Vaginismus is a perplexing and fascinating problem. The woman who experiences the involuntary, spasmodic contraction of the pubococcygeus and related muscles controlling the vaginal introitus may be unable to tolerate penetration or have intercourse but may be quite capable of becoming sexually aroused, lubricating, and even experiencing multiple orgasms with manual or oral stimulation (Leiblum 2000). Some “virgin” wives and their partners report a rich sexual repertoire. However, when a vaginismic woman senses or fears that her vagina is going to be “penetrated,” her circumvaginal muscles contract, her anxiety increases, and intercourse becomes impossible. It is not uncommon for women to have experienced years of dating and/or marriage without being able to accomplish the vaginal penetration of a gynecologist’s speculum, an erect penis, or even their own fingers. In fact, many vaginismic women are unable to use tampons and have avoided gynecological examinations. Consequently, vaginismus not only causes considerable personal and relationship frustration but also thwarts adequate gynecological health care (e.g., Pap smears) and procreation. Often, it is threat of divorce or the desire to have children that ultimately propels a woman to seek treatment.

Prevalence

Although estimates of the incidence of vaginismus vary widely, it is likely that it occurs with greater frequency than is typically acknowledged. Vaginismus rates of between 12% and 17% have been reported in women presenting to sex therapy clinics (Spector and Carey 1990). The most recent National Health and Sexual Life Survey, which used random sampling and structured interviewing, reported that between 10% and 15% of women reported having experienced pain during intercourse during the last 6 months (Laumann et al. 1994). However, this study did not differentiate between vaginismus and dyspareunia.

While primary vaginismus is quite common, many women experience partial or situational vaginismus - that is, they may be able to tolerate tampon insertion or gynecological examination but panic at the anticipation of penile entry. During sexual encounters, the vaginal entrance is so constricted that it feels like an impenetrable “wall,” lubrication is scant, and penetration occurs, if at all, only with discomfort. Not surprisingly, a woman with a long-term history of vaginismus often has a partner who has developed erectile failure or is experiencing sexual avoidance because of the anticipation or frustration of sexual failure.

Etiology of Vaginismus

Primary vaginismus tends to be of psychological etiology, although vaginismus is often secondary to dyspareunia. Sometimes a history of physical or sexual abuse, gynecological trauma. religious orthodoxy, or extremely restrictive sexual upbringing predates the vaginismus. At times, however, no major precipitating factor can be identified, and the woman’s background differs in no significant way from that of a nonvaginismic woman. Frequently, not one but a variety of factors contribute to creating vaginismus. Fear of intimacy or of losing control, poor self-esteem, sexual ignorance and misinformation, clumsy male partners, intrusive gynecological examinations, and physical or sexual abuse during childhood or adulthood may all be contributory factors. Lazarus (1989) suggested that three classes of factors are often implicated in dyspareunia and that these same factors should be assessed with vaginismic patients as well: 1) developmental factors (e.g., negative psychosexual upbringing, religious taboos that invest sex with shame and guilt, intrapsychic fears and conflicts), 2) traumatic factors (e.g., rape, violent first intercourse), and 3) relational factors (e.g., conflicted and antagonistic feelings toward men in general or one’s sexual partner in particular; sexual clumsiness).

Secondary vaginismus is common. If women have experienced vaginal pain due to infection, surgery, or chemical agents, they are understandably guarded about vaginal penetration and may develop lubrication problems. The lack of lubrication, coupled with lack of sexual arousal and vaginal tightening, can cause secondary vaginismus. It is important to determine when the “phobia” about vaginal penetration first developed, so that appropriate treatment interventions can be undertaken.