1. THE TRUTH BEHIND VAGINISMUS DISEASE
A Term Paper
Presented to
Ms, Bai Salam M. Ibrahim
Faculty of the English Department
College of Social Science and Humanities
Mindanao State University
Marawi City
In Partial Fulfillment
Of the Requirements for the Course
English 2 Dd2 (College English II)
by
Alkhima M. Macarompis
March 2011

2. OUTLINE
Thesis Statement: “A condition that can close the entrance of the vagina preventing
intercourse.”
Introduction
Vaginismus can strike any woman at any time at any age. This methodology is discussed in its
various aspects and with a cultural background. It also emphasizes the need for physicians to be mindful
of cases of Vaginismus requiring psychiatric intervention rather than gynecological treatment.
I. Nature of Vaginismus Disease
A. Definition/Description
B. Prevalence
C. Types of Vaginismus Disease
a. Primary Vaginismus
b. Secondary Vaginismus
D. Cycle of Pain
II. Symptoms and Diagnosis of Vaginismus Disease
A. Common Symptoms of Vaginismus Disease
B. Medical Diagnosis of Vaginismus Disease
III. Causes of Vaginismus Disease
A. Physical Causes
B. Non-physical Causes
IV. Treatment of Vaginismus Disease
A. Physical Treatment
B. Psychological Treatment
Conclusion

3. Vaginismus can be triggered by physical events as simple as having inadequate foreplay or
lubrication, or non-physical emotions as simple as general anxiety, it is important that it be understood
that Vaginismus is not the woman's fault. Once triggered, the involuntary muscle tightness occurs without
conscious direction; the woman has not intentionally 'caused' or directed her body to tighten and cannot
simply make it stop. Women with Vaginismus may initially be sexually responsive and deeply desire to
make love but over time this desire may diminish due to pain and feelings of failure and discouragement.
It is extremely frustrating to be unable to physically engage in pleasurable sexual intercourse.

4. INTRODUCTION
Vaginismus is a sexual dysfunction involving various branches of medicine, including psychiatry
and gynecology. Psychiatric help is sought in only a small proportion of cases, although it is probable that
the psychopathological etiology is more frequent than generally recognized. This article deals with the
causes and psychological circumstances in four Turkish couples who presented with unconsummated
marriage for 3 to 7 years. Vaginismus F52.5 to the ICD-10 is a sexual dysfunction characterized as: deep
anxiety about coitus leading to extreme spasm of musculature making coitus impossible or extremely
unpleasant and painful.
This study reflects the importance of letting the readers know about how Vaginismus disease
affects women and men living life. This paper aims to explain what is Vaginismus, what is its Diagnosis
and symptoms and what are its causes including the treatments of Vaginismus Disease.
The researcher used internet and some books related to the topic as her reference for the study.
The data and information presented in this research paper are only limited to the reading materials
available at the Mindanao State University (MSU) and the college of Health Sciences (CHS) library.

5. Vaginismus is a vaginal tightness causing discomfort, burning, pain, penetration problems, or
complete inability to have intercourse. A condition where there is involuntary tightness of the vagina
during attempted intercourse. Its tightness actually caused by involuntary contractions of the
pelvic floor muscles surrounding the vagina.
The prevalence of Vaginismus has been reported to be 6% in two widely divergent cultures,
Morocco and Sweden. The prevalence of manifest dyspareunia has been reported as low as 2% in elderly
British women, yet as high as 18-20% in British and Australian studies. By another study Vaginismus
rates of between 12% and 17% have been reported in women presenting to sex therapy clinics (Spector
and Carey, 1990). National Health and Sexual Life Survey, which used random sampling and structured
interviewing, found that between 10% and 15% of women reported having experienced pain during
intercourse the last 6 months (Laumann et al. 1994).
There are two types of Vaginismus disease: Primary Vaginismus and Secondary Vaginismus. The
Primary Vaginismus is when a woman has never been able to have penetrative sex or experience vaginal
penetration without pain. It is commonly discovered in teenagers and women in their early twenties, as
this is when many young women in the Western world attempt to use tampons, have penetrative sex or
undergo a Pap smear.
According to Lamont, sometimes the primary Vaginismus is idiopathic and he describes four
degrees of Vaginismus. In first degree, the patient has spasm of the pelvic floor which can be relieved
with reassurance. In second degree, the spasm is present but maintained throughout the pelvis even with
reassurance. In third degree, the patient elevates the buttocks to avoid being examined. In fourth degree
Vaginismus (also known as grade 4 Vaginismus), the severe form of Vaginismus, the patient elevates the
buttocks, retreats and tightly closes the thighs to avoid examination. And the secondary Vaginismus is a
sexual pain can affect women in all stages of life, even women who have had many years of pain-free
intercourse. It refers to the experience of tightness pain or penetration difficulties later in life, after

6. previously being able to have normal, pain-free intercourse. It typically follows or is triggered by
temporary pelvic pain or other related problems. It can be triggered by medical conditions, traumatic
events, relationship issues, surgery, life-changes (e.g. menopause), or for no apparent reason and it is the
common culprit where there is continued, ongoing sexual pain or penetration tightness where there had
been no problem before.
For many women, Vaginismus comes as a surprise; unexplained tightness, discomfort, pain, and
entry problems are unexpectedly experienced during intercourse attempts. The painresults from the
tightening of the muscles around the vagina (PC muscles). Since this occurs without the conscious intent
or control of the woman, it can be very perplexing.
Usually at the root of Vaginismus is a combination of physical or non-physical triggers that cause
the body to anticipate pain. Reacting to the anticipation of pain, the body automatically tightens the
vaginal muscles, bracing to protect itself from harm. Sex becomes uncomfortable or painful, and entry
may be more difficult or impossible depending upon the severity of this tightened state. With attempts at
sex, any resulting discomfort further reinforces the reflex response so that it intensifies more. The body
experiences increased pain and reacts by bracing more on an ongoing basis, further entrenching this
response and creating a Vaginismus 'cycle of pain.' Here is a Cycle of Pain: Firstly, the body anticipates
pain because of the fear and the anxiety it contributes. Secondly, the body automatically tightens vaginal
muscles. Thirdly, tightness makes sex painful penetration maybe impossible because tightness results
from the involuntary tightening of the pelvic floor (especially the pubococcygeus (PC) muscle group),
although the woman may not be aware that this is the cause of her penetration or pain difficulties.
Fourthly, pain reinforces/intensifies reflex response. Fifthly, the body reacts by “bracing” more on
ongoing basis. And the lastly, avoidance of intimacy lack of desire may develop.
Some researchers have suggested that fear of pain isn’t a cause of Vaginismus, rather a symptom.
On the other hand, others have stressed its possible causal and maintaining role in the disorder. Fear of

7. pain was the primary reason for abstinence in an interview study of 476women with Vaginismus.
Symptoms of Vaginismus vary between women, Vaginismus cancause distress and relationship problems
and may prevent a woman from starting a family because it disrupts or completely stops her sex life.
Depending on the intensity, Vaginismus symptoms range from minor burning sensations with tightness to
total closure of the vaginal opening with impossible penetration. Strong indicators of vaginismus include
any of the following:
Difficult penetration or impossible intercourse / unconsummated couples
Female penetration problems and unconsummated marriages are typically due to vaginismus.
Entry tightness and pain are common symptoms of vaginismus.
Ongoing sexual pain after a pelvic problem, medical issue, or surgery
The experience of ongoing sexual pain or tightness after resolving or managing a
pelvic medical or pain issue is typically due to vaginismus (see also dyspareunia).
Ongoing sexual pain after childbirth
The experience of ongoing sexual pain or tightness following childbirth (after everything has
healed) is typically due to secondary vaginismus.
Ongoing sexual pain and tightness with no discernible physical cause
Vaginismus often occurs only during sex attempts. Physicians may initially be unable to find any
problem or cause for the sexual difficulties.
Avoidance of sex due to pain and/or failure
When a woman states that she avoids being intimate with her husband because sex does not feel
good or has become very painful, vaginismus should be strongly considered.
One of the most important aspects of Vaginismus diagnosis is simply the thorough elimination of
other possible physical or medical conditions that may be causing the symptoms
- leaving the near-certain likelihood of vaginismus. The process of elimination is a critical part

8. of vaginismus diagnosis. The diagnostic process will typically entail giving a medical and sexual history
and undergoing a pelvic or gynecological exam. The physician will discuss the location and occurrence of
pain to help render an accurate vaginismus diagnosis or may request some other tests to help rule out any
other problems besides vaginismus.
Note that many women seeking diagnosis are often simply left undiagnosed and turned away by
physicians who fail to find anything physically wrong and feel there is nothing more they can do. They
may not consider a diagnosis of vaginismus due to simple lack of awareness. There are many dangers in
being given an improper diagnosis from an uninformed professional.Unnecessary, invasive and
potentially harmful surgeries and medications have been suggested for women with vaginismus who have
not been properly diagnosed.
Misdiagnosis and the promotion of invasive or unhelpful surgeries are sometimes the unfortunate
result of all this confusion. There is no surgery to cure vaginismus. It is very important to seek a second
opinion if surgery to 'widen' the vaginal opening has been recommended as this does not normally resolve
the penetration problem, but instead may further complicate the problem. Unnecessary, invasive, and
potentially harmful surgeries and medications have been suggested for women with vaginismus who have
not been properly diagnosed. Vaginismus is a highly treatable condition that does not require any invasive
procedures.
Women often suspect they have vaginismus from their symptoms, but getting medical
confirmation can be challenging. Confirming a formal diagnosis of vaginismus may take some planning
and perseverance. No definitive medical test exists for the diagnosis of vaginismus so it may take a
number of visits to several physicians or specialists before a medical diagnosis is obtained. When
physicians are initially unable to find any specific medical problem (a common experience of vaginismus
sufferers), no diagnosis or misdiagnosis is a common outcome of initial medical exams. Many physicians
are unfamiliar with vaginismus, so part of the process is simply finding a physician that is knowledgeable

9. about the condition. A successful medical diagnosis of vaginismus is typically determined through patient
history and description of the problem, gynecological examination and the process of ruling out the
possibility of other conditions.
Talking to physicians about sexual problems can be difficult. Embarrassment, shame andanxiety
are often present, making it hard to communicate and obtain appropriate care. Women may need to
strongly advocate for themselves, insisting on a full diagnosis from a knowledgeable professional to rule
out any other medical condition and properly confirm the vaginismus diagnosis. A medical diagnosis is
helpful in removing any doubts or anxiety related to identifying the condition and enables women to have
more confidence in moving toward treatment solutions.
Vaginismus is a unique condition in that it may result from a combination of either physical or
non-physical causes or it may seem to have no cause at all. Here are some examples of Non-Physical
causes: 1) Fear “Fear or anticipation of intercourse pain, fear of not being completely physically healed
following pelvic trauma, fear of tissue damage (ie. "being torn"), fear of getting pregnant, concern that a
pelvic medical problem may reoccur, etc. 2) Anxiety or stress “General anxiety, performance pressures,
previous unpleasant sexual experiences, negativity toward sex, guilt, emotional traumas, or other
unhealthy sexual emotions. 3) Partner issues “Abuse, emotional detachment, fear of commitment,
distrust, anxiety about being vulnerable, losing control, etc. 4) Traumatic events “Past emotional/sexual
abuse, witness of violence or abuse, repressed memories. 5) Childhood Experiences “Overly rigid
parenting, unbalanced religious teaching (ie."Sex is BAD"), exposure to shocking sexual imagery,
inadequate sex education. And 6) No cause “Sometimes there is no identifiable cause (physical or non-
physical).
And also here are some examples of Physical Causes: 1) Medical conditions
“Urinary tract infections or urination problems, yeast infections, sexually transmitted disease,
endometriosis, genital or pelvic tumors, cysts, cancer, vulvodynia / vestibulodynia, pelvic inflammatory
disease, lichen planus, lichen sclerosus, eczema, psoriasis, vaginal prolapse, etc.”
2) Childbirth “Pain from normal or difficult vaginal deliveries and complications, c-sections,

10. miscarriages, etc.” 3) Age-related changes “Menopause and hormonal changes, vaginal dryness /
inadequate lubrication, vaginal atrophy.” 4) Temporary discomfort “Temporary pain or discomfort
resulting from insufficient foreplay, inadequate vaginal lubrication, etc.” 5) Pelvic trauma “Any type of
pelvic surgery, difficult pelvic examinations, or other pelvic trauma.” 6) Abuse “Physical attack, rape,
sexual/physical abuse or assault.” And 7) Medications “Side-effects may cause pelvic pain.”
These are a variety of factors that can contribute to Vaginismus. These may be psychological or
physiological and the treatment required can depend on the reason that the woman has developed the
condition. As each case is different, an individualized approach to treatment is useful. The condition will
not necessarily become more severe if left untreated, unless the woman is continuing to attempt
penetration, despite feeling pain. Some women may choose to refrain from seeking treatment for their
condition.
According to the Cochrane Collaboration review of the scientific literature, “In spite of
encouraging results reported from uncontrolled case series there is very limited evidence from controlled
trials concerning the effectiveness of treatments for Vaginismus. Further trials are needed to compare
therapies with waiting list control and with other therapies.” Although few controlled trials have been
carried out, many serious scientific studies have tested and proved the efficacy of the treatment of
Vaginismus. In all cases where the systematic desensitization method was used, success rates were close
to 90-95% and even 100%. For an example of one of these studies, see Nasab, M., and Farnoosh, Z., or
for a basic review, see Reissing’s literature review. A Dutch study showed that many women were
subsequently able to be penetrated, but far fewer women actually enjoyed being penetrated.
According to Ward and Ogden’s qualitative study on the experience of Vaginismus for women (
1994), the three most common contributing factors to Vaginismus are fear of painfulsex; the belief that
sex is wrong or shameful (often the case with patients who had a strict religious upbringing); and
traumatic early childhood experiences (not necessarily sexual in nature.

11. Vaginismus patients are twice as likely to have a history of childhood sexual interference and
held less positive attitudes about their sexuality whereas no correlation was noted for lack of sexual
knowledge or physical abuse.
For some women, especially those with primary Vaginismus, it is important to address the
psychological aspects of the problem as well as the actual muscle spasm.
A woman may choose to address the issue on her own terms, or she may avail the help of a
therapist. Some women, especially those with secondary Vaginismus, may rely on a physical rather than
psychological treatment and also be successful. There are emotional difficulties associated with
Vaginismus, which can include low self-esteem, fears and depression. As Vaginismus includes a reflex,
Vaginismus should not be viewed as an behavior problem; so behavior therapies are problematic.
Therapies that include the body and deeper brain structures (like EMDR) appear to be the more logical
therapeutic choice.
Physical treatment of the internal spasm may include sensate focus exercises, exploring the
vagina through touching, and desensitization with vaginal dilators. Dilating involves inserting objects,
usually phallic in shape, into the vagina. In treating the spasms through dilation, the objects used
gradually increase in size as the woman progresses.

12. CONCLUSION
It is important to note that Vaginismus is not triggered deliberately or intentionally by women. It
happens involuntarily without their intentional control and often without anyawareness on their part.
Vaginismus has a variety of causes, often in response to a combination of physical or emotional factors.
Since Vaginismus can be triggered by physical events as simple as having inadequate foreplay or
lubrication, or non-physical emotions as simple as general anxiety, it is important that it be understood
that Vaginismus is not the woman's fault. Once triggered, the involuntary muscle tightness occurs without
conscious direction; the woman has not intentionally 'caused' or directed her body to tighten and cannot
simply make it stop. Women with Vaginismus may initially be sexually responsive and deeply desire to
make love but over time this desire may diminish due to pain and feelings of failure and discouragement.
It is extremely frustrating to be unable to physically engage in pleasurable sexual intercourse.
Life experiences vary dramatically from person to person. Some women's bodies react with
Vaginismus, while others with nearly identical experiences do not.
The anticipation of pain, emotional anxieties, or unhealthy sexual messages can contribute to and
reinforce the symptoms of Vaginismus. Frequently, but not always, there are deep-seated underlying
negative feelings of anxiety associated with vaginal penetration. Emotional triggers that result in
Vaginismus symptoms are not always readily apparent and require some exploration. It is important that
effective treatment processes include addressing any emotional triggers so a full pain-free and pleasurable
sexual relationship can be enjoyed upon resolution.

13. BIBLIOGRAPHY
A. JOURNALS
Crowley, Tessa; et al., (2006). “Recommendations for the Management of Vaginismus”.
International Journal of STD & AIDS 17 (January 2006):m14-18.
Reissing E, E.; et al. “Does Vaginismus exist? A critical review of the literature”. The Journal of
Nervous and Mental Disease 187 (1999): 261-271.
Ward, E.; Ogyden, J. “Experiencing Vaginismus: suffering beliefs about causes and effects”. The
Journal of Nervous and Mental Disease 9 (1994): 33:45.
Lamont, JA. “ Vaginismus”. American Journal of Obstetrics and Gyneology 131 ( 1978): 633-6.
Ronald W. Lewis, MD, Kersten S. Fugl-Meyer, PhD. “ Epidemiology/Risk Factors of Sexual
Dysfunction”. The Journal of Sexual Medicine 1 (2004): 35
B. DICTIONARY ENTRY
“Vaginismus Disease”. Microsoft Student with Encarta Premium. 2009.
C. ON-LINE RESOURCES
http://www.vaginismus.com/vaginismus-diagnosis
http://epharmapedia.com/news/details/11/102/Vaginismus_Pathophysiology_Etiology_and_New_
Treatment.html?lang=en
http://www.vaginismus-awareness-network.org/lit_reveiw.html