Sexual Health
CMECNE

Primary Vaginismus – Signs, Symptoms and Treatment Options 

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Learning Objectives and CME/Disclosure Information

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

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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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