Diagnosing and managing vaginismus

#### Summary points Recent consensus defined vaginismus as, “The 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.”1 The definition also noted that affected women often avoid intercourse; experience involuntary pelvic muscle contraction; and anticipate, fear, or experience pain. However, it can be difficult to diagnose vaginismus. Women with total vaginismus are unable to tolerate penetration of their vagina by any object, but those with partial vaginismus tolerate penetration with difficulty and pain. The condition can be lifelong (primary) or it can occur after sexual function has been normal (secondary). It can also be situational, occurring only with certain partners or in particular circumstances, or it can be global, occurring independent of partner or circumstances. It is thus a clinical syndrome, not a definitive diagnosis, that consists of overlapping elements of hypertonic pelvic floor muscles, pain, anxiety, and difficulty in penetration. The Diagnostic and Statistical Manual of Mental Disorders , fourth edition (DSM-IV) categorises vaginismus as a sexual pain disorder along with dyspareunia. It describes vaginismus as occurring when “recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina” interferes with intercourse.2 According to this definition, the experience of pain is not necessary for the diagnosis. …