients usually have normal sexual desire but often suffer distress due to the inability to engage in intercourse. It can occur in women of any age who are sexually active, though the prevalence of vaginismus in the general population is unknown.
bubble_chart Etiology
Vaginal spasms may result from pelvic and genital disorders, such as perineal trauma or postoperative scarring, vaginal inflammation, painful scar formation at the vaginal apex after hysterectomy, and other conditions. However, most patients have no organic basis, and the condition is often caused by psychosocial factors, typically stemming from a fear of penile penetration—especially when the partner lacks experience. Patients who were exposed to religious orthodoxy during childhood or adolescence may develop negative attitudes toward sexual activity, viewing it as vulgar, sinful, or obscene. Initial-stage sexual activities repeatedly disrupted or any distressing sexual experiences at any age can trigger vaginal spasms.
The diagnostic criteria for vaginal spasm in CCMD-2-R are:
(1) Strong contraction of vaginal muscles during intercourse, making penile insertion difficult or causing pain.
(2) Not a secondary symptom caused by local lesions or somatic diseases.
bubble_chart Treatment Measures
The treatment principle for this condition should primarily focus on eliminating psychological barriers, understanding the patterns of sexual life, encouraging both spouses to participate in treatment together, cooperating with each other, actively caring for one another, correcting poor sexual habits, and establishing new, well-coordinated sexual behaviors through emotional communication and learning. The main method involves the use of a vagina dilator.
(1) Psychotherapy: Provide both spouses with medical information about vagina spasms, such as anatomy and possible disease causes, and discuss with them the affected areas of vagina spasms. Emphasize to both spouses that the vagina spasm reflex is involuntary, dispel the husband’s misconception that the patient is intentionally hindering intercourse, and have them observe the involuntary tightening characteristics of the vagina.
(2) Perform "tighten-relax" exercises for the pelvic muscles: Instruct the patient to tightly contract the pelvic muscles, hold for 3–4 seconds, then relax, repeating this process until the pelvic muscles become relatively relaxed.(3) Dilate the vagina: Based on the "tighten-relax" training, use lubricated vagina dilators (starting with the smallest size) sequentially, four times daily for 10–15 minutes each session. Continue the "tighten-relax" exercises after inserting the dilator until the No. 4 dilator can be inserted smoothly. Once adapted to the No. 4 dilator, intercourse can be attempted appropriately, which can generally be completed successfully.
