Vaginismus
Vaginismus is an involuntary contraction of muscles around the opening of the vagina that makes sexual intercourse painful or impossible.
Vaginismus may result from a woman's unconscious desire to prevent sexual intercourse. Pain experienced in the past during sexual intercourse can lead to vaginismus. Other reasons women do not want to engage in intercourse include fear of becoming pregnant, of being controlled by their partner, or of losing control. Sometimes vaginismus is caused by a physical disorder, such as a pelvic infection or scarring of the vaginal opening (due to injury, childbirth, or surgery). Irritation (due to douches, spermicides, or latex in condoms) may also cause vaginismus.
Because of the pain, some women who have vaginismus cannot tolerate sexual intercourse (that is, penetration of the vagina by the penis). However, sexual activity that does not involve penetration may be pleasurable. Some women cannot tolerate the insertion of a tampon and may need an anesthetic when a doctor performs a pelvic examination.
Diagnosis and Treatment
The diagnosis is based on the woman's description of the problem, her medical history, and the physical examination, including her reaction to a pelvic examination.
Physical disorders that may be causing or contributing to vaginismus are treated. If the cause is psychologic, counseling for the woman and her partner is usually helpful.
If vaginismus persists, the woman is taught a technique to relax the muscle spasms. The technique involves gradually widening (dilating) the vagina. The woman begins by inserting very small, lubricated plastic rods (dilators) into her vagina. The woman inserts slightly but progressively larger dilators as her level of comfort increases. Once the woman can tolerate having large dilators inserted without discomfort, she and her partner may try to have sexual intercourse again.
Kegel exercises, which strengthen the pelvic muscles, can be helpful if performed while the dilators are in place. For these exercises, the muscles around the vagina, urethra, and rectum--the muscles used to stop the flow of urine--are repeatedly squeezed hard and then relaxed 10 to 20 times. Performing the exercises several times a day is recommended. These exercises enable the woman to develop a sense of control over the muscles that were contracting involuntarily.
 See the sidebar Kegel Exercises: Squeeze and Relax.
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