x. Vaginismus

Vaginismus is a condition characterized by the permanent or recurrent involuntary contraction of the pubococcygeus muscle whereby the patient is unable to admit a penis, finger or any other object into the vagina, despite being willing (and perhaps eager) to do so. In many cases, it is due to (phobic) avoidance behavior and/or fear of anticipated pain. Structural or physical abnormalities must be excluded or, if present, treated.
The exact cause of the anxiety is often unclear. In many cases, the patient has developed the idea (often at a very early age) that penetration by a penis is just impossible. Primary vaginismus is frequently accompanied by other phobic anxieties, such as an aversion to the sight of blood, injuries, needles, injections, etc. There are also indications that feelings of revulsion, avoidance behavior, morality and pain cognition may play a part.
Interestingly, many women with primary vaginismus do not experience severe sexual problems: arousal and orgasm (through masturbation) remain possible. However, women whose vaginismus has been induced by traumatic experiences such as rape or incest will often show various sexual dysfunctions, including reduced sexual desire or an aversion to any form of sexual contact. In such cases, it is not possible to cure the vaginismus without first resolving the other problems. Vaginismus can also be secondary to dyspareunia. Anticipation of pain then causes hypertonia of the vaginal sphincter muscles, most notably the levator ani, at any attempt at coitus. Acquired vaginismus can also be situational, further to unconscious unwillingness to copulate, for example.
Treatment is primarily directed at reducing fear and anxiety through gradual exposure whereby the patient is encouraged to introduce fingers, tampons and dilators of increasing size into her vagina. This approach is combined with cognitive restructuring, education and sex therapy.