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Sexual Health
CMECNE

Primary Vaginismus – Signs, Symptoms and Treatment Options 

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Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Recall the prevalence of vaginismus
2. Outline management protocols for the treatment of vaginismus

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

Primary vaginismus is a condition in which tight muscles and fear do not allow a patient to experience normal vaginal penetration.

  • Consider the diagnosis of vaginismus when attempting to conduct a pelvic exam, and  the patient elevates her buttocks, moves away, and tightly closes her thighs to prevent an examination
  • Be aware that moving away from the pelvic exam may be reflective of a significant fear/pain reaction which may indicate primary vaginismus
  • Assess whether you can provide the necessary support or if the patient needs to be referred for appropriate follow up treatment with a sexual medicine physician or a pelvic floor physical therapist

SYNOPSIS:

Vaginismus is a condition that can prevent a patient from inserting a tampon, completing an internal vaginal exam or achieving penile penetration. The incidence of primary vaginismus is estimated at 6-17% of the population. Many patients are so ashamed of the condition that they do not seek help. If left untreated, the condition can have significant negative impact on the sexual lives of the patients, as well as their ability to conceive.

KEY POINTS:

  • Primary vaginismus is a common but treatable problem once identified
  • Ascertain the severity of the condition by ranking on the Lamont Scale 1-4
  • If the condition is considered only mild in severity,  the following therapies can be considered:
    • Introduction of anti-anxiety medication or relaxation techniques to address the phobic response
    • If introduction of dilators is possible, patient should work with gradually increasing sizes both under clinical guidance and at home to alleviate muscle spasms and decrease fear
  • If the condition is considered severe, refer to a sexual medicine specialist or a pelvic floor physical therapist for a more comprehensive assessment as to patient’s phobia versus tight muscles
  • In the most severe cases, pelvic floor physical therapy may be helpful or vaginal onabotulinumtoxinA injections can be administered under conscious sedation

Learn More – Primary Sources:

Epidemiology/risk factors of sexual dysfunction

Incidence and prevalence of sexual dysfunctions: a critical review of the empirical literature

Treatment Protocol for Vaginismus

Interventions for vaginismus

Take a post-test and get CME credits

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Related ObG Topics:

Practical info on sexual health for your women's healthcare practice
Vaginismus – What Is It?
When is Painful Intercourse Secondary Vaginismus?
Practical info on sexual health for your women's healthcare practice
The Lamont Scale – What is it?

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Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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