Vaginismus

Specialty: Gynecology and breast.

• Involuntary vaginal spasm
• involuntary contraction of the introitus
• dyspareunia due to muscle spasm

Why it occurs

• Hypertonic dysfunction of the pelvic floor muscles (pubococcygeus and levator ani muscles)
• Basic psychological factors (fear of pain, sexual phobias, history of trauma or sexual abuse)
• Conditioning due to previous pain due to serious untreated infections, endometriosis or imperforate hymen
• Restrictive sexual education or severe taboos

Initial workup

Extremely careful gynecological examination, with explicit step-by-step consent, using minimal caliber pediatric specula or simple external visual examination to rule out anatomical anomalies (septum hymen, stenosis). Gentle palpation of the pelvic floor muscles to evaluate basal muscle tone and trigger involuntary reflex spasm. Multidisciplinary evaluation by clinical psychology and sexology.

Standard management

• There are no specific drugs authorized for primary vaginismus. In selected cases with high anxiety comorbidity, benzodiazepines can be used at low doses such as Diazepam 2-5 mg orally or formulated in local vaginal suppositories before physical therapy sessions.
• Injection of Botulinum Toxin type A (100-150 IU) into the muscle bundles of the levator ani under light sedation in severe refractory cases (note: the mainstay of treatment is systematic desensitization with vaginal dilators of progressive size combined with cognitive-behavioral therapy and physiotherapy).