Materiały źródłowe

• #1 The Neurobiology and Psychiatric Perspective of Vaginismus: Linking the Pharmacological and Psycho-Social Interventions – PubMed

  https://pubmed.ncbi.nlm.nih.gov/28228081/

  Vaginismus is an involuntary muscle contraction of the outer third of vaginal barrel causing sexual penetration almost impossible. […] The etiology of vaginismus is complex: through multiple biopsycho-social processes, involving bidirectional connections between pelvic-genital (local) and higher mental function (central regulation). […] It has robust neural and psychological-cognitive loop feedback involvement. […] The internal neural circuit involves an inter-play of at least two-pathway systems, i.e. both „quick threat assessment” of occipital-limbic-occipital-prefrontal-pelvic-genital; and the chronic pain pathways through the genito-spinothalamic-parietal-pre-frontal system, respectively. […] In this review, a neurobiology root of vaginismus is deliberated with the central role of an emotional-regulating amygdala, and other neural loop, i.e. hippocampus and neo-cortex in the core psychopathology of fear, disgust, and sexual avoidance.

• #2 Clinical assessment and management of vaginismus

  https://www1.racgp.org.au/ajgp/2024/january-february/clinical-assessment-and-management-of-vaginismus

  Vaginismus is defined as persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger, and/or any object, despite the woman’s expressed wish to do so. […] Clinically, people with vaginismus often present with varying degrees of increased pelvic floor muscle tone and involuntary contractions of the pelvic floor muscles, which make vaginal penetration difficult, painful or impossible. […] The fear-avoidance model of pain is often used to conceptualise the development and maintenance of vaginismus. The model outlines how a negative experience with penetration can lead to catastrophic thinking and resultant fear of penetration. This gives rise to two options: one, to avoid all activities relating to vaginal penetration or, two, to become hypervigilant to stimuli associated with penetration. Hypervigilance can lead to exaggerated defensive pelvic muscle contractions, making it difficult to achieve penetration during a subsequent attempt. An inability to achieve penetration might result in more pain and confirm negative experiences associated with penetration. In this way, the experience of vaginismus is then exacerbated and perpetuated in a vicious cycle.

• #3 Vaginismus/pelvic floor dysfunction (inability to experience vaginal penetration) – Vulvovaginal Disorders

  https://vulvovaginaldisorders.org/pelvic-floor-dysfunction/

  And finally, long expected findings of fear and avoidance behaviors appeared to be the primary distinguishing features. […] The change in research focus to the properties of the pain experienced during sexual penetration or any other vaginal entry also illuminated the lack of clarity in the difference between dyspareunia and vaginismus. Pain was associated with the former, and a blocking muscle spasm was purportedly associated with the latter. […] The DSM-5 definition presents vaginismus as “persistent difficulties to allow vaginal entry of a penis, a finger, and/or any object, despite the woman’s expressed wish to do so. There is variable involuntary pelvic muscle contraction, (phobic) avoidance, and anticipation/fear/experience of pain.” […] The construction of an etiology for any clinical syndrome with vast connections to psychological and relational well-being is arduous.

• #4 Vaginismus Causes

  https://hopeandher.com/pages/vaginismus-causes

  For most women, vaginismus comes as a surprisedifficulties with penetration or ongoing vaginal tightness and pain seem to start mysteriously and continue repeatedly. […] The involuntary tightness itself is caused by an internal repeating limbic reaction starting in the brain and extending to the pelvic region. […] Some clinicians describe vaginismus as a fight or flight reaction in the pelvic floor and surrounding musculature. […] The muscle tightness is involuntarywithout conscious control. […] When the sensory system detects various forms of touch, pelvic vulnerability, or the anticipation of penetration, the limbic system signals the body to tense up internally as a protection mechanism. […] It mistakenly alerts the body to danger, causing the vaginal muscles to tighten and, thus, interfere with sex.

• #5 Vaginismus Causes

  https://hopeandher.com/pages/vaginismus-causes

  Though normally very effective, life experiences may be internalized in a way that causes the limbic system to respond with vaginismus. […] Vaginismus does not always have an obvious cause. Sometimes women with near-perfect childhoods, great relationships, no physical problems, and few anxieties, have trouble identifying a trigger to their vaginismus. […] Fortunately, vaginismus is fully treatable. Women can gain control over their vaginal muscles and override the limbic system reaction that causes the tightness.

• #6 Study of the pelvic floor muscles in vaginismus: a concept of pathogenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/12270568/

  Neither the cause of vaginismus nor the muscles involved are precisely identified. […] To define the involved muscles and their role in the pathogenesis of vaginismus. […] The pelvic floor muscles of vaginismus patients exhibited increased EMG activity at rest and on vaginismus induction; the cause is unknown. The concept of a disordered sacral reflex arc is put forward but needs further studies to be verified.

• #7 What is vaginismus?

  https://www.new-dimensions-physical-therapy.com/post/2019/06/05/what-is-vaginismus

  Vaginismus is an involuntary spasm of vaginal pelvic floor muscles particularly around the vaginal opening. […] A study, performed by Shafik and El-Sibai, looked at pelvic floor muscle activity and found increased EMG activity in the levator ani, puborectalis and bulbocavernosus in subjects with vaginismus. […] Vaginismus is considered secondary if a woman used to be able to engage in pain-free intercourse. Causes of secondary vaginismus include frequent yeast infections, thinning of the vaginal wall after menopause or trauma from childbirth. […] A study performed by Reissing et al. suggests that physical therapy may be a promising treatment option for some women with lifelong vaginismus. […] This study found internal manual therapy techniques to be most effective in treatment. […] Shafik, A., El-Sibai, O. (2002). Study of the pelvic floor muscles in vaginismus: A concept of pathogenesis. European Journal of Obstetrics Gynecology and Reproductive Biology, 105(1), 67-70. doi:10.1016/s0301-2115(02)00115-x

• #8 Vaginismus: Diagnostic Challenges and Proposed Diagnostic Criteria – Balkan Medical Journal

  https://balkanmedicaljournal.org/text.php?lang=en&id=2569

  Vaginismus is a relatively rare FSD with a low prevalence in society but a higher reported clinical prevalence rate of 5-7%.1 The term vaginismus was coined by James Marion Sims in 1862.2 […] Vaginismus was defined by DSM IV-TR as a recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina, which interferes with coitus and causes distress and interpersonal difficulty.3 […] According to the definition, involuntary spasm of the vaginal musculature is an important requirement for the diagnosis of vaginismus. […] On induction of the vaginismus reflex, surface EMG (SEMG) or needle electromyography revealed higher vaginal/pelvic muscle (levator ani, puborectalis, and bulbocavernosus muscles) tone than the control group.6,7. However, other studies have failed to show increased muscle spasms8 in people with vaginismus, adding to the diagnostic confusion.

• #9 Vaginismus – Wikipedia

  https://en.wikipedia.org/wiki/Vaginismus

  Vaginismus occurs when penetrative sex or other vaginal penetration cannot be experienced without pain. It is commonly discovered among teenage girls and women in their early twenties, as this is when many girls and young women first attempt to use tampons, have penetrative sex, or undergo a Pap smear. Awareness of vaginismus may not happen until vaginal penetration is attempted. Reasons for the condition may be unknown. […] The cause of primary vaginismus is often unknown. […] Although the pubococcygeus muscle is commonly thought to be the primary muscle involved in vaginismus, Pacik identified two more spastic muscles in people who were treated under sedation. These include the entry muscle (bulbocavernosum) and the mid-vaginal muscle (puborectalis). Spasm of the entry muscle accounts for the common complaint that people often report when trying to have intercourse: „It’s like hitting a brick wall”. […] Specific muscle involvement is unclear, but the condition may involve the levator ani, bulbocavernosus, circumvaginal, or perivaginal muscles.

• #10 Comprehensive Guide to Vaginismus for Beginners | PHRC

  https://pelvicpainrehab.com/blog/vagi-what-a-rough-guide-to-vaginismus/

  Vaginismus, pronounced vaj-uh-niz-muhs, is characterized by involuntary contractions of the pelvic floor muscles, particularly the muscles surrounding the vaginal opening, interfering with vaginal penetration. […] The cause of vaginismus varies. It may be due to an emotional response, such as rigid upbringing, sexual assault/rape, or negative feelings. It can be brought on as a physical response too (for example, yeast/urinary infections, childbirth, or hormonal changes, such as those occurring during menopause). There may also be no identifiable cause at all. […] Fear and anxiety are commonly associated with vaginismus, as they feed into the pain cycle. The pain cycle, in this case, starts with a woman anticipating pain with penetration. When this happens, the body involuntarily contracts the pelvic floor muscles to guard from potential pain, which tightens the muscles making penetration painful. The pain felt during penetration further induces the pelvic floor to guard and spasm, which actually creates more pain. […] Relaxation of the pelvic floor musculature is key to treating vaginismus. This means that kegel exercises are not appropriate! Kegels contract the pelvic floor and when you have something already tight, you do not want to tighten it even further and cause more spasming.

• #11 Vaginismus/pelvic floor dysfunction (inability to experience vaginal penetration) – Vulvovaginal Disorders

  https://vulvovaginaldisorders.org/pelvic-floor-dysfunction/

  The question arose once again: “Is the pain sexual or is the sex painful?” […] There is growing evidence that some, but not all, people with chronic musculoskeletal pain avoid a wide variety of stimuli, including those directly (e.g. physical activities) and indirectly (e.g. social activities) associated with pain. […] A primary cognitive-behavioral framework is the Fear-Avoidance Model, which posits that pain catastrophizing and fear of pain (including avoidance, cognitions and physiological reactivity) are key antecedents to, and drivers of, pain intensity and disability, in addition to pain-related psychological distress. […] Research that followed showed that women suffering from vaginismus not only fear vaginal penetration situations, but also may have a general heightened fear/anxiety susceptibility.

• #12

  https://link.springer.com/article/10.1007/s001920170035

  This study investigates the mechanism underlying vaginismus, which may be part of a general defense mechanism. […] This increase of involuntary pelvic floor muscle activity is part of a general defense mechanism that occurs during exposure to threatening situations. […] The results of this study shed new light on the concept of vaginismus as a primarily sexual dysfunction.

• #13 Causes of Vaginismus – Vaginismus Center

  https://www.vaginismus-center.com/en/causes-of-vaginismus

  Vaginismus develops due to psychological and organic causes. Statistically, 90% of the reason for vaginismus is attributable to psychological anxieties and 10% to organic causes (non-psychological). […] Vaginismus is accepted as an anxiety disorder. In reality, it is a defense mechanism of the body. The problem resides in the persons subconscious. […] The cause of vaginismus might be prior unpleasant sexual experiences or fears that have been engraved in the subconscious. […] Among the psychological causes are those that have been embedded in the subconscious, such as fears left over from childhood, living in a very strict social structure, severe moral rules and/or taboos, guilt, shame, sin and prejudices and misinformation about the first sexual experience and sexuality and fear in the subconscious about the penis entering the body.

• #14 The Pathophysiology and Etiology of Vaginismus: Ingenta Connect

  http://www.ingentaconnect.com/content/10.1016/S1028-4559(09)60047-4

  Vaginismus is defined as an involuntary spasm of the pelvic muscles surrounding the outer third of the vagina, especially the perineal muscles and the levator ani muscles. Its severe form usually makes penetration virtually impossible and causes a severe, burning pain, and leads to unconsummated marriage. There appears to be basic agreement that vaginismus is a psychosociologic disorder with phobic elements resulting from actual or imagined negative experiences with penetration attempts. Fear and anxiety concerning penetration is expressed physiologically via the involuntary vaginal muscle spasm that characterizes vaginismus. […] However, the etiology of vaginismus remains controversial. Women with vaginismus generally experience shame, disgust and dislike toward their genitals. They frequently have or have had other phobias. They are usually overprotected by their fathers and have been good girls since childhood. Their sexual partners are usually kind, gentle, considerate and passive nice guys. The male partner’s lack of aggressiveness actually leads to unconsummation of the marriage. The sexually secure husband can usually overcome mild degrees of vaginismus by persistent but firm penile insertion. For moderate to severe degrees of vaginismus, medical intervention is usually necessary to lead to consummation of the marriage.

• #15 Vaginismus | Baylor Medicine

  https://www.bcm.edu/healthcare/specialties/obstetrics-and-gynecology/ob-gyn-conditions/vaginismus

  Vaginismus is a condition in which the muscles around the opening of the vagina and surrounding the vagina involuntarily contract or tighten, making intercourse painful if not impossible. […] The muscle tightening is a reflex or involuntary spasm. In some cases women aren’t even aware it is happening. […] Vaginismus can occur the first time a woman attempts intercourse, or it can occur later in life after years of normal sexual functioning. […] Treatment strategies combine education, counseling and physical exercises, including: Physical therapy and Kegel exercises to stop vaginal muscles from contracting.

• #16 What is vaginismus? Learn about this condition – with Sydney Pelvic Clinic

  https://www.sydneypelvicclinic.com.au/vaginismus-genito-pelvic-pain-disorder-gppd/

  Vaginismus is vaginal tightness resulting from the involuntary tightening of the pelvic floor muscles, causing discomfort, burning, pain, penetration problems, or even the complete inability to have intercourse. […] Vaginismus is a unique condition in that it may result from a combination of either physical or non-physical causes or it may seem to have no cause at all. […] With vaginismus, the mind and body have developed a muscle memory or conditioned response against penetration. The body has learned to expect or anticipate pain upon penetration, so that the PFM flinches or contracts to protect against the potential of intercourse pain. […] Although acting as a defense mechanism against pain, the repeated tightening of the PFM ultimately causes pain. The overactive PFM may cause burning or pain upon penetration or movement and may even completely block entry.

• #17 Vaginismus: Results from Treatment with the PRM Protocol™ | Auctores

  https://www.auctoresonline.org/article/vaginismus-results-from-treatment-with-the-prm-protocol

  Vaginismus, a condition characterized by involuntary pelvic floor muscle spasms, presents considerable challenges in diagnosis and treatment, impacting sexual health and quality of life. […] The severity of vaginismus can vary, ranging from mild discomfort to extreme pain. The condition can have a significant impact on sexual relationships, causing emotional distress and anxiety for individuals experiencing it and their partners. […] The traditional indicator of vaginismus has been involuntary muscle spasms leading to sexual dysfunction. […] However, both the American College of Obstetrics and Gynecology (ACOG) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) V-Text Revision (TR) have defined vaginismus as a part of genitopelvic pain/penetration disorder. […] The PRM Protocol employs ultrasound-guided trigger point injections in each muscle of the levator ani-sling to address the underlying myofascial pain and pelvic floor dysfunction. This intervention alleviates ongoing nociception, creating space for enhanced flow of pelvic peripheral nerves with reduced constriction and improved blood circulation.

• #18 Vaginismus: Results from Treatment with the PRM Protocol™ | Auctores

  https://www.auctoresonline.org/article/vaginismus-results-from-treatment-with-the-prm-protocol

  Additionally, the PRM Protocol targets both peripheral and central sensitization, aiming to mitigate neurogenic inflammation, inhibit feedback loops from the peripheral to central nervous systems, and prevent cross-sensitization between the pudendal and posterior femoral cutaneous nerves. […] The PRM Protocol’s multi-faceted approach, addressing myofascial dysfunction, pelvic floor dysfunction, and peripheral and central sensitization, demonstrates a comprehensive strategy for managing the intricate facets of vaginismus. […] The outcomes revealed that this comprehensive approach achieved pain-free intercourse successfully, even for patients with a history of long-term failures with alternative vaginismus treatments. […] The PRM Protocol specifically targets pelvic nerve inflammation and the pelvic muscles associated with both intercourse and vaginismus, leading to a reversal of pelvic neurogenic inflammation and a reduction in hypertonic pelvic floor conditions.

• #19 Vaginismus – what is it and how to treat it efficiently? – CAPENERGY MEDICAL

  https://capenergy.com/en/vaginismus-what-is-it-and-how-to-treat-it

  Vaginismus is a common but often misunderstood condition that affects women across the world. But what actually is vaginismus? Its an involuntary contraction of the pelvic floor muscles that impedes penetration, be it during coitus or while inserting a tampon, sex toys, a finger, a speculum or during vaginal exploration. Vaginismus is a sexual dysfunction that’s more common than one may think as its not often openly discussed. This muscular hyperactivity is caused by trigger points located on the muscles and the contraction is generated in spite of the existence of desire or excitement. Emotional triggers can be for instance: fear of pain or pregnancy, anxiety, feelings of guilt, pressure (affective, familiar or social), relationship problems (abusive partner or feelings of vulnerability), sexually traumatic experiences (rape or abuse), childhood experiences (exposure to sexual intercourse or sexual images), among others. On the other hand, physical triggers can be recurring infections, medical conditions (cancer or lichen sclerosus), childbirth, menopause, pelvic surgery, insufficient vaginal lubrication equivalent to vaginal dryness, increasing pain during penetration, secondary effects from medication, etc. Until now, vaginismus is considered to be a psychological pathology and its treatment is therefore mostly based on psychotherapy. And although the emotional background is of vital importance, we should not forget that its essentially about myofascial trigger points in the muscles and that the issue, as with any other contraction of other muscles in the body, should be treated taking this into account. It is therefore important, when taking a physical approach, to have access to a tool that allows the inhibition of the sympathetic system. This part of the autonomic nervous system is activated in stressful situations, when the body enters in fight or flight mode, generating cortisol, the stress hormone. This is translated into an increase of the heart frequency, inhibition of digestion and an increase of the body’s muscle tone, including the pelvic floor muscles, generating a spasm that narrows and tightens the vaginal cavity. The application of CAPENENERGY’s radiofrequency systematically inhibits the activity of the sympathetic nervous system, thusly activating the parasympathetic system, in charge of relaxation and digestion. The treatment with Capenergy’s radiofrequency is very simple: it makes use of automatic active plates, equipped with a temperature sensor, that are located strategically to generate this relaxation. The treatment furthermore reduces pain and inflammation, improves the blood flow, transporting oxygen and nutrients to the vaginal mucosa and improving its natural lubrication. It is important to always accompany the treatment with a correct evaluation of the progress, so both the physiotherapist and the patient have an objective idea of how the muscle tone is evolving. The electromyography is the ideal instrument for the registration of these changes of the basal muscle tone. This tone will start with a high value and during the course of the treatment we will see how it gradually goes down until reaching values close to 0.

• #20 Vaginismus: Diagnostic Challenges and Proposed Diagnostic Criteria – Balkan Medical Journal

  https://balkanmedicaljournal.org/text.php?lang=en&id=2569

  Excessive dread of pain during penetration is a common symptom reported by people with vaginismus. […] Vaginismus is a phobic disorder characterized by significant emotional distress, fear, or anxiety with vaginal penetration, which helps to differentiate between the two. […] The presence of increased muscle spasm on per vaginal examination (partial vaginismus) or spasm leading to inability to perform per vaginal examination (total vaginismus) which is disproportionate to the anticipated pain from underlying pathology confirms the diagnosis of vaginismus and is an objective clinical criterion for making the diagnosis of vaginismus. […] In severe cases of vaginismus the patient elevates her buttocks and closes her thighs to prevent vaginal examination. […] Vaginismus is a phobic disorder, whereas dyspareunia is a pain disorder.

• #21

  https://thepelvicpeople.com/blogs/journal/vaginismus-101?srsltid=AfmBOoqHPxPnfGFEFBgTXGlTqyG2JyImNv8bkYO_yxvQk9e9lThsEsOh

  Vaginismus is when the pelvic floor muscles around the vagina involuntarily contract, usually in response to attempts at penetration. […] Experts say vaginismus is related to fear and anxiety surrounding penetration. How we feel has very real impacts on whats going on in our bodies. […] Dr. Krapf says, There are two main ways to think about muscle tightening/spasm related to vaginal penetration. […] Theres a fear of touch and penetration, and so the pelvic floor muscles clench involuntarily, preventing vaginal insertion. […] The pelvic floor muscles surrounding the vaginal opening are always contracted, so touch or penetration hurts. This can lead to pain-related anxiety, which reinforces a pain cycle. […] Dr. Jeffrey-Thomas says, Anecdotally, a lot of pelvic floor physical therapists report seeing vaginismus in people who were taught shame-based sex education, including some highly religious communities. There are also many people who have experienced [sexual] assault, or other trauma who will have vaginismus. […] Secondary vaginismus may also develop after childbirth or after surgery.

• #22 Vaginismus: Types, Symptoms, Causes, Diagnosis, Treatment and More

  https://www.health.com/vaginismus-overview-7377046

  Vaginismus occurs when your pelvic floor muscles involuntarily start to contract when you are anticipating or having vaginal penetration. As a result, this can make vaginal penetration that is painful or even impossible. […] Vaginismus occurs when the pelvic floor muscles around your vagina contract or become tight. Your pelvic floor muscles are a group of muscles that form a hammock-like shape across the floor of the pelvis (also known as the hip bone). Pelvic floor muscles hold pelvic organs in place, which allows organs such as the vagina, bladder, and rectum to work properly. […] Healthcare providers and researchers are still working to understand what exactly causes vaginismus. Although more research is still needed, some studies suggest different factors may play a role in why a person develops the condition. These factors include: shame and other negative attitudes toward sex or sexuality, a history of sexual trauma or abuse, lack of sexual knowledge or education, fear of physical pain, penetration, or pregnancy, pelvic floor dysfunction, vaginal damage via childbirth.

• #23 Vaginismus/pelvic floor dysfunction (inability to experience vaginal penetration) – Vulvovaginal Disorders

  https://vulvovaginaldisorders.org/pelvic-floor-dysfunction/

  The strongest relational predictor of pain experience and the couple’s sexual and relationship adjustment, however, is partner responses to the pain problem. […] The latest study delved into the interdependence of both partners’ responses in the context of GPPPD. […] Vaginismus may develop in response to a man’s sexual problems, or vaginismus may cause sexual problems in men. […] The inability to experience penetrative vaginal intercourse (PVI), previously diagnosed as vaginismus, was subsumed under genito-pelvic pain penetration disorder (GPPPD) along with dyspareunia. […] The new, sole pain category encompasses both dyspareunia and vaginismus, based on the argument of insufficient empirical evidence warranting a clear distinction between the two.

• #24 Clinical assessment and management of vaginismus

  https://www1.racgp.org.au/ajgp/2024/january-february/clinical-assessment-and-management-of-vaginismus

  Currently, there is no defined aetiology for vaginismus. Most researchers and clinicians agree that vaginismus is a psychophysiological problem involving cognitive, behavioural and physiological factors. […] Given that vaginismus is associated with a fear response, explicit and implicit sociocultural attitudes play a major role in predisposing someone to developing vaginismus. […] Implicit sex-related cognitions have a direct influence on the pelvic floor: people with vaginismus have higher levels of disgust and greater pelvic floor muscle contraction in response to sex-related images and videos than healthy controls. […] The latest clinical practice guideline on female sexual dysfunction recommends an individualised, multidisciplinary approach for vaginismus, tailored according to an individual’s underlying contributing factors and any existing comorbidities. […] When vaginismus is considered through the fear-avoidance model of pain, the importance of a multidisciplinary approach is evident.

• #25 Vaginismus (306.51) | Abnormal Psychology

  https://courses.lumenlearning.com/atd-herkimer-abnormalpsych/chapter/vaginismus-306-51/

  Vaginismus, or spasm of the muscle surrounding the vagina often occurs in response to attempted intercourse, but can also occur in response to penetration by a finger, tampon, or speculum. Although this disorder is listed as a pain disorder, pain is not a necessary condition for the diagnosis. Vaginismus may be best defined as a phobic/aversive response to vaginal penetration. […] Non-physical causes are fears, anxiety, stress, traumatic event, childhood experiences, and partner issues. Sometimes, there is no known cause at all. Physical causes are medical conditions, childbirth, abuse, menopause, pelvic trauma, and temporary discomfort. […] Most common causes are fears and anxiety about intercourse and pain. Anxiety due to performance pressures and negativity towards sex can also cause a woman to experience this. Partner issues such as abuse, distrust, and fear of commitment are causes as well. Childhood experiences like overly rigid parenting, inadequate sex education, and exposure to shocking sexual imagery can lead to vaginismus.

• #26 Vaginismus Everything you need to know | Dr. Gómez Roig Institute

  https://www.gomezroig.com/en/vaginismo/

  El Vaginismus It is characterized by the involuntary contraction of the pelvic floor muscles that surround the vaginal opening. […] Vaginismus is a female sexual dysfunction which is defined as an involuntary contraction of the pelvic floor muscles of the vagina, triggered by a fear of pain that may have been caused by different factors or situations. […] The causes that produce vaginismus They depend on whether the disorder is primary or secondary. […] In the case of primary vaginismus It can generally be influenced by the lack of sexual education, by psychological, cultural or religious reasons associated with taboos or beliefs. […] In the case of secondary vaginismus Generally there is a predisposing factor that produces pain or difficulty in penetration, which will secondarily produce this involuntary contraction as a defense mechanism against this pain.

• #27 Causes of Vaginismus – Vaginismus Center

  https://www.vaginismus-center.com/en/causes-of-vaginismus

  Strict teachings about sexuality and the idea that the hymen is a structure that is very crucial and by all means must be protected taught to young girls throughout their childhoods, are among the most important causes for vaginismus specially in Moslem countries. […] Moreover, the unpleasant experiences and memories from childhood (abuse or rapes, domestic violence, harsh parental behavior) may also cause vaginismus. […] As stated previously, most of the time, in vaginismus patients, fears/anxieties about sexuality and sexual intercourse lie deep in the subconscious and the contraction of the PC muscles acts like a defense mechanism that protects the woman from an experience of which she is genuinely frightened. […] In 10% of cases, vaginismus might not arise because of a psychological problem but can be the result of an underlying organic pathology.

• #28

  https://journals.lww.com/ijwd/fulltext/2024/12000/botulinum_toxin_treatment_of_refractory.2.aspx

  Vaginismus is a common sexual dysfunction. A few studies have indicated that botulinum neurotoxin type A (BoNTA) can help treat refractory vaginismus by alleviating muscle tension. However, such studies did not use standardized methodology and BoNTA dosage. […] The etiology of vaginismus remains elusive; however, a psychological overlay can be involved. Factors that can play a role in vaginismus include a strict sexual upbringing, religious emphasis on chastity, cultural taboos, viewing sex as sinful, and lack of comprehensive sexual education, all of which may lead to a negative attitude toward sex. […] Injection of botulinum neurotoxin type A (BoNTA) in the perivaginal muscles is a newer therapeutic approach for this condition, indicated in cases that have not responded to the modalities mentioned earlier. BoNTA, produced by the bacterium Clostridium botulinum, prevents the presynaptic release of acetylcholine and blocks neuromuscular transmission, thus causing muscle paresis.

• #29 Causes of Vaginismus – Vaginismus Center

  https://www.vaginismus-center.com/en/causes-of-vaginismus

  Among the organic causes of vaginismus are Vulvar Vestibulitis Syndrome, PIH (Pelvic inflammatory disease), Bartholin Abscess and Cyst, Vaginal Fungal Infection (Candida Vaginitis), and Congenital Anatomic Disabilities: Short and blind vagina, septum on the vagina wall (cloak), hymen structured wide and thick. […] The organic causes of vaginismus can be treated by a gynecologist with medicine or simple operations. In this way, without the need for psychological treatment, the problem can be overcome.

• #30 Vaginismus – Whria

  https://www.whria.com.au/for-patients/pelvic-pain/vaginismus/

  Tissue or nerve hypersensitivity at the entry of the vagina, such as with pudendal nerve pain (the pelvic and perineal nerve), also called pudendal neuralgia. […] Vulval pain. Skin changes can occur after menopause, early menopause or menopause after breast cancer treatment. Irregular periods, long term absent periods or long term use of the oral contraceptive pill may also affect the vulval skin integrity due to under oestrogenisation of the tissues. Thinning of the skin, dryness, redness, splitting and irritation may occur, which may cause skin pain with attempts at penetration that can lead to the anticipatory PFM contraction that is vaginismus.

• #31 Vaginismus – Whria

  https://www.whria.com.au/for-patients/pelvic-pain/vaginismus/

  Vaginismus is involuntary spasm or contraction of the muscles surrounding the lower third of the vagina with attempts at any form of vaginal penetration. It involves the muscles just below the skin called the perineal muscles and the deeper pelvic floor muscles (PFM). Once you have experienced pain with attempts at penetration, it makes the next time even more difficult, as a fear of pain can increase your pain as well as heighten the muscle contraction, further compounding the pain. […] Vaginismus is poorly understood. It is thought to affect 1-7 % females, is cross-cultural and has no definite cause. Many women have never managed a tampon, a vaginal ultrasound, a vaginal examination, a Pap smear (except under general anaesthetic in hospital). […] Some physical conditions to consider and discuss with your doctor or allied health practitioner include: Undiagnosed endometriosis may be a contributor. This is often associated with period pain, pain with bowel opening, non-menstrual pelvic pain and pain with, or inability to manage sexual intercourse due to pain.

• #32 Vaginismus: Causes, Symptoms & Treatment

  https://pelvicare.uk/blog/vaginismus-causes-symptoms-treatment

  The precise cause of vaginismus remains unknown. However, some researchers suggest that the squeezing of the vaginal muscles in this way is linked to an involuntary psychological anxiety about possible pain during vaginal penetration. As a result of this fear, the mind sends a signal to the vaginal muscles tighten and limit or prevent penetration to protect against anticipated discomfort or pain. […] Some may develop anxiety about penetration after pelvic injury, surgery, or giving birth. Others may find it follows as the result of the discomfort of menopausal vaginal dryness, interstitial cystitis, or an underlying vaginal infection, resulting in what is termed as Secondary Vaginismus. This type typically arises in older women who had previously experienced penetration without pain. […] Primary vaginismus is diagnosed when women have always felt pain during penetration, even when young and attempting to use a tampon for the first time. In such cases, anxiety about penetration may come as a result of a lack of sexual education, fear of intercourse, worry about getting pregnant, or a history of sexual abuse.

• #33 Vaginismus/pelvic floor dysfunction (inability to experience vaginal penetration) – Vulvovaginal Disorders

  https://vulvovaginaldisorders.org/pelvic-floor-dysfunction/

  After forty years of sometimes conflicting research, there is strong evidence that the vulva and vagina have unique inflammatory and immunological properties, representing pain from pro-inflammatory substances as the etiology of genital pain. […] Hypertonicity and weakened muscle control are prominent features. […] It is amazing that it has taken so long to find evidence to support the 500-year old definition of vaginismus as related to spasms of the muscles of the pelvic floor. […] The fact that vulvodynia tends to overlap with other chronic pain conditions—chronic fatigue syndrome, chronic migraine, chronic low-back pain, chronic tension headaches, fibromyalgia, endometriosis, interstitial cystitis, and temporomandibular disorders—leads to the inference that central mechanisms are involved.

• #34 Dyspareunia in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0515/p597.html

  Vaginismus (involuntary contraction of the pelvic floor muscles with attempted vaginal penetration) is now combined with dyspareunia into the term genitopelvic pain/penetration disorder. Vaginismus leads to fear or anxiety about penetration, causing pelvic floor muscle constriction, which is distinct from causes of entry dyspareunia, such as infections, vulvodynia, or pelvic floor dysfunction. Primary vaginismus occurs in patients who have never had painless penetration, whereas secondary vaginismus occurs when the patient previously had painless penetration but now reports pain. Although vaginismus may be associated with anxiety, fear, traumatic sexual experiences, or medical conditions that cause painful penetration, some patients with vaginismus do not have any antecedent risk factors. […] Successful multidisciplinary treatment of vaginismus may include cognitive behavior therapy, psychotherapy, relationship and sexual counseling, vaginal lubricants, sequential vaginal dilators, and onabotulinumtoxinA injection.

• #35 Vaginismus: Causes, Symptoms & Treatment

  https://pelvicare.uk/blog/vaginismus-causes-symptoms-treatment

  Pelvic physiotherapy, specializing in addressing dysfunction and discomfort in the pelvic and vaginal area, is often the primary treatment for vaginismus. Therapists use massage and muscle retraining techniques to relax the tight muscles associated with vaginismus. […] Combining women’s healthy physiotherapy with mindful therapy helps address the psychological aspect of vaginismus. Women benefit from speaking with a therapist or sex therapist to uncover the root cause of their fear and work towards overcoming it. […] In cases where other treatments are ineffective, a brief surgical procedure involving Botox injections into the vaginal muscles may be considered. This temporarily prevents muscle tightening, and when they combine it with post-surgery dilator therapy, many women experience pain-free penetration and a return to a satisfying sex life as a result.

• #36

  https://journals.lww.com/ijwd/fulltext/2024/12000/botulinum_toxin_treatment_of_refractory.2.aspx

  Our study demonstrates that BoNTA injection yields significant improvement in patients suffering from recalcitrant vaginismus. There were no complications or adverse effects, and appropriately injected modest BoNTA doses, as detailed here, are safe. […] BoNTA effectively treats recalcitrant vaginismus that is explained by a relationship between muscular spasms and the severity of vaginismus. […] BoNTA treatment can serve as second-line therapy when conventional therapies fail. BoNTA injections can facilitate dilator therapy and increase compliance with the latter.

• #37 Surgical Treatments for Vaginismus and Dyspareunia

  https://theflowerempowered.com/knowledge-portal/sexual-dysfunction/surgical-treatments-for-vaginismus-and-dyspareunia/

  Some research suggests that when comparing Botox directly with physiotherapy alone, botox was not as effective in treating sexual functioning including successful intercourse, desire, arousal, lubrication, orgasm, satisfaction, and pain. […] Botox is best when combined with physiotherapy and other conservative therapies.

• #38 Vaginismus: Diagnostic Challenges and Proposed Diagnostic Criteria – Balkan Medical Journal

  https://balkanmedicaljournal.org/text.php?lang=en&id=2569

  According to the newly proposed criteria, those who meet the subjective, objective, and frequency-duration criteria and the exclusion criteria are classified as having vaginismus. […] We expect that the proposed diagnostic criteria would be useful for practicing clinicians worldwide in confidently diagnosing vaginismus and providing appropriate care to those in need. […] To summarize, vaginismus, a common female sexual disorder, is challenging to diagnose, and the proposed criteria are likely to help practicing clinicians worldwide overcome these challenges.

Zobacz więcej