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Partial vaginismus: definition, symptoms and treatment
Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine . Linköping University, Faculty of Health Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Vaginismus is a sexual pain disorder, where spasm of musculature of the outer third of the vagina interferes with intercourse. Vaginismus exists in two forms: total vaginismus, where intercourse is impossible, and the more seldom described partial vaginismus, in which intercourse is possible but painful.

The aim of the thesis was to develop a useful definition of partial vaginismus for both clinical and scientific purposes; to describe the prevalence of partial vaginismus among women with superficial coital pain; to report on symptoms and clinical findings in women with partial vaginismus; and to present treatment results for women with vaginismus.

In a clinical sample of 224 women with superficial coital pain, we found a great overlap of the clinical diagnoses of partial vaginismus (PaV) and vulvar vestibulitis (VVS) (nowadays called provoked vestibulodynia); 102 women had both PaV and VVS. All women with VVS had vaginismus. Partial vaginismus was more common in all our samples than total vaginismus.

sEMG of pelvic floor muscles was found to be of no value in distinguishing women with partial vaginismus with or without vulvar vestibulitis (PaV+/-VVS) (n=47) from each other or from an asymptomatic group (n=27).

Women with PaV+/-VVS (n=53) reported not only burning pain but also itch during a standardized penetration situation (sEMG of pelvic floor muscles), while asymptomatic women (n=27) did not. In most cases, the appearance of burning pain preceded the appearance of itch.

In a retrospective interview study, 24 women with PaV+/-VVS reported pain after intercourse more often than pain during penetration at the onset of the problem. When the women ceased having intercourse, both symptoms were equally common. Intensity of pain during penetration increased dramatically from very low at onset of the problem to very high when the women ceased having intercourse, while intensity of pain after intercourse was already high at onset of the problem and increased to very high when the women ceased having intercourse.

Pain after intercourse in women with PaV+/-VVS was described as burning and/or smarting and lasted in mean for two hours, while pain during penetration was described with words like sharp/incisive/bursting and lasted for one minute.

At long-term follow-up (more than three years) of a group of women treated with cognitive behaviour therapy for vaginismus (n=59, response rate 44/59 on a questionnaire), a majority were able to have and enjoy intercourse. The proportion of women with positive treatment outcome was, however, associated to the definition of treatment outcome. An ability to have intercourse at end of therapy was maintained at follow-up. Every tenth women with vaginismus healed spontaneously after thorough assessment.

Conclusion: Partial vaginismus was more common in our studies than total vaginismus, and all women with vulvar vestibulitis had partial vaginismus. Women with PaV+/-VVS reported not only burning pain during standardized penetration but also itch. When the problem started in women with PaV+/-VVS, pain after intercourse was more common than pain during penetration. Pain after intercourse was described as longlasting and burning and/or smarting, while pain during penetration was described as short and sharp/incisive/bursting. Long-term follow-up results of a series of women treated with CBT for vaginismus show good treatment outcome.

Place, publisher, year, edition, pages
Institutionen för klinisk och experimentell medicin , 2007.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1015
Keyword [en]
Partial vaginismus, vulvar vestibulitis, provoked vestibulodynia, electromyography, pelvic floor muscles, burning pain, itch, symptoms, long-term follow-up, cognitive behaviour therapy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-10036ISBN: 978-91-85895-92-2 (print)OAI: oai:DiVA.org:liu-10036DiVA: diva2:16787
Public defence
2007-11-20, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2007-10-17 Created: 2007-10-17 Last updated: 2009-08-22
List of papers
1. Vulvar vestibulitis syndrome and vaginismus: A case report
Open this publication in new window or tab >>Vulvar vestibulitis syndrome and vaginismus: A case report
Show others...
2000 (English)In: Journal of reproductive medicine, ISSN 0024-7758, Vol. 45, 219-223 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Recent reports have argued for a revision of the criteria used for the establishment of a diagnosis of vulvar vestibulitis syndrome (VVS). On theoretical grounds it might be hypothesized that women with VVS also suffer from vaginismus.

CASE: A young woman presented with a history, symptoms and objective findings typical of vaginismus, yet she suffered from continuous, burning pain and itching in the vestibule. Earlier in the course of the problem she had received a diagnosis VVS. The patient was treated with behavioral therapy developed for vaginismus. Notations made during the course of therapy supported the assumption that the pain and itching were conditioned responses to penetration in the same way that a vaginal muscular reflex is.

 

CONCLUSION: Differential diagnostic difficulties exist in the field of VVS and vaginismus. Psychophysiologic theories are needed as the basis for research to clarify the connections between different diagnostic entities associated with coital burning pain and itching in the vestibule.

Keyword
vulva, vestibule, vaginismus, vestibulitis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12653 (URN)
Available from: 2007-10-17 Created: 2007-10-17 Last updated: 2009-08-21
2. Surface electromyography diagnostics in women with partial vaginismus with or without vulvar vestibulitis and in asymptomatic women
Open this publication in new window or tab >>Surface electromyography diagnostics in women with partial vaginismus with or without vulvar vestibulitis and in asymptomatic women
2004 (English)In: Journal of Psychosomatic Obstetrics & Gynecology, ISSN 0167-482X, Vol. 25, no 3/4, 281-294 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate to what extent women with superficial dyspareunia can be diagnosed for both partial vaginismus (PaV) and vulvar vestibulitis (VVS) and to discover to what extent surface electromyography (sEMG) of the pelvic floor muscles (PFM) can distinguish between women with PaV solely, PaV + VVS, and asymptomatic women. A total of 224 consecutive women with superficial dyspareunia were examined clinically for both PaV and VVS diagnoses. We examined 47 women with PaV ± VVS and 27 asymptomatic women with sEMG of the PFM. The results showed that 102/224 women with superficial dyspareunia and 33/47 women with PaV in the sEMG part of the study had both PaV and VVS. All women with VVS had vaginismus, while 42/224 had PaV but not VVS. sEMG measurements revealed no significant differences between the three groups of women (PaV solely, PaV + VVS, and asymptomatic). Almost half of the women with superficial dyspareunia referred to our clinic have both the diagnosis PaV and VVS. sEMG was not a method of any value to distinguish between women with PaV solely, PaV + VVS, or asymptomatic women. The increased tone found clinically in the PFM of women with PaV ± VVS may be of other origin than electrogenic contractions.

Keyword
electromyography, pelvic floor muscles, muscular tone; diagnostic criteria, dyspareunia, vulvar vestibulitis, vaginismus, asymptomatic group
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12654 (URN)10.1080/01674820400017921 (DOI)
Available from: 2007-10-17 Created: 2007-10-17 Last updated: 2009-08-18
3. Itch and burning pain in women with partial vaginismus with or without vulvar vestibulitis
Open this publication in new window or tab >>Itch and burning pain in women with partial vaginismus with or without vulvar vestibulitis
2007 (English)In: Journal of Sex and Marital Therapy, ISSN 0092-623X, Vol. 33, no 2, 171-186 p.Article in journal (Refereed) Published
Abstract [en]

Fifty-three women with partial vaginismus with or without vulvar vestibulitis and 27 asymptomatic women estimated sensations of burning pain and itch at 20 standardized moments during a standardized penetration situation, including vaginal muscle contractions. Forty-three women with partial vaginismus (81.1%) reported burning pain, 23 (43.4%) itch, and 22 (41.5%) both complaints, compared to 0% of the asymptomatic women. In 17 of 22 cases, burning pain preceded the appearance of itch and in four cases the two complaints coincided. The median time from the moment when burning pain started until itch appeared was 150 seconds.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12655 (URN)10.1080/00926230601098506 (DOI)
Available from: 2007-10-17 Created: 2007-10-17 Last updated: 2012-04-09
4. Postcoital burning pain and pain at micturition: early symptoms in women with partial vaginismus with or without vulvar vestibulitis?
Open this publication in new window or tab >>Postcoital burning pain and pain at micturition: early symptoms in women with partial vaginismus with or without vulvar vestibulitis?
2008 (English)In: Journal of Sex and Marital Therapy, ISSN 0092-623X, Vol. 34, no 5, 413-428 p.Article in journal (Refereed) Published
Abstract [en]

Twenty-four women with partial vaginismus with or without vulvar vestibulitis participated in a semi-structured telephone interview concerning early signs and development of their pain symptoms during/after intercourse. At the onset of the problem, pain after intercourse was more common than pain during penetration. Pain intensity during penetration increased from the onset of the problem to when the women ceased having intercourse. Pain during penetration lasted for 1 minute, and was most often described as sharp/incisive/bursting, while pain after intercourse had a duration of 2 hours and was described as burning and/or smarting. Post-coital pain during micturition was described by 70% of the women.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12656 (URN)10.1080/00926230802156210 (DOI)
Available from: 2007-10-17 Created: 2007-10-17 Last updated: 2012-04-06
5. Long-term coital behaviour in women treated with cognitive behaviour therapy for superficial coital pain and vaginismus
Open this publication in new window or tab >>Long-term coital behaviour in women treated with cognitive behaviour therapy for superficial coital pain and vaginismus
2010 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 39, no 3, 193-202 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of the present study was to investigate long-term coital behaviour in women treated with cognitive behaviour therapy (CBT) for superficial coital pain and vaginismus. Data were taken from a questionnaire concerning long-term coital behaviour sent to 59 women who presented to Linköping University Hospital because of superficial coital pain, had been diagnosed with vaginismus, and had been treated with CBT. Data were also traced from therapy records: mean follow-up time was 39 months, the women had suffered for an average of almost 4 years, and required a mean of 14 treatment sessions. Forty-four of the 59 women returned the questionnaire, for a response rate of 74.6%. At follow-up, 81% of the treated women had had intercourse. A majority (61%) rated their ability to have intercourse without pain as 6 or higher (on a scale from 0-10), and 61% rated their ability to enjoy intercourse as 6 or higher (on a scale from 0-10). The proportion of women with positive treatment outcome at follow-up ranged from 81% (able to have intercourse) to 6% (able to have pain-free intercourse). An ability to have intercourse at end of therapy was maintained at follow-up. Two-thirds of the women reported high fulfillment of individual treatment goals. At follow-up, the women estimated a significantly higher self-worth as sex partners, and as women and human beings, than before treatment. Twelve per cent of the original sample had healed after a few assessment sessions and without treatment.

Place, publisher, year, edition, pages
Routledge, 2010
National Category
Family Medicine
Identifiers
urn:nbn:se:liu:diva-12657 (URN)10.1080/16506070903571014 (DOI)20390584 (PubMedID)
Available from: 2007-10-17 Created: 2007-10-17 Last updated: 2015-11-09Bibliographically approved

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