Vaginismus - Primary Vaginismus

Primary Vaginismus

A woman is said to have primary vaginismus when she has never been able to have penetrative sex or experience vaginal penetration without pain. It is commonly discovered in teenagers and women in their early twenties, as this is when many young women in the Western world first attempt to use tampons, have penetrative sex, or undergo a Pap smear. Women with vaginismus may be unaware of the condition until they attempt vaginal penetration. A woman may be unaware of the reasons for her condition.

A few of the main factors that may contribute to primary vaginismus include:

• a condition called vulvar vestibulitis syndrome, more or less synonymous with focal vaginitis, a so-called sub-clinical inflammation, in which no pain is perceived until some form of penetration is attempted
• urinary tract infections
• vaginal yeast infections
• sexual abuse, rape, other sexual assault, or attempted sexual abuse or assault
• knowledge of (or witnessing) sexual or physical abuse of others, without being personally abused
• domestic violence or similar conflict in the early home environment
• fear of pain associated with penetration, particularly the popular misconception of "breaking" the hymen upon the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs
• personality traits such as pain-catastrophizing cognitions and harm-avoidance behaviour
• any physically invasive trauma (not necessarily involving or even near the genitals)
• generalized anxiety
• stress
• negative emotional reaction towards sexual stimulation, e.g. disgust both at a deliberate level and also at a more implicit level
• strict conservative moral standards with low liberal moral standards — a general difficulty at doing 'wrong' or behaving in ways perceived as transgressive, which also can elicit negative emotions

Occasionally, primary vaginismus is idiopathic.

Vaginismus has been classified by Lamont according to the severity of the condition. He describes four degrees of vaginismus: In first degree vaginismus, the patient has spasm of the pelvic floor that can be relieved with reassurance. In second degree, the spasm is present but maintained throughout the pelvis even with reassurance. In third degree, the patient elevates the buttocks to avoid being examined. In fourth degree vaginismus (also known as grade 4 vaginismus), the most severe form of vaginismus, the patient elevates the buttocks, retreats and tightly closes the thighs to avoid examination. Pacik expanded the Lamont classification to include a fifth degree in which the patient experiences a visceral reaction such as sweating, hyperventilation, palpitations, trembling, shaking, nausea, vomiting, losing consciousness, wanting to jump off the table, or attacking the doctor. The Lamont classification continues to be used to the present and allows for a common language among researchers and therapists.

However, it does not provide for a language with which a woman might best be able to verbalise her concerns, pain or problems. A woman with a lot of trust in the doctor might be classified as 1 but experience severe pain. A woman with less trust, or a woman who is or has been subjected to harsh examination, might be classified as 4 or 5 even if the physical discomfort she experiences with attempts at penetration in non-clinical settings is comparatively mild.

Though spasm of the pubococcygeus muscle is commonly thought to be the primary muscle involved in vaginismus, Pacik identified two additionally-involved spastic muscles in treated patients under sedation. These include the entry muscle (bulbocavernosum) and the mid-vaginal muscle (puborectalis). This accounts for the common complaint that patients often report when trying to have intercourse: "It's like hitting a brick wall".