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Vaginismus: Types, Causes, Symptoms, Diagnosis, Treatment

Home » Vaginismus

Vaginismus is the term used when there is an involuntary contraction of the vaginal muscles in a woman whenever the partner tries penetration. It is seen in 5 to 17 % of patients and is believed to be one of the most prevalent sexual dysfunctions in women. Vaginismus can prevent sexual activity or make it painful; and can come in the way of the couple trying to get the baby.

Vaginismus can not only happen during sexual activity but also can happen when a woman tries to insert a tampon or a woman is touched near the vaginal area. 

Though vaginismus does not interfere with arousal; it can prevent penetration. Though having vaginismus is no fault of yours; it can interfere with relationships and affect the quality of life.

ICD-10 Codes for Vaginismus:

Vaginismus is a condition where there is an involuntary contraction of the vaginal muscles, making penetration painful or difficult. Relevant ICD-10 codes include:

  • N94.1: Dyspareunia (painful intercourse, which can be related to vaginismus)
  • N94.2: Vulvodynia (chronic pain in the vulva which can be associated with vaginismus)
  • N94.4: Dysmenorrhea (if the pain during intercourse is associated with menstrual pain)
  • N94.6: Female sexual arousal disorder (if vaginismus is associated with sexual dysfunction)

CPT Codes for Diagnosis and Treatment of Vaginismus:

Diagnosis and treatment of vaginismus may involve several procedures:

  1. 99201 – 99215: Office or other outpatient visits (for evaluation, diagnosis, and management of vaginismus)
  2. 76830: Ultrasound, transvaginal (to evaluate pelvic anatomy if relevant)
  3. 58100: Endometrial biopsy (if there are concerns about endometrial pathology)
  4. 58558: Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C (if hysteroscopic evaluation is needed)
  5. 58660: Laparoscopy, surgical; with lysis of adhesions (if adhesions are contributing to pain or vaginismus)
  6. 58300: Endometrial biopsy (if necessary for diagnostic purposes)

 

Dr. Dimple Doshi at Vardaan Hospital; believes prevention is better than cure, and thus apart from the precise treatment guidelines; preventive measures are an essential part of our consultations with the patients who have either had it or want to know more about it.

Vaginismus is divided into two types:

  1. Primary vaginismus: When vaginal penetration has never been achieved.
  2. Secondary vaginismus: Vaginal penetration was achieved once but is no longer possible due to factors like gynecological surgery; menopause; trauma or irradiation

Many times there is no reason for vaginismus but it can result from:

  1. Past painful intercourse
  2. Emotional factors
  3. Past sexual abuse or trauma

 To make a diagnosis; your gynaecologist will do your physical examination and take your medical and sexual history. This history may give a clue to your treating gynaecologist as to why and how often vaginismus is happening.

Your gynaecologist will diagnose vaginismus based on your symptoms to really confirm the diagnosis of vaginismus and will ask

  1. When it happened
  2. How often it occurs
  3. What triggers it

Usually the women who have vaginismus; are also likely to have intolerance to physical examination by the gynaecologist. So your gynaecologist will try to make you comfortable and then carry out the vaginal examination if possible.

Whenever there is vaginismus; there will not be any obvious findings on your physical examination which would thereby confirm the diagnosis of vaginismus.

Vaginismus is a treatable condition as it does not involve any disease or abnormality in a woman.

Treatment of vaginismus requires education; counseling and exercises.

  1. Education:  Education involves learning about the body anatomy; what happens during sexual intercourse; which vaginal muscles show contraction before the sexual activities; this helps you to understand how your body is responding and there is no need to panic.
  2. Counselling: If education does not work enough; then a sexologist will counsel you and your partner about the condition.
  3. Relaxation techniques and hypnosis can promote stress-free mind to make you comfortable.
  4. Vaginal dilators: Your gynaecologist may recommend you to use the dilators. These vaginal dilators start form a small to bigger size. You will be explained in detail about the use and how to switch to the bigger sizes; how frequently you should be doing and when to resume the sexual intercourse after a certain number of vaginal dilator starts to go in without the resistance.
  5. Examination under anesthesia: It may be suggested by your gynaecologist if you are planning a baby and suffering from vaginismus.  

Having vaginismus is nothing to be ashamed of. Instead; do not hesitate to talk to your gynaecologist and explain the problem. Talk freely to your partner also and tell him that you are ready to seek medical help. 

Having vaginismus is not the end of the sexual life. Yes; proper guidance and treatment can prevent it from taking a toll on relationship. Many people recover and go on to live happy sexual lives. 

Scheduling treatment with the counsellor may be beneficial. Confide in your partner ; experiment and find out what works best for you .

Vaginal dilators start from the small to bigger sizes. You should be starting with the smallest one first.

Start by getting into a comfortable position.

  1. Lie on your back with your feet flat on the bed; your knees slightly bent.
  2. Spread your legs so they’re shoulder-width apart.  You can also place pillows under your knees for support.
  3. Make sure you can easily touch the opening of your vagina with your hand, you can also use a mirror to see where you are going.

When you start using the dilators; initially you can insert only the tip and that is fine.

Dilating can be painful in beginning and it may take weeks or months. And when you push the dilator; do not go above 3 to 4 pain level.

Use one dilator for at last 15 to 20 minutes; one or two times a day. Remain lying on your back while the dilator is in place. Leave it there for 20 min. While you may have to hold the dilator in place; your overactive muscles may try to push it out especially if you are suffering from vaginismus.

And yes; if you are not use your dilators for 20 min for the first time; do not worry.

Once you are able to insert a smaller dilator with ease; you may progress upto the next size; Note that progressing up in size may take weeks or days. If your muscles are loose and relaxed; you may progress up in size easily.

In a span of few months; you will be able to insert the desired dilator without any pain or without your vaginal muscles contracting strong enough to push it back.