Primary Vaginismus – Signs, Symptoms and Treatment Options

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 Genoox, Inc., 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 2019, 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