Vaginismus is a fairly common sexual disorder (up to 2% of women) that tends to worsen over time. It consists of an involuntary, reflex contraction of the muscles of the perineum, vulva and vaginal opening, associated with a fear of intercourse, which makes penetration impossible or very painful (dyspareunia). There is often a significant psychological and emotional component, which can make even a simple digital examination during a gynaecological visit impossible.
The disorder may be linked to traumatic memories, but often there is no connection with negative sexual experiences. Sometimes a vicious circle develops: fear of penetration causes spasm of the perineal muscles, which makes penetration impossible and may be accompanied by sweating, nausea and vomiting. Vaginismus can be approached in several ways: psychological therapy is very important, with autogenic training and muscle relaxation techniques, and lubricants, local anaesthetics and muscle relaxants are also used.
Progressive dilators to overcome the muscle spasm and Kegel exercises are also proposed. In some cases surgery may be used, especially when the hymen is particularly fibrous. Another way to treat the condition is with botulinum toxin injections.
Botulinum toxin is a neuromodulator, mainly used in aesthetic medicine to reduce wrinkles of the upper face, but increasingly used for many other conditions. The injection relaxes the muscles affected by the spasm, allowing penetration after a few days. The psychological aspect then also improves, and according to the scientific literature most couples can begin a normal sex life.
The treatment is done in the outpatient clinic and takes a few minutes. In selected cases it can be combined with light sedation. Patients can return to their normal activities straight away. See also female intimate rejuvenation.