Vaginismus Diagnosis - How to Diagnose Vaginismus?

Vaginismus diagnosis

The diagnosis of vaginismus can be made by a variety of health care professionals. A detailed history often will indicate that the woman has persistent and recurrent difficulties in having vaginal intercourse. She may express depression or frustration that she is unable to have successful intercourse.  A psychiatrist or psychologist can use detailed questioning to ascertain the diagnosis. A gynecologist may also be able to make the diagnosis, who may sense an apprehension during the history and often the patient expresses much anxiety or declines a pelvic examination.  A trained pelvic floor physical therapist (PT) may also be able to give the diagnosis after an examination and after review of the patient history. Sometimes behavior immediately preceding or during a pelvic examination may give the examiner an impression of likely vaginismus. The patient may decline pelvic examination, may request pediatric speculum or may even be on the examination table with tightly closed thighs and arching back.

Some other providers may also use a questionnaire.  As reported in Klassen et al in 2009, a study group from the Netherlands has published results of a detailed questionnaire called the Vaginal Penetration Cognition Questionnaire (VPCQ). This questionnaire tries to identify non-physical correlates linked to vaginismus.

According to an article by Hope and Associates (Hope 2010) the prevalence of vaginismus varies from 4%-42%. According to Laumann et all, the prevalence of vaginismus has been reported to be approximately 6% in two widely National Health and Sexual Life Survey. Women may have primary vaginismus when she has never been able to achieve successful penetration or sexual intercourse without pain. Secondary vaginismus occurs when a woman has previously been able to have penetration but subsequently develops vaginismus.

Lamot classified vaginismus into varying severities: first degree where spasm can be relieved with reassurance; second degree where spasm is maintained even with reassurance; third degree is associated with buttock elevation to avoid examination; fourth degree is associated with elevation of the buttocks and tight closure of the thighs; fifth degree is associated with visceral responses including fear reaction of palpitations, nausea, vomiting, shaking, trembling or wanting to jump off the examination table or even attack the health care provider.

A detailed history is a critical aspect for evaluating a woman with vaginismus. Some common characteristics in the history may include: past sexual trauma, abuse, psychological disorders such as anxiety, depression, marital discord or negative messaging regarding sexual activity during childhood and the teen aged years.



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