What is Vaginal Spasm? How is Vaginal Spasm Treated?

Vaginal spasm is a condition in which the vaginal muscles involuntarily contract during sexual intercourse, making penetration difficult. Vaginal spasm can also occur during situations such as tampon insertion or pelvic examinations. As a result of vaginal spasm, women may experience pain during sexual intercourse. Vaginal spasm is considered both a pathological and psychological condition and is treated in a combined manner. Symptoms of vaginal spasm typically emerge in the late teenage years or during early adulthood when a woman first engages in sexual intercourse. In some women, the onset of vaginal spasm may occur at a much later age.

What is Vaginal Spasm?

Vaginal spasm is a disorder formed by the combination of the words "vagina," meaning sheath, and "ismus," meaning action. In vaginal spasm, there is a painful condition accompanied by fear during sexual intercourse. Vaginal spasm makes penetration nearly impossible.

Women with vaginal spasm experience severe physical pain and psychological distress during sexual intercourse. The pain associated with vaginal spasm occurs due to the involuntary, intense contraction of the muscles in the pubococcygeal area at the bottom of the vagina. In this situation, the individual may shy away from sexual intercourse, potentially developing a phobia. Vaginal muscle spasms, phobia, and avoidance behaviors continuously feed into each other, creating a vicious cycle that can lead the individual to regard sexual activity as a complete taboo. In societies where sexuality and related issues are viewed as shameful and something to be hidden, this condition leaves couples feeling quite helpless. As a treatable disorder that can be improved with professional help, it is crucial for couples with vaginal spasm to be supportive of each other.

What are the Symptoms of Vaginal Spasm?

The symptoms exhibited by individuals with vaginal spasm make it impossible to engage in sexual intercourse. Symptoms of vaginal spasm include:

• Pain and discomfort in the vulva, vagina, or pelvic floor during vaginal intercourse,
• Involuntary, intense contractions and tension in the pelvic floor muscles during vaginal entry,
• Avoidance of sexual intercourse, tampon use, and pelvic examinations, accompanied by fear of these situations,
• Failed attempts at sexual intercourse due to vaginal contraction,
• Disgust towards sexual intercourse,
• Fear of excessive bleeding,
• The presence of contraction and fear lasting at least six months.

What Causes Vaginal Spasm?

The exact factors causing vaginal spasm have not been definitively identified. However, it is known that certain physical and psychological disorders can trigger vaginal spasm. Factors that can provoke the onset of vaginal spasm include:

• Urinary tract infections and yeast infections,
• Anxiety disorders,
• Vaginal injuries and trauma occurring during childbirth,
• Having undergone vaginal surgery,
• Having had negative sexual experiences in the past that have been traumatized,
• A history of sexual abuse or rape,
• Vaginal atrophy and related symptoms,
• Uterine prolapse,
• Vulvar vestibulitis syndrome (VVS),
• Having chocolate cysts,
• Presence of vaginal tumors or sexually transmitted diseases,
• Abnormal blood flow disorders in the groin or hip area,
• Lack of knowledge about sexual intercourse or possessing incorrect information.

What are the Types of Vaginal Spasm?

Vaginal spasm has been categorized based on the timing of its onset. The types and characteristics of vaginal spasm are as follows:

• Primary Vaginal Spasm: This type occurs during the first sexual experience. It is characterized by a woman's experience of pain whenever any foreign object, including the penis, enters her vagina. This condition is also referred to as lifelong vaginal spasm.
• Secondary Vaginal Spasm: Also known as acquired vaginal spasm, women with secondary vaginal spasm have not encountered any pain or discomfort in previous relationships. However, despite this, they experience pain, discomfort, and fear in subsequent relationships. Secondary vaginal spasm often arises as a secondary effect of a chronic pain syndrome.
• Situational (Partial) Vaginal Spasm: In this type, the issue arises only in specific contexts and does not occur in others. If sexual problems occur independently of the context and during all types of sexual activity, it is referred to as generalized (total) vaginal spasm.

How is Vaginal Spasm Diagnosed?

The diagnosis of vaginal spasm is based on the DSM-IV-TR criteria. These criteria include:

• Persistent or recurrent difficulty in one or more of the following areas:
  • Vaginal entry during sexual intercourse,
  • Experiencing significant pain in the vulvovagina and pelvic region during attempts at vaginal entry,
  • Having a clear concern or fear that pain will occur in the vulvovagina/pelvis due to attempts at vaginal entry or actual entry.
• Abnormal contraction or stretching of the pelvic floor muscles during vaginal entry,
• Symptoms in the first item of the four diagnostic criteria having persisted for at least six months,
• Symptoms in the first item of the four diagnostic criteria causing clinically significant distress in the individual,
• Vaginal spasm cannot be better explained by another non-sexual psychiatric disorder or caused by significant relationship issues (e.g., a partner displaying domineering behaviors), other important stressors, or linked to a substance/drug or another health problem.

Almost all the diagnostic criteria for vaginal spasm in the DSM-IV-TR also apply to other sexual dysfunctions. Consequently, the only distinguishing diagnostic criterion for vaginal spasm is the vaginal contractions that occur during sexual intercourse.

How is Vaginal Spasm Treated?

Since the factors causing vaginal spasm are multifaceted, the treatment methods for this disorder are quite broad and varied. Vaginal spasm has a relatively high success rate compared to other sexual dysfunctions and is also more commonly encountered. However, despite this, no standard treatment regimen has been established for vaginal spasm. Treatment options range from psychoanalysis to surgical operations.

In modern treatment approaches for vaginal spasm, the patient is considered a psychosocial entity, and alongside medical examinations, psychological and sociocultural factors are evaluated. Therefore, when selecting a treatment method, both the individual characteristics and cultures of the patient and their partner, as well as their relationship dynamics, are taken into account. Before treating vaginal spasm, the partners' tendency to reject each other is assessed, and both partners are informed about all procedures to be performed. The strategy followed in the treatment of vaginal spasm is as follows:

• Applying vaginal dilation techniques or facilitating vaginal exercises to desensitize the individual to vaginal entry,
• Educating the female patient that sexuality is a normal and necessary action,
• Addressing psychological issues such as the conversion of sexuality into phobia, negative conditioning, feelings of guilt, and anxiety about experiencing pain through strategies like psychoanalysis or sexual therapy.

What are the Treatment Methods for Vaginal Spasm?

A wide range of methods can be employed in the treatment of vaginal spasm. These methods vary from medical interventions to psychoanalytical approaches and include:

• Medical Treatment: One of the most commonly preferred medical methods is injecting Botulinum toxin into the bulbospongiosus muscles. This method has been reported to prevent prolonged recurrence of vaginal spasm. Another method used in medical treatment is the application of gels or creams containing local anesthetics. These products, applied before intercourse, reduce vaginal sensitivity. Additionally, oral muscle relaxants and anxiolytic medications are frequently used in the treatment of vaginal spasm.
• Cognitive Behavioral Therapy: One of the most commonly used methods in the treatment of vaginal spasm. This method involves systematic desensitization, where the individual's fear is identified and the person is taught how to cope with that fear. This method also includes educating the woman on how to control her pelvic muscles and the anatomy and physiology of her sexual organ.
• Psychodrama: With this method, the patient can reenact traumatic experiences, allowing for more comfortable and concrete expression. In this method, unconscious factors triggering the disorder are addressed.

For vaginal spasm, which is classified under psychological and sexual disorders, a combined treatment or individual therapies may be recommended. Seeking advice from specialized units in this area can facilitate a healthy sexual relationship and maintain dialogue between partners in a short time with the correct treatment.