VAGINISMUS: The one common sexual health problem women are silent on

Somewhere this minute, there is the newlywed who can’t consummate her relationship with the love of her life. There is the husband and wife who have tried for years to have sex, but now live more as roommates than as a married couple. There is the woman who feels like a failure and grows more depressed by the day, because no matter how many treatments she tries, she can’t overcome this condition. There is her partner who feels rejected and angry; is there something wrong with him? Vaginismus is a common medical problem a lot of females and couples all over the world are battling with yet it lacks the needed attention.

Vaginismus is a medical condition characterised by the involuntary contraction or spasm of muscles around the opening of the vagina in women with no abnormalities in the genital organs.The tight muscle contraction makes sexual intercourse painful in women with this condition despite their sexual desires; they tend to enjoy non penetrative sexual activity. Women with vaginismus cannot tolerate tampons and undergoing gynaecological exams.

Vaginismus can classified into two types:

Primary vaginismus : It is when vaginal penetration has never been achieved ; tight muscles and fear do not allow a patient to experience normal vaginal penetration..It is often experienced by women during their firsIt attempt at intercourse.

Secondary vaginismus : It is when vaginal penetration was once achieved, but is no longer possible, potentially due to factors such as gynecologic surgery, trauma, or radiation.The pain has not always been present. It can occur at any stage of life, and it may not have happened before.

Symptoms of vaginismus:

• Intense fear of penetration and avoidance of sex

• Loss of sexual desire if penetration is attempted

• Difficult or impossible penetration of the vagina, because the muscles in the vagina have tightened

• Burning or stinging pain and tightness of the vagina if penetrated by a tampon, finger or penis

• Fear of pain

Causes :

5. Vaginismus can be triggered by emotional strssors, physical stressors or both.
5. Emotional stressors may include:

• Fear of pain or pregnancy

• Anxiety or guilt about performance of act

• Feelings of vulnerability in a relationship as a result of abuse

• History of rape or defilement

• Exposure to cruel portrayal or sexual images during childhood

5. Physical stressors may include:

• Infection like UTI or yeast infection

• Child birthVaginismus

• Menopause

• Inadequate foreplay

• Insufficient vaginal lubrications

Treatment:

• Kegel exercises to improve the control of the pelvic floor muscles

• Education and counseling: Providing information about the sexual anatomy and sexual response cycle can help the individual understand their pain and the processes their body is going through.

• Emotional exercises: This can help the person identify, express, and resolve any emotional factors that may be contributing to their vaginismus.

• Insertion or dilation training: Once a woman can do this without pain, she will learn to use a plastic dilator, or a cone-shaped insert. If she can insert this without pain, the next step will be to leave it in for 10 to 15 minutes, to let the muscles get used to the pressure. Next, she can use a larger insert, and then she can teach her partner how to apply the insert.

• When the woman feels comfortable with this, she can allow her partner to put his penis near the vagina, but not inside. When she is completely comfortable with this, the couple can try intercourse again. They may wish to build up gradually to this, as with the insert.

• Reducing sensitivity to insertion: A woman will be encouraged to touch the area as close as possible to the vaginal opening every day without causing pain, moving closer each day. When she is able to touch the area around the vagina, she will be encouraged to touch and open the vaginal lips, or labia. The next step will be to insert a finger.

REFERENCES:Woo J, Armstrong AY, MacKay H. Gynecologic Disorders. In: Papadakis MA, McPhee SJ, Rabow MW. eds. Current Medical Diagnosis & Treatment 2015. New York, NY: McGraw-Hill; 2015.

Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-Walsh Urology, Tenth Edition. 2012. chapter 30, 823-833.e2 Smith RP. Netter's Obstetrics and Gynecology. Elsevier Health Sciences; 2008. Chapter 82, 215-216.

American College of Obstetrics and Gynecology. When sex is painful Accessed 3/20/2015

Acknowledgment: Dr.Kingsley Pereko

School of Medical Sciences,UCC

Dr. Derrick Touyire

School of Medical Sciences, UCC

WRITTEN BY: Akosua Owusua Asiedu

A level 200 Physician Assistant student , UCC