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Updated: Nov 30 2021


  • Snapshot
    • A 40-year-old, recently divorced, woman presents with pain upon sexual intercourse. When attempting intercourse after her divorce, there was severe pain upon penetration, forcing her to end sexual intercourse. Upon further questioning, she reveals that she is a sexual assault survivor. On physical exam, there is involuntary vaginal muscle contractions during pelvic examination.
    • Vaginismus is a sexual pain disorder
      • note, dyspareunia is also a sexual pain disorder but distinct from vaginismus
        • dyspareunia results from medical or psychological issues and cannot be diagnosed on physical exam
      • vaginismus results in physical difficulty allowing vaginal penetration, despite willingness
    • Vaginismus is the only type of sexual dysfunction that can be diagnosed with physical exam
    • Risk factors
      • generalized anxiety disorder
      • depression
      • history of sexual trauma
      • strict religious upbringing
    • Associated conditions
      • dyspareunia
        • even after dyspareunia is resolved, memory of dyspareunia may cause vaginismus
    • Pathogenesis
      • involuntary, painful reflex spasm of the paravaginal thigh adductor muscles
      • results from anxiety about sex or pelvic exam
        • results from a bad experience with either in the past
  • Presentation
    • Symptoms
      • pain during intercourse
      • difficulty with vaginal penetration
    • Physical exam
      • pain with pelvic exam
  • Differential Diagnosis
    • Dyspareunia
    • Psychological (e.g. performance anxiety)
    • Diagnosis confirmed if vaginal muscles contract involuntarily with pelvic exam
  • Treatment
    • Gradual vaginal dilators
    • Physical therapy to relax the tight muscles
    • Counseling
  • Prognosis
    • Vaginal dilators are typically very successful
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