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Sexual Penetration Disorders: Vaginismus and Vestibulodynia

Difficulty with achieving comfortable sexual penetration in women is an underreported and distressing experience, which may result from a number of conditions including vaginismus and vestibulodynia.

Vaginismus is the persistent or recurrent difficulty of a woman to achieve vaginal penetration, despite an expressed wish to do so.  Often there is an associated involuntary pelvic floor muscle contraction, which may cause the vaginal entrance to appear smaller.

Vestibulodynia is characterised by severe pain associated with touch or light pressure applied to the tissues surrounding the entrance to the vagina.

Vaginismus and vestibulodynia may occur independently or together.  Both conditions, however, may result in considerable pain during penetration, or the inability to achieve penetration at all.  Discomfort or difficulty is often experienced with insertion of a tampon or gynaecological examination (Pap smear).

Clinical research reports that 3-18% of women are suffering from one or both of these conditions.  However, prevalence may be underreported due to embarrassment, fear or sensitivities surrounding these conditions.

What is the difference between primary and secondary vaginismus?

A woman with primary vaginismus has never had comfortable penetration, and in some cases may never have achieved penetrative intercourse.  Secondary vaginismus is characterised by a period of normal sexual relations prior to the onset of symptoms.

What causes vaginismus and vestibulodynia?

Whilst there are a percentage of women in whom a physical and/or psychological trauma precipitates the onset of symptoms, for many women the underlying cause may be a reaction to another medical condition.  Examples include conditions such as endometriosis, urinary tract infection, constipation, and bladder or bowel urgency/frequency.

Who should seek treatment?

Women experiencing difficulty in achieving comfortable vaginal penetration, or severe pain associated with touch applied to the vaginal tissues should consider a consultation with a health practitioner, such as a GP, Gynaecologist or Physiotherapist with a special interest in the pelvic floor.  Assessment will enable differential diagnosis, and allow the most appropriate treatment to be determined.  Fortunately, there are a number of treatment options available to assist in normalising muscle tone and response to light touch.  Treatment often allows women to achieve normal sexual function, and to experience sexual intimacy in more fulfilling ways.