The truth behind vaginismus disease by Alkhima Macarompis


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The truth behind vaginismus disease by Alkhima Macarompis

  1. 1. THE TRUTH BEHIND VAGINISMUS DISEASEA Term PaperPresented toMs, Bai Salam M. IbrahimFaculty of the English DepartmentCollege of Social Science and HumanitiesMindanao State UniversityMarawi CityIn Partial FulfillmentOf the Requirements for the CourseEnglish 2 Dd2 (College English II)byAlkhima M. MacarompisMarch 2011
  2. 2. OUTLINEThesis Statement: “A condition that can close the entrance of the vagina preventingintercourse.”IntroductionVaginismus can strike any woman at any time at any age. This methodology is discussed in itsvarious aspects and with a cultural background. It also emphasizes the need for physicians to be mindfulof cases of Vaginismus requiring psychiatric intervention rather than gynecological treatment.I. Nature of Vaginismus DiseaseA. Definition/DescriptionB. PrevalenceC. Types of Vaginismus Diseasea. Primary Vaginismusb. Secondary VaginismusD. Cycle of PainII. Symptoms and Diagnosis of Vaginismus DiseaseA. Common Symptoms of Vaginismus DiseaseB. Medical Diagnosis of Vaginismus DiseaseIII. Causes of Vaginismus DiseaseA. Physical CausesB. Non-physical CausesIV. Treatment of Vaginismus DiseaseA. Physical TreatmentB. Psychological TreatmentConclusion
  3. 3. Vaginismus can be triggered by physical events as simple as having inadequate foreplay orlubrication, or non-physical emotions as simple as general anxiety, it is important that it be understoodthat Vaginismus is not the womans fault. Once triggered, the involuntary muscle tightness occurs withoutconscious direction; the woman has not intentionally caused or directed her body to tighten and cannotsimply make it stop. Women with Vaginismus may initially be sexually responsive and deeply desire tomake love but over time this desire may diminish due to pain and feelings of failure and discouragement.It is extremely frustrating to be unable to physically engage in pleasurable sexual intercourse.
  4. 4. INTRODUCTIONVaginismus is a sexual dysfunction involving various branches of medicine, including psychiatryand gynecology. Psychiatric help is sought in only a small proportion of cases, although it is probable thatthe psychopathological etiology is more frequent than generally recognized. This article deals with thecauses and psychological circumstances in four Turkish couples who presented with unconsummatedmarriage for 3 to 7 years. Vaginismus F52.5 to the ICD-10 is a sexual dysfunction characterized as: deepanxiety about coitus leading to extreme spasm of musculature making coitus impossible or extremelyunpleasant and painful.This study reflects the importance of letting the readers know about how Vaginismus diseaseaffects women and men living life. This paper aims to explain what is Vaginismus, what is its Diagnosisand symptoms and what are its causes including the treatments of Vaginismus Disease.The researcher used internet and some books related to the topic as her reference for the study.The data and information presented in this research paper are only limited to the reading materialsavailable at the Mindanao State University (MSU) and the college of Health Sciences (CHS) library.
  5. 5. Vaginismus is a vaginal tightness causing discomfort, burning, pain, penetration problems, orcomplete inability to have intercourse. A condition where there is involuntary tightness of the vaginaduring attempted intercourse. Its tightness actually caused by involuntary contractions of thepelvic floor muscles surrounding the vagina.The prevalence of Vaginismus has been reported to be 6% in two widely divergent cultures,Morocco and Sweden. The prevalence of manifest dyspareunia has been reported as low as 2% in elderlyBritish women, yet as high as 18-20% in British and Australian studies. By another study Vaginismusrates of between 12% and 17% have been reported in women presenting to sex therapy clinics (Spectorand Carey, 1990). National Health and Sexual Life Survey, which used random sampling and structuredinterviewing, found that between 10% and 15% of women reported having experienced pain duringintercourse the last 6 months (Laumann et al. 1994).There are two types of Vaginismus disease: Primary Vaginismus and Secondary Vaginismus. ThePrimary Vaginismus is when a woman has never been able to have penetrative sex or experience vaginalpenetration without pain. It is commonly discovered in teenagers and women in their early twenties, asthis is when many young women in the Western world attempt to use tampons, have penetrative sex orundergo a Pap smear.According to Lamont, sometimes the primary Vaginismus is idiopathic and he describes fourdegrees of Vaginismus. In first degree, the patient has spasm of the pelvic floor which can be relievedwith reassurance. In second degree, the spasm is present but maintained throughout the pelvis even withreassurance. In third degree, the patient elevates the buttocks to avoid being examined. In fourth degreeVaginismus (also known as grade 4 Vaginismus), the severe form of Vaginismus, the patient elevates thebuttocks, retreats and tightly closes the thighs to avoid examination. And the secondary Vaginismus is asexual pain can affect women in all stages of life, even women who have had many years of pain-freeintercourse. It refers to the experience of tightness pain or penetration difficulties later in life, after
  6. 6. previously being able to have normal, pain-free intercourse. It typically follows or is triggered bytemporary pelvic pain or other related problems. It can be triggered by medical conditions, traumaticevents, relationship issues, surgery, life-changes (e.g. menopause), or for no apparent reason and it is thecommon culprit where there is continued, ongoing sexual pain or penetration tightness where there hadbeen no problem before.For many women, Vaginismus comes as a surprise; unexplained tightness, discomfort, pain, andentry problems are unexpectedly experienced during intercourse attempts. The painresults from thetightening of the muscles around the vagina (PC muscles). Since this occurs without the conscious intentor control of the woman, it can be very perplexing.Usually at the root of Vaginismus is a combination of physical or non-physical triggers that causethe body to anticipate pain. Reacting to the anticipation of pain, the body automatically tightens thevaginal muscles, bracing to protect itself from harm. Sex becomes uncomfortable or painful, and entrymay be more difficult or impossible depending upon the severity of this tightened state. With attempts atsex, any resulting discomfort further reinforces the reflex response so that it intensifies more. The bodyexperiences increased pain and reacts by bracing more on an ongoing basis, further entrenching thisresponse and creating a Vaginismus cycle of pain. Here is a Cycle of Pain: Firstly, the body anticipatespain because of the fear and the anxiety it contributes. Secondly, the body automatically tightens vaginalmuscles. Thirdly, tightness makes sex painful penetration maybe impossible because tightness resultsfrom the involuntary tightening of the pelvic floor (especially the pubococcygeus (PC) muscle group),although the woman may not be aware that this is the cause of her penetration or pain difficulties.Fourthly, pain reinforces/intensifies reflex response. Fifthly, the body reacts by “bracing” more onongoing basis. And the lastly, avoidance of intimacy lack of desire may develop.Some researchers have suggested that fear of pain isn’t a cause of Vaginismus, rather a symptom.On the other hand, others have stressed its possible causal and maintaining role in the disorder. Fear of
  7. 7. pain was the primary reason for abstinence in an interview study of 476women with Vaginismus.Symptoms of Vaginismus vary between women, Vaginismus cancause distress and relationship problemsand may prevent a woman from starting a family because it disrupts or completely stops her sex life.Depending on the intensity, Vaginismus symptoms range from minor burning sensations with tightness tototal closure of the vaginal opening with impossible penetration. Strong indicators of vaginismus includeany of the following:Difficult penetration or impossible intercourse / unconsummated couplesFemale penetration problems and unconsummated marriages are typically due to vaginismus.Entry tightness and pain are common symptoms of vaginismus.Ongoing sexual pain after a pelvic problem, medical issue, or surgeryThe experience of ongoing sexual pain or tightness after resolving or managing apelvic medical or pain issue is typically due to vaginismus (see also dyspareunia).Ongoing sexual pain after childbirthThe experience of ongoing sexual pain or tightness following childbirth (after everything hashealed) is typically due to secondary vaginismus.Ongoing sexual pain and tightness with no discernible physical causeVaginismus often occurs only during sex attempts. Physicians may initially be unable to find anyproblem or cause for the sexual difficulties.Avoidance of sex due to pain and/or failureWhen a woman states that she avoids being intimate with her husband because sex does not feelgood or has become very painful, vaginismus should be strongly considered.One of the most important aspects of Vaginismus diagnosis is simply the thorough elimination ofother possible physical or medical conditions that may be causing the symptoms- leaving the near-certain likelihood of vaginismus. The process of elimination is a critical part
  8. 8. of vaginismus diagnosis. The diagnostic process will typically entail giving a medical and sexual historyand undergoing a pelvic or gynecological exam. The physician will discuss the location and occurrence ofpain to help render an accurate vaginismus diagnosis or may request some other tests to help rule out anyother problems besides vaginismus.Note that many women seeking diagnosis are often simply left undiagnosed and turned away byphysicians who fail to find anything physically wrong and feel there is nothing more they can do. Theymay not consider a diagnosis of vaginismus due to simple lack of awareness. There are many dangers inbeing given an improper diagnosis from an uninformed professional.Unnecessary, invasive andpotentially harmful surgeries and medications have been suggested for women with vaginismus who havenot been properly diagnosed.Misdiagnosis and the promotion of invasive or unhelpful surgeries are sometimes the unfortunateresult of all this confusion. There is no surgery to cure vaginismus. It is very important to seek a secondopinion if surgery to widen the vaginal opening has been recommended as this does not normally resolvethe penetration problem, but instead may further complicate the problem. Unnecessary, invasive, andpotentially harmful surgeries and medications have been suggested for women with vaginismus who havenot been properly diagnosed. Vaginismus is a highly treatable condition that does not require any invasiveprocedures.Women often suspect they have vaginismus from their symptoms, but getting medicalconfirmation can be challenging. Confirming a formal diagnosis of vaginismus may take some planningand perseverance. No definitive medical test exists for the diagnosis of vaginismus so it may take anumber of visits to several physicians or specialists before a medical diagnosis is obtained. Whenphysicians are initially unable to find any specific medical problem (a common experience of vaginismussufferers), no diagnosis or misdiagnosis is a common outcome of initial medical exams. Many physiciansare unfamiliar with vaginismus, so part of the process is simply finding a physician that is knowledgeable
  9. 9. about the condition. A successful medical diagnosis of vaginismus is typically determined through patienthistory and description of the problem, gynecological examination and the process of ruling out thepossibility of other conditions.Talking to physicians about sexual problems can be difficult. Embarrassment, shame andanxietyare often present, making it hard to communicate and obtain appropriate care. Women may need tostrongly advocate for themselves, insisting on a full diagnosis from a knowledgeable professional to ruleout any other medical condition and properly confirm the vaginismus diagnosis. A medical diagnosis ishelpful in removing any doubts or anxiety related to identifying the condition and enables women to havemore confidence in moving toward treatment solutions.Vaginismus is a unique condition in that it may result from a combination of either physical ornon-physical causes or it may seem to have no cause at all. Here are some examples of Non-Physicalcauses: 1) Fear “Fear or anticipation of intercourse pain, fear of not being completely physically healedfollowing pelvic trauma, fear of tissue damage (ie. "being torn"), fear of getting pregnant, concern that apelvic medical problem may reoccur, etc. 2) Anxiety or stress “General anxiety, performance pressures,previous unpleasant sexual experiences, negativity toward sex, guilt, emotional traumas, or otherunhealthy sexual emotions. 3) Partner issues “Abuse, emotional detachment, fear of commitment,distrust, anxiety about being vulnerable, losing control, etc. 4) Traumatic events “Past emotional/sexualabuse, witness of violence or abuse, repressed memories. 5) Childhood Experiences “Overly rigidparenting, unbalanced religious teaching (ie."Sex is BAD"), exposure to shocking sexual imagery,inadequate sex education. And 6) No cause “Sometimes there is no identifiable cause (physical or non-physical).And also here are some examples of Physical Causes: 1) Medical conditions“Urinary tract infections or urination problems, yeast infections, sexually transmitted disease,endometriosis, genital or pelvic tumors, cysts, cancer, vulvodynia / vestibulodynia, pelvic inflammatorydisease, lichen planus, lichen sclerosus, eczema, psoriasis, vaginal prolapse, etc.”2) Childbirth “Pain from normal or difficult vaginal deliveries and complications, c-sections,
  10. 10. miscarriages, etc.” 3) Age-related changes “Menopause and hormonal changes, vaginal dryness /inadequate lubrication, vaginal atrophy.” 4) Temporary discomfort “Temporary pain or discomfortresulting from insufficient foreplay, inadequate vaginal lubrication, etc.” 5) Pelvic trauma “Any type ofpelvic surgery, difficult pelvic examinations, or other pelvic trauma.” 6) Abuse “Physical attack, rape,sexual/physical abuse or assault.” And 7) Medications “Side-effects may cause pelvic pain.”These are a variety of factors that can contribute to Vaginismus. These may be psychological orphysiological and the treatment required can depend on the reason that the woman has developed thecondition. As each case is different, an individualized approach to treatment is useful. The condition willnot necessarily become more severe if left untreated, unless the woman is continuing to attemptpenetration, despite feeling pain. Some women may choose to refrain from seeking treatment for theircondition.According to the Cochrane Collaboration review of the scientific literature, “In spite ofencouraging results reported from uncontrolled case series there is very limited evidence from controlledtrials concerning the effectiveness of treatments for Vaginismus. Further trials are needed to comparetherapies with waiting list control and with other therapies.” Although few controlled trials have beencarried out, many serious scientific studies have tested and proved the efficacy of the treatment ofVaginismus. In all cases where the systematic desensitization method was used, success rates were closeto 90-95% and even 100%. For an example of one of these studies, see Nasab, M., and Farnoosh, Z., orfor a basic review, see Reissing’s literature review. A Dutch study showed that many women weresubsequently able to be penetrated, but far fewer women actually enjoyed being penetrated.According to Ward and Ogden’s qualitative study on the experience of Vaginismus for women (1994), the three most common contributing factors to Vaginismus are fear of painfulsex; the belief thatsex is wrong or shameful (often the case with patients who had a strict religious upbringing); andtraumatic early childhood experiences (not necessarily sexual in nature.
  11. 11. Vaginismus patients are twice as likely to have a history of childhood sexual interference andheld less positive attitudes about their sexuality whereas no correlation was noted for lack of sexualknowledge or physical abuse.For some women, especially those with primary Vaginismus, it is important to address thepsychological aspects of the problem as well as the actual muscle spasm.A woman may choose to address the issue on her own terms, or she may avail the help of atherapist. Some women, especially those with secondary Vaginismus, may rely on a physical rather thanpsychological treatment and also be successful. There are emotional difficulties associated withVaginismus, which can include low self-esteem, fears and depression. As Vaginismus includes a reflex,Vaginismus should not be viewed as an behavior problem; so behavior therapies are problematic.Therapies that include the body and deeper brain structures (like EMDR) appear to be the more logicaltherapeutic choice.Physical treatment of the internal spasm may include sensate focus exercises, exploring thevagina through touching, and desensitization with vaginal dilators. Dilating involves inserting objects,usually phallic in shape, into the vagina. In treating the spasms through dilation, the objects usedgradually increase in size as the woman progresses.
  12. 12. CONCLUSIONIt is important to note that Vaginismus is not triggered deliberately or intentionally by women. Ithappens involuntarily without their intentional control and often without anyawareness on their part.Vaginismus has a variety of causes, often in response to a combination of physical or emotional factors.Since Vaginismus can be triggered by physical events as simple as having inadequate foreplay orlubrication, or non-physical emotions as simple as general anxiety, it is important that it be understoodthat Vaginismus is not the womans fault. Once triggered, the involuntary muscle tightness occurs withoutconscious direction; the woman has not intentionally caused or directed her body to tighten and cannotsimply make it stop. Women with Vaginismus may initially be sexually responsive and deeply desire tomake love but over time this desire may diminish due to pain and feelings of failure and discouragement.It is extremely frustrating to be unable to physically engage in pleasurable sexual intercourse.Life experiences vary dramatically from person to person. Some womens bodies react withVaginismus, while others with nearly identical experiences do not.The anticipation of pain, emotional anxieties, or unhealthy sexual messages can contribute to andreinforce the symptoms of Vaginismus. Frequently, but not always, there are deep-seated underlyingnegative feelings of anxiety associated with vaginal penetration. Emotional triggers that result inVaginismus symptoms are not always readily apparent and require some exploration. It is important thateffective treatment processes include addressing any emotional triggers so a full pain-free and pleasurablesexual relationship can be enjoyed upon resolution.
  13. 13. BIBLIOGRAPHYA. JOURNALSCrowley, Tessa; et al., (2006). “Recommendations for the Management of Vaginismus”.International Journal of STD & AIDS 17 (January 2006):m14-18.Reissing E, E.; et al. “Does Vaginismus exist? A critical review of the literature”. The Journal ofNervous and Mental Disease 187 (1999): 261-271.Ward, E.; Ogyden, J. “Experiencing Vaginismus: suffering beliefs about causes and effects”. TheJournal of Nervous and Mental Disease 9 (1994): 33:45.Lamont, JA. “ Vaginismus”. American Journal of Obstetrics and Gyneology 131 ( 1978): 633-6.Ronald W. Lewis, MD, Kersten S. Fugl-Meyer, PhD. “ Epidemiology/Risk Factors of SexualDysfunction”. The Journal of Sexual Medicine 1 (2004): 35B. DICTIONARY ENTRY“Vaginismus Disease”. Microsoft Student with Encarta Premium. 2009.C. ON-LINE RESOURCES