Genito-Pelvic Pain/Penetration Disorder (Vaginismus)

Genito-Pelvic Pain/Penetration Disorder (Vaginismus) is a topic covered in the 5-Minute Clinical Consult.

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Basics

Genito-pelvic pain/penetration disorder is the name of the conditions formally known as vaginismus and dyspareunia. Vaginismus results from involuntary contraction of the vaginal musculature. Primary vaginismus occurs in women who have never been able to have penetrative intercourse. Women with secondary vaginismus were previously able to have penetrative intercourse but are no longer able to do so.

Description

  • Persistent or recurrent difficulties for 6 months or more with at least one of the following:
    • Inability to have vaginal intercourse/penetration on at least 50% of attempts
    • Marked genito-pelvic pain during at least 50% of vaginal intercourse/penetration attempts
    • Marked fear of vaginal intercourse/penetration or of genito-pelvic pain during intercourse/penetration on at least 50% of vaginal intercourse/penetration attempts
    • Marked tensing or tightening of the pelvic floor muscles during attempted vaginal intercourse/penetration on at least 50% of occasions
  • The disturbance causes marked distress or interpersonal difficulty.
  • Dysfunction is not as a result of:
    • Nonsexual mental disorder
    • Severe relationship stress
    • Other significant stress
    • Substance or medication effect
  • Specify if with a general medical condition (e.g., lichen sclerosus, endometriosis) (1).
Pregnancy Considerations
May first present during evaluation for infertility
  • Pregnancy can occur in patients with genito-pelvic pain/penetration disorder when ejaculation occurs on the perineum.
  • Vaginismus may be an independent risk factor for cesarean delivery.

Epidemiology

Incidence
The incidence of vaginismus is thought to be about 1–17% per year worldwide. In North America, 12–21% of women have genito-pelvic pain of varying etiologies (2).


Prevalence
  • True prevalence is unknown due to limited data/reporting.
  • Population-based studies report prevalence rates of 0.5–30%.
  • Affects women in all age groups
  • Approximately 15% of women in North America report recurrent pain during intercourse.

Etiology and Pathophysiology

Most often multifactorial in both primary and secondary vaginismus

  • Primary
    • Psychological and psychosocial issues
      • Negative messages about sex and sexual relations in upbringing may cause phobic reaction.
      • Poor body image and limited understanding of genital area
      • History of sexual trauma
    • Abnormalities of the hymen
    • History of difficult gynecologic examination
  • Secondary
    • Often situational
    • Often associated with dyspareunia secondary to:
      • Vaginal infection
      • Inflammatory dermatitis
      • Surgical or postdelivery scarring
      • Endometriosis
      • Inadequate vaginal lubrication
      • Pelvic radiation
      • Estrogen deficiency
    • Conditioned response to pain from physical issues previously listed

Risk Factors

  • Most often idiopathic
  • Although the exact role in the condition is unclear, many women report a history of abuse or sexual trauma.
  • Often associated with other sexual dysfunctions

Commonly Associated Conditions

  • Marital stress, family dysfunction
  • Anxiety
  • Vulvodynia/vestibulodynia

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Citation

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TY - ELEC T1 - Genito-Pelvic Pain/Penetration Disorder (Vaginismus) ID - 816419 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816419/all/Genito_Pelvic_Pain_Penetration_Disorder__Vaginismus_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -