Vaginismus

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Classification according to ICD-10
N94.2 Vaginismus
F52.5 Inorganic vaginismus
ICD-10 online (WHO version 2019)

Under Vaginismus (or vaginismus ) is defined as an involuntary spasm or distortion of the pelvic floor and of the outer third of the vaginal muscles , causing the vaginal opening tight or sealed as will appear. Vaginal intercourse , a gynecological examination and the insertion of tampons or other objects can be very painful or - in the case of vaginismus in its most severe form - impossible.

A more recent definition by Basson et al. Leaving aside the aspect of cramping because it has never been proven, describes vaginismus as "persistent or recurring difficulty in the body allowing a penis, finger, or other object to be inserted into the vagina despite one's express desire to insert something . "

Vaginismus belongs to the sexual dysfunction, more precisely to pain disorders, and is often at least organically caused, but can also be caused purely psychologically.

to form

There are usually two types of vaginismus:

Primary vaginismus is when it has never been possible to insert something into the vagina without pain. It is usually only discovered during puberty or adolescence , because no attempt has been made beforehand.

Under secondary vaginismus the form of vaginismus is understood, which was triggered by a specific event. Triggers can be severe traumatic experiences such as rape or a birth trauma, but also comparatively harmless experiences such as a rough gynecological examination or repeated painful experiences during sexual intercourse.

Crowley et al. In addition to primary and secondary vaginismus, there are other forms:

  • "Consistent vaginismus" occurs every time an attempt is made to insert something into the vagina.
  • "Global vaginismus" is independent of circumstances or partners.
  • "Situational vaginismus" occurs only under certain circumstances or with certain partners, for example only during gynecological examinations, while vaginal intercourse is possible without problems, or vice versa.

treatment

Possible therapies are training with vaginal dilators , biofeedback and pelvic floor training .

Vaginal dilators are smooth, conically shaped rods (usually available in sets with several rods of different diameters). With these, the vagina is used to the insertion and desensitized and the tense tissue is loosened.

Pelvic floor training, sometimes used in conjunction with vaginal self-examination , can also make a significant contribution to curing vaginismus. By training the striated pelvic floor muscles, control over the muscles can be regained, as those affected learn to consciously tense or relax them.

Psychotherapy can be helpful, but the main success of the treatment is achieved in most cases through physical therapy.

Diagnosis in the DSM-5

Since the introduction of the DSM-5 in 2013, the diagnoses of non-organic vaginism and dyspareunia have been combined as genito-pelvic pain penetration disorder . This decision resulted from the scientific findings that the two disorders cannot be reliably differentiated. In contrast to the emphasis on vaginal muscle spasms in the DSM-IV diagnostic criteria for vaginismus, the focus of the diagnosis is now on penetration problems, since an empirical proof of muscle spasm in vaginismus could not be provided.

In addition, the fear of pain with vaginal penetration is characteristic of vaginismus, which also suggests a strong relationship between the diagnosis and dyspareunia. Those affected often report impaired self-esteem as well as feelings of inferiority and worthlessness with regard to sexuality.

Trivia

Hannes Wader ironically described such a situation in his chant Der Tankerkönig in 1972 : “Why did you frighten us so? My friend has a cramp and now we're stuck! "

literature

  • JW Dudenhausen, HPG Schneider, Gunther Bastert : Gynecology and obstetrics. 2nd edition, Walter de Gruyter, 2003.
  • Stephan Dressler, Christoph Zink: Pschyrembel, Dictionary Sexuality. Walter de Gruyter, 2003.
  • Claudia Amherd: When love hurts: A self-help book for women who suffer from pain during sex. 2nd Edition. Books on Demand, 2009.

Individual evidence

  1. ^ WHO: Manual of The International Statistical Classification of Diseases, Injuries, and Causes of Death. 10th edition. Geneva 1992.
  2. ↑ W. Weijmar Schultz, R. Basson, Y. Binik, D. Eschenbach, U. Wesselmann, J. van Lankveld: Women's sexual pain and its management. In: J Sex Med . 2, pp. 301-316 (2005).
  3. ^ R. Basson, S. Althof, S. Davis et al .: Summary of the Recommendations on Sexual Dysfunctions in Women. J Sex Med 2004.
  4. ^ Tessa Crowley, Daniel Richardson and David Goldmeier on behalf of the BASHH Special Interest Group for Sexual Dysfunction: Recommendations for the management of vaginismus. In: International Journal of STD & AIDS 2006.
  5. ↑ Ulrich Schnyder, Christine Schnyder-Lüthi, Pietro Ballinari, Andreas Blaser: Therapy for Vaginismus. In: Can J Psychiatry 1998.
  6. ^ Walter Dmoch: Sexual dysfunction. (PDF; 192 kB) In: Gynecologist. 34 (2001), pp. 278–290, doi: 10.1007 / s001290050713 , excerpt on the treatment of vaginismus ( Memento from December 1, 2017 in the Internet Archive )
  7. ↑ T. Rosenbaum: Physiotherapy treatment of sexual pain disorders. J. Sex Marital Ther. 31: 329-340 (2005).
  8. ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) . 5th ed. American Psychiatric Publishing, Washington 2013, ISBN 978-0-89042-555-8 (English).
  9. ↑ a b Yitzchak M. Binik: The DSM diagnostic criteria for vaginismus . In: Archives of sexual behavior . tape 39 , no. 2 , 2010, p. 278-291 , doi : 10.1007 / s10508-009-9560-0 .
  10. ↑ J. van der Velde, E. Laan, W. Everaerd: Vaginismus , a component of a general defensive reaction. an investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus . In: International urogynecology journal and pelvic floor dysfunction . tape 12 , no. 5 , 2001, p. 328-331 .
  11. ^ Joana Carvalho, Armando Luis Vieira, Pedro Nobre: Latent structures of female sexual functioning . In: Archives of sexual behavior . tape 41 , no. 4 , 2012, p. 907-917 , doi : 10.1007 / s10508-011-9865-7 .
  12. ↑ a b H. S. Kaplan: The classification of the female sexual dysfunctions . In: Journal of sex & marital therapy . tape 1 , no. 2 , 1974, p. 124-138 , doi : 10.1080 / 00926237408405280 .
  13. ↑ Barbro Wijma, Klaas Wijma: A cognitive behavioral treatment model of vaginismus . In: Scandinavian Journal of Behavior Therapy . tape 26 , no. 4 , 1997, p. 147-156 , doi : 10.1080 / 16506079708412484 .
  14. ↑ Hannes Wader Der Tankerkönig Lyrics ( Memento from March 11, 2016 in the Internet Archive )