A Woman Who Never Could Have Coitus: Treatment of Lifelong Vaginismus
Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other “objects” (e.g., tampons, fingers, speculum), despite the woman’s expressed wish to do so. Lifelong vaginismus is diagnosed when a woman has never be
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Moniek M. ter Kuile and P.T.M. Weijenborg
17.1 Introduction and Aims Lifelong vaginismus is diagnosed when a woman has never been able to have intercourse. The prevalence rates vary between 0.4 and 6.0 % in a general population. Research on the etiology of vaginismus is scarce, and no definitive cause has been identified. The aim of this chapter is to provide insight into the recent diagnostics and treatment of lifelong vaginismus. A fear-avoidance model for vaginismus is described that can give the professional (gynecologists, psychologists, physical therapist) and the women herself pointers to understand a woman’s physical and emotional response(s) to (attempts at) penetration.
17.2 Definition in Lay Terms Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other “objects” (e.g., tampons, fingers, speculum), despite the woman’s expressed wish to do so.
17.3 Didactic Goals After reading this chapter you: • Are able to recognize lifelong vaginismus as a sexual problem • Are familiar with the fear-avoidance model of vaginismus
M.M. ter Kuile, PhD (*) • P.T.M. Weijenborg, MD, PhD Department of Gynecology, Leiden University Medical Centre, Leiden, The Netherlands e-mail: [email protected]; [email protected] © Springer International Publishing Switzerland 2017 K.M. Paarlberg, H.B.M. van de Wiel (eds.), Bio-Psycho-Social Obstetrics and Gynecology, DOI 10.1007/978-3-319-40404-2_17
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M.M. ter Kuile and P.T.M. Weijenborg
• Are familiar with the most recent insights in diagnostics in lifelong vaginismus • Are familiar with the most recent insights in treatment interventions in lifelong vaginismus
Case History
Jane Periwinkle, 32 years old, 5 years married to Peter, is referred by her general practitioner with the complaint that sexual intercourse has never been possible; attempts resulted in pain. She and her partner are very hopeful to overcome this problem in order to be able to conceive children. Questions Belonging to the Case History 1. Give three possible explanations why sexual intercourse has never been possible? 2. As a doctor (general practitioner/gynecologist), would you perform an internal gynecological examination to exclude physical pathology? 3. If this couple is only interested to overcome this problem in order to conceive children, what would you advise them? 4. If this couple wants to overcome this problem in order to have sexual intercourse, what would you advise them?
17.4 F acts and Figures: Definitions, Classification, and Prevalence Vaginismus is defined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR), as an involuntary contraction of the musculature of the outer third of the vagina interfering with intercourse, causing distress and interpersonal difficulty [1]. This definition has received considerable criticism. For example, the focus on vaginal spasm as the key diagnostic criterion has never been empirically supported [2]. In response to the lack of empirical
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