What is Vaginismus?

Vaginismus is a condition in women when intercourse is either very painful or impossible. Vaginismus is defined as an involuntary contraction of the vaginal musculature. This usually results in the failure of insertion including tampons, digits, gynaecological exams and intercourse.

What are the causes?

This has been believed to be psychological (fear and anxiety of penetration) or some physical conditions can contribute to the spasm of the vaginal muscles resulting in vaginismus.

Physical causes

Medical Conditions:

  • Urinary Tract infection
  • Yeast infection
  • Endometriosis
  • Vulvodynia
  • Lichen Sclerosis/Planus

Childbirth trauma

Menopausal changes – Dry vagina

Following pelvic surgery

Abuse- Sexual assault

Non – Physical causes

  • Fear of sex
  • Anxiety
  • Past sexual abuse or trauma
  • Partner issues
  • Negative thoughts towards sex
  • No cause

Why does it occur?

The reason why the vagina seems to tighten is because of a strong band of muscle in the first third of the vagina. The muscle which can be the most troublesome in vaginismus is called the ‘pubococcogeus muscle’ and is part of the pelvic floor. The expected pain associated with penetration causes an involuntary contraction of this muscle. Therefore, sex can be uncomfortable, painful and sometimes impossible.

Types of Vaginismus

Vaginismus is very common and can happen to any woman at any stage in her life including those who have already enjoyed a successful sex life.

Vaginismus may be primary in nature, or secondary. It is also important to understand the differences between primary vaginismus, in which a woman has always had pain with intercourse, or has never achieved intercourse; and secondary vaginismus, which occurs later in life. 

If primary, the woman has never been able to have penetrative intercourse without pain, or never been able to achieve penetrative intercourse. It may also be discovered when first attempting to use tampons, or at the first gynaecological examination or smear.

Secondary vaginismus describes these symptoms developing in a woman who has previously been able to allow penetration. In this situation, a precipitating cause, whether organic or psychological, may be easier to detect.

How common is it?

Community estimates of the prevalence of vaginismus are 0.5-1%. This increases to 4.2-42% in specialist and clinical settings

When reading vaginismus overview, a number of medical terms may be used that need to be understood, such as vulvodynia and vestibulodynia. These conditions may be associated with vaginismus, but more often they are misdiagnosed in patients with vaginismus

Treatment

Mild cases of vaginismus may respond to a number of treatments.

  • Vaginal dilators
  • Sexual counselling
  • Behavioural therapy
  • Vaginal oestrogens in postmenopausal women.

BOTOX injections

How Does Botox For Vaginismus Work?

The treatment utilizes BOTOX, injected into the pelvic floor muscles to relax the area and break the pain cycle. Botox works on vaginismus by relaxing the contracting vaginal muscles that are obstructing penetration. The treatment usually takes place under local anaesthesia or sedation depending on the degree of vaginismus.

The injections are given at the vaginal areas causing spasm and obstruction steering away from anus and urethra in order to avoid incontinence.

Approximately 10 days after the initial treatment, you can begin dilator use in conjunction with physical relaxation therapy.

Usually only one Botox injection is necessary although Botox effect lasts around four months.  It is effective in 90% of the women.

For further enquiries, please contact

Dr. A S Arun MD DNB CCST, FRCOG, FRANZCOG

Waikiki Specialist Centre

221 Wilmott Drive

Waikiki 6169

Tel: 08 95500300

Fax: 08 95929830

Email: reception.drarun@gmail.com

Website: www.doctorarun.com.au

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Pudendal neuralgia is a type of long­term (chronic) pelvic pain that originates from damage or irritation of the pudendal nerve.

The pudendal nerve is one of the main nerves in the pelvis, supplying areas such as the lower buttocks
area between the buttocks and genitals (perineum) area around the back passage (rectum)
vulva, labia, and clitoris in women
scrotum and penis in men.
Pudendal neuralgia can be very uncomfortable and distressing, but help is available and there are several treatments that can be tried.
Symptoms of pudendal neuralgia
The main symptom of pudendal neuralgia is pelvic pain. Any of the areas supplied by the pudendal nerve can be affected.

The pain may:

  • feel like a burning, crushing, shooting or prickling sensation
  • develop gradually or suddenly
  • be constant – but worse at some times and better at others
  • be worse when sitting down and improve when standing or lying down

Other symptoms can include:

  • numbness and pins and needles in the pelvic area
  • increased sensitivity to pain – you may find just a light touch or wearing clothes uncomfortable
  • feeling as though there’s swelling or an object in your perineum – often described as
  • feeling like a golf or tennis ball
  • needing to go the toilet frequently or suddenly
  • pain during sex, difficulty reaching orgasm, and erectile dysfunction in men

Causes of pudendal neuralgia

Pudendal neuralgia can occur if the pudendal nerve is damaged, irritated or squashed (compressed).
Possible causes include:

  • compression of the pudendal nerve by nearby muscles or tissue – sometimes called pudendal nerve entrapment or Alcock canal syndrome
  • prolonged sitting, cycling, horse riding or constipation (usually for months or years) – this can cause repeated minor damage to the pelvic area previous surgery to the pelvic area
  • a break in one of the bones in the pelvis
  • damage to the pudendal nerve during childbirth – this may improve after a few months
  • a non­cancerous or cancerous growth (tumour) pressing on the pudendal nerve
  • In some cases, a specific cause isn’t identified.

When to get medical advice

See your GP if you have persistent pelvic pain.
Don’t delay seeking advice if the pain is causing problems. Pudendal neuralgia can continue to get worse if left untreated, and early treatment may be more effective.
The stress of living with the condition can also have a significant impact on your physical and mental health if it’s not treated.

Tests for pudendal neuralgia

Your GP will ask about your symptoms and may carry out an examination of the area to check for any obvious causes of your pain.
If they think you could have pudendal neuralgia, or they’re not sure what’s causing your pain, they may refer you to a specialist for further tests.
These tests may include:
A vaginal or rectal exam – to see if the pain occurs when your doctor applies pressure to the pudendal nerve with their finger
A magnetic resonance imaging (MRI) scan – to check for problems such as entrapment (compression) of the pudendal nerve and rule out other possible causes of your pain
Nerve block injections – painkilling medication is injected around the pudendal nerve to see if your pain improves

Treatments for pudendal neuralgia

Treatments for pudendal neuralgia include:

  • Avoiding things that make the pain worse, such as cycling, constipation or prolonged sitting – it may help to use a special cushion with a gap down the middle when sitting and try constipation treatments
  • Medications to alter the pain – these will normally be special medications for nerve pain, rather than ordinary painkillers like paracetamol
  • Physiotherapy – a physiotherapist can teach you exercises to relax your pelvic floor muscles (muscles used to control urination) and other muscles that can irritate the pudendal nerve
  • Painkilling injections – injections of local anaesthetic and steroid medication may relieve the pain for a few months at a time
  • Nerve stimulation – a special device is surgically implanted under the skin to deliver mild electrical impulses to the nerve and interrupt pain signals sent to the brain
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