Vaginismus, literally formed by the combination of the words vagina (sheath) and ismus (action), occurs as a result of the involuntary and reflexive contraction of the muscles in the lower part of the women's vagina, making sexual intercourse difficult or impossible or quite painful. is the situation that causes it to happen. Depending on the degree of this contraction, the penis may not be able to enter the vagina. Sometimes even the thought of having intercourse can cause some symptoms similar to panic attacks, which can also occur as a result of trying to have sexual intercourse.
It is one of the most commonly observed female psychosexual problems. Palpitations, commonly observed body convulsions, panic and fear are generally observed symptoms. It can occur not only with the penis, but also with the influence of a finger or tampon. It has been observed that similar reactions may occur to the speculum used in gynecological examinations. In addition to all these, vaginismus can also occur due to imagination. This condition may also occur with similar symptoms as a result of imagining the penis or an object entering the vagina. Therefore, it should not be limited to being related to sexual intercourse, but should be defined generally as the result of pain and fear related to sexual activity. Vaginismus, which is a phobia-level fear of penetrating the vagina, causes extreme physical pain during sexual intercourse, as well as psychological pain of the same intensity. Often these symptoms are accompanied by an avoidance response. The resulting spasms lead to a vicious cycle that brings with it phobia and avoidance. This disorder causes distress in the individual or difficulties and problems in interpersonal relationships.
Salemo Trotula defined vaginismus in 1547 as "a narrowing of the vulva that causes a woman to remain a virgin despite arousal" and was first published in 1867. The concept of vaginismus was defined by the American gynecologist Sims in 1999.
Diagnosis in Vaginismus
In the first studies on vaginismus, it was argued that the reason for the spasms was due to the insufficiency in the size of the vagina. However, research conducted in subsequent years As a result of the research, it has been revealed that sexual stimulation causes an increase in the size and width of the vagina, and due to its flexible structure, the vagina can accommodate penises of almost any size. In this direction, studies on vaginismus as a psychological problem rather than diagnosing it as a physical problem have gained importance.
The developed vaginismus diagnoses were based on the idea that it is a state of hypersensitivity seen only in the sexual organs. In this regard, the vaginal muscle spasm experienced has been described as a phobic response to pain. For this reason, "psychotherapy" and "sexual education" approaches have been adopted in vaginismus treatments rather than enlargement or surgery.
If the problem and symptoms occur from the first sexual experience,primary vaginismusis in question. Primary vaginismus can also be defined as lifelong vaginismus.
If the symptoms appear later and there is a satisfactory period in the individual's sexual life in which no symptoms or problems are experienced, there is secondary vaginismus.
Situational (partial) vaginismus is the occurrence of symptoms in certain environments and not in other situations.
Diffuse (total) vaginismus is that the sexual problem occurs during all sexual activities.
Causes of Vaginismus
According to research, it has been revealed that there is no single cause of vaginismus and the causes are classified as physical or psychological reasons.
Organic/Physical Causes Causing Vaginismus
- Vaginal shrinkage and adhesions due to vaginal shrinkage
- Vaginal Operation
- Intra- Vaginal Radiation
- Uterine Prolapse
- Pain during sexual intercourse
- Chocolate Cyst
- Vaginal tissue disorders and tumors
- Sexually transmitted diseases
- Pelvic Blood Pressure Abnormalities
However, it should be noted that these causes have limited effects on vaginismus.
Psychological Reasons Causing Vaginismus
Psychology For these reasons, we are trying to determine and make sense of the underlying psychological processes, not why the spasms that occur with vaginismus occur. We are trying to understand the unconscious process of the spiritual structure that causes these contractions in the body. Within the framework of this approach, the center of the unconscious process is generally the hostility or jealousy towards the opposite sex or the fear of being harmed by sexual attitudes.
Psychological reasons according to the Cognitive Approach: Disturbances in the meaning, interpretation and perception of the cognitive process in the development of the vaginismic response in vaginismus. stages play an active role. The brain, which basically develops a situation of misinterpretation, also acts with some automatic thoughts. The things that cause these automatic processes are generally; exaggerated or unrealistic expectations resulting from incomplete and incorrect information about sexuality, etc.
Psychological reasons according to the Behavioral Approach: According to the behavioral approach, the natural sexual reflex of the individual is conditioned by a negative internal or external stimulus, and this disrupts the natural flow of sexual behavior. The individual develops a reaction to sexual stimulation situations due to these internal or external stimuli. This reaction turns into an above-normal anxiety in the person and the sexual response occurs negatively. Thus, a vicious circle emerges.
Clinical applications are carried out by considering the behavioral approach and the cognitive approach equally.
According to the Psychodynamic Approach, on the basis of individuals' development of vaginismic response; They develop consciously or pre-consciously anger-based feelings towards the opposite sex. Women who develop these feelings unknowingly develop a sense of satisfaction by making their partners sexually unhappy or not allowing sexual intercourse.
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