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Vaginismus (Pain With Spasm At Time Of Entry)

In vaginismus involuntary painful contraction of vaginal entry muscles (i.e. vaginal opening) is so painful that entry is virtually impossible. So that due to spasm of introitus muscles there occurs virtual closure of the vaginal opening with significant pain. Vaginismus is one of the causes of Dyspareunia. This is one of the common cause of coital pain & even this one of the important cause for non-consummation of marriage. This can be classified as lifelong or situational. Similarly it may be classified as primary from beginning or secondary means started later in life. It is found in approximately one percent of women. In some women there may be mild degree of vaginismus in which sexual intercourse is possible but with pain. In one study approximately 10% housewife had some degree of vaginismus pain.

In vaginismus pain felt by girl or female is so much that next time she starts avoiding the sexual contact of any kind because of fear that it will give her pain. Thus in most cases husband is unable to penetrate her successfully also called as non-consummation of marriage.
But the fore play & sexual desire excitation & lubrication may be absolutely normal in vaginismus women. In many women they do sex between their abducted thighies. With this technique even many vaginismic women may get enough arousal & even orgasm.
Due to any of the various below-mentioned causes the vaginal penetration or intercourse may be painful. This leads to development of a conditioned response in the body, so that the moment penis or even finger comes closure to vagina for penetration there occurs painful spasm of all the pelvic muscles at vaginal opening with associated fear of penetration. Thus nothing can enter. In future She starts avoiding sex.

THE CAUSES OF VAGINISMUS ARE
Disorder of sex centre: So that vagina & muscles around it goes into painful spasm at the point of penis entry rather than relaxing.
arrow It may also occur following any previous painful penetration of penis i.e. painful sexual intercourse or painful entry of some other object as painful examination of vagina by doctor with some instrument or by some traumatic experience in the past.
arrow Sexual aversion disorder & female sexual arousal disorder
arrow Hormone disorder:In which female hormones are less some other sex stimulating hormone are disturbed.

These hormone disorders may be due to any of the following causes:
Hypothalmic idiopathic hypogonadotropic hypogonadism, Prolactinomas, Empty sella, Sheehan syndrome, Panhypopituitarism, Inflammatory /infiltrative

Ovarian lesions : Granulosa-theca cell, Brenner, mucinous/serous cystadenomas, Krukenberg. mumps oophoritis, Resistant ovary (Savage syndrome), Autoimmune disease
Defect in uterus or vagina : Narrow vaginal openings or small vagina,Labial agglutination/fusion, transverse vaginal septum, Complete androgen resistance (testicular feminization).
Infections: in genital tract or vulvae vestibule, vulvo-vaginitis
arrow Less lubrication due to various reasons as hormone deficiency
arrow Connective tissue diseases leading to dryness
arrow Psychological problems: as depression & other psychiatry disorders
arrow Sicca syndrome
arrow Idiopathic
arrow Any ulcerative lesions of vagina as chronic lichen planus, herpese genitals, Pemphigus vulgaris of vagina
arrow Decreased blood supply to vagina due to various medical conditions can lead to diminish vaginal lubrication, pain during intercourse
arrow Vulvar vestibulitis
arrow Restrictive upbringing, Inadequate sexual information, early insecurity in psychosexual role
arrow Obstructive vaginal lesions: Vaginal stenosis, vaginal scarring, post surgical problems, retroverted uterus, organic diseases of uterus, endometriosis, adenomyosis, tubes or ovaries, chronic pelvic inflammatory diseases, urethral diverticulum
arrow Idiopathic vulvodynia

DIAGNOSIS OF CAUSE OF PAIN DURING SEX
First step in proper treatment of pain during sex is accurate diagnosis of cause of her pain during sex. So we first try to find out cause. We take detailed history, thorough sex counseling and physical examination by female doctor, examination genitals. After that depending on likelihood of particular, cause relevant tests are done at our centre. Thus you may consult us at our centre & at same time you may get all test done also. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.
arrow Fear of pain: In this the moment lady thinks of going for sex, She starts fearing that, I may get pain again thus she start getting anxious about pain during sex. This fear decreases her confidence leading to further worsening of the pain. Many times due to this fear patient starts avoiding sex & his desire for intercourse decreases.
arrow Anxiety due to anticipation of pain: Woman develops severe anxiety before real sex. Patient develops obsessive concern for pain during sex i.e. whether or not She can do the sexual activity without pain & can keep his partner satisfied. This performance anxiety can be cured by sex therapy in few sittings.
arrow So by sex therapy, the patient is taught how to avoid fearing and become free of fear of failure & performance anxiety.
arrow So above secondary problems hinder into normal recovery of sexual function even if the original cause may have been cured. After correcting primary cause also sometimes pain during se does not disappears, because these secondary factors interfere with normal sexual functioning. If these factors are also removed by sex therapy, sexual functioning soon becomes normal. The new, intensive team treatment of sexual dysfunction has revolutionized sex therapy. In most cases, for cure of pain during sexual intercourse detailed sex counseling & sex therapy is necessary.

DIAGNOSIS OF CAUSE OF PAIN DURING SEX
First step in proper treatment of pain during sex is accurate diagnosis of cause of her pain during sex. So we first try to find out cause. We take detailed history, thorough sex counseling and physical examination by female doctor, examination genitals. After that depending on likelihood of particular, cause relevant tests are done at our centre. Thus you may consult us at our centre & at same time you may get all test done also. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.

DETAILED HISTORY
Onset: We take detailed history, as for quality of pain whether is at the introitus, superficial or deep inside, whether it is mild, moderate or severe pain. Then we decide whether it occurs all the time only during sexual activity. How is the response of previous treatment? Response to previous therapy, Libido, Stress (physical or mental), History of precipitation by some drugs any past history of sexual abuse or painful sex.

EXAMINATION OF GENITALS
We examine whether any Sexual Development defect is present or not. For this vaginal size is measured by vaginometer or Genitometer (if patient is outstation then by radiological tests). The vagina is examined for some local problem. In many cases vaginal examination may or may not elicit the spasm & pain. If the vaginal examination is very painful with accompanied spasm is another proof of the diagnosis as vaginismus. Status of female hormone is assessed by examination of various estrogenic signs. Galactorrhoeas & features of other hormones disorders are checked up. Blood supply of vagina is assessed, by assessing the texture of vaginal wall. Nerves supplying the female genitals examined by sensation testing & Deep Tendon reflexes. Then other systems of body are also examined.

INVESTIGATIONS I.E. DIAGNOSTIC TESTS
At our centre we have all the facility for complete investigation of cause of pain during coitus & other difficulties. So we perform following tests, step by step depending on their need based on history & examination.
The various diagnostic tests needed/performed are as follows:
arrow HORMONE TESTING Various Female sex hormones & other associated Hormones are tested by latest-immunoassay techniques. These hormones includes total Estradiol, Estriol, Prolactin, LH, FSH, T3, T4, TSH others as Cortical, E2, Free testosterone SHBG etc. Among above tests relevant hormones are tested in that particular patient. Results are available in 36 hours. When we find out any of above hormones disorder correction of these hormone disorder helps a lot in eliminating pain. Blood glucose & other relevant tests are also done.
arrow ULTRASOUND SCANNING Ultrasound scanning is done to decide whether any type of local problem is present or not, accordingly treatment is prescribed
arrow SEX COUNSELING After detail discussion with our female sex therapist, we try to finds out the root cause of pain problem then we treat accordingly. For counseling we take detail history of sexual development, her thoughts, her misconception about sex, her old experience in sex, her unconscious fears about sex. This counseling session unravels all the hidden psychological causes of sexual pain disorder.
arrow OTHER TESTS (If required)
arrow Pelvic Nerve Testing: By conduction and sensory testing (NCV, EMG).
arrow Psychoanalysis: To find different factor leading to psychogenic pain disorder.
arrow Detailed Sex Counseling 

TREATMENT OF VAGINISMUS
Once the diagnosis of vaginismus is confirmed after detailed history, examination, relevant investigations, we start the treatment. It involves giving the sex therapy session, which is focused on eliminating the painful vasospasm of pelvic muscles & associated fear of entry of penis into vagina.
The various treatment options are:
arrow Sex Therapy
arrow Hormone Therapy
arrow Treatment of any secondary cause found as infection, or local cause or any psychiatric disorder.

HORMONES THERAPY
arrow Sex Therapy: The various sex therapy is offered by sex therapist leading to elimination of the pelvi-vaginal muscular spasm & fear of penis entering vagina. Sex therapy begins with detail sex education about the anatomy of male & female genitals. Then we give the patients specific exercises, which, the couple has to do at their home. After every exercise session fear of penetration decreases. Along with these exercise vaginal dilators of increasing sizes are given. These vaginal dilators, along with S focus exercise sex therapy is designed to gradually expose the women to vaginal penetration with increasing sizes. With these exercises along with behavioural therapy, hypnotherapy,& couple’s therapy leads to cure in few months.
arrow Anti-in-effective drugs: The anti-microbial treatment is indicated whenever the infection is found.
arrow Hormone Therapy: Hormones therapy is given to cure the hormone problem whenever hormone disorder is found. Estrogen treatment is given when deficiency of hormones are found. Hormones therapy helps n fast cure of this problem & do not have any adverse effects as they given to only those patients in whom some hormone disorder is found.
arrow Other drugs found effective are anti-inflammatory, serotonin reuptake inhibitors.

RESPONSE OF TREATMENT
As we have fully dedicated team of highly qualified, experienced, doctors, sex counselors, sex therapist, who are expert in the treatment of female sexual problems, we get cure in almost all cases. It is cured in most patients by two months treatment.

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