tanmay_mehta
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vaginismus: details!
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03.12.06 (2 years ago)
#1
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when female says no to sex vaginismus
Recurrent or persistent involuntary contraction of the outer third of the vagina interfering with sexual intercourse
It is involuntary reflex precipitated by real or imagined attempts at vaginal penetration
It consists of:
Phobia of penetration of the vagina &
Involuntary spasm of the lower third of the vagina
In general population: The exact prevalence rate is not known. Rare(1%)
1.Primary (never able to have intercourse) or
secondary (past history of vaginal penetration without problems). Secondary vaginismus is often associated with dysparunia
2.Global (unable to place any thing in the vagina) or
situational (able to use a tampon & can tolerate a pelvic examination but cannot have intercourse)
causes
I. Psychological
1. An unpleasant experience:
Past sexual abuse, painful first attempt of coitus or vaginal examination
2. Extreme fear of penetration because of wrong belief that her vagina is too small to accommodate an erect penis, fear of pregnancy or intimacy
3. Unexpressed negative feelings towards her husband
4. Religious orthodoxy
5. Pain-tension-pain cycle
II. Physical: Rare.
PID
endometriosis
tender scar
partially imperforate hymen
vaginal stenosis
treatment
Aim:
To break the vicious cycle & replacing pain by pleasure & spasm by relaxation
To make the women feels that she owns her own vagina & can share it for sexual activity should she wish.
Requirements:
Warm, empathetic attitude & great patience
Lines of treatment:
1.Exploration of phobia
2.Sex education
3.Guided tour
4.Control of muscles: Adductor muscles
& P coccygeus
5. Systematic vaginal desensitization:
Step 1:Insertion of a trainers under controlled relaxation
Step 2: Sharing of control with husband
Step 3: Insertion of penis with the woman in control
Step 4: Transfer control of insertion of penis to husband
6. Drugs
7. Surgical treatment
summary
Vaginismus is recurrent or persistent involuntary contraction of the outer third of the vagina interfering with sexual intercourse.
Vaginismus causes marked stress, anxiety, break down of marital relationship & infertility
Vaginismus is caused mainly by psychological factors
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