Investigating the causes and factors of vaginismus and its treatment

Vaginismus is an uncontrollable and painful spasm of the muscles around the vagina. It happens when something like a tampon, penis, or medical device like a speculum is about to be inserted into the vagina or when a person has to do a pap smear test. This disease is associated with the involuntary contraction of the muscles around the vagina (the lower third of the vagina) and pain and burning in the vagina during sexual intercourse, a condition that prevents or makes it painful or even impossible to penetrate any object into the vagina. Primary vaginismus is the inability to experience painless vaginal penetration. This problem usually occurs around the time when women have sex for the first time, start using tampons, or have their first gynecological examination. Symptoms of vaginismus include: muscle spasms or breathing problems during intercourse, impossibility or difficulty of penetration, pain when inserting a tampon, pain during pelvic examinations, inability to have sex, fear of sexual pain, loss of sexual desire. Causes of primary vaginismus include: urinary tract infections (UTIs), vulvar vestibulitis syndrome (VVS), vestibulodynia or vulvar vestibulitis, yeast infections, chronic pain conditions. When primary vaginismus is psychological in origin, it can be triggered by: history of sexual abuse, sexual assault or attempted sexual abuse, witnessing sexual or physical abuse of others, penetration phobia, any physical aggression, even if the organ genitals are not involved, anxiety, stress, negative emotional reactions related to sexual stimulation, educational factors and moral issues. Secondary vaginismus occurs when a woman who was previously able to penetrate develops this condition and is therefore no longer able to have intercourse or other forms of penetration. The causes of secondary vaginismus are: yeast infections, trauma during childbirth, endometriosis, drying of vaginal tissue as a result of estrogen reduction in menopause, pelvic surgeries, pelvic floor tumors. Secondary vaginismus can be caused by psychological factors, which in many cases are also related to primary vaginismus, including a history of sexual abuse, mistrust of a partner, general misconceptions about sex, undiscovered sexual orientation.Method:The current review by searching in reliable books and useful databases such as Scopus, Elsevier, PubMed, Science Direct, Google Scholar, Mag Iran, Iran Dog, Iran Medex in the years ۲۰۱۳ to ۲۰۲۳ with keywords such as vaginismus, dyspareunia, Sexual dysfunction, laser (RF), was performed.Findings:Any possible physical illness, such as an infection, should be treated before treating vaginismus. Giving information about sexual anatomy and the cycle of sexual response can help a woman understand her pain better and learn more about what is happening in her body. If a painful experience in the past, such as rape or painful memories, is the cause of this disorder, with the help of psychotherapy (psychoanalytical) and hypnosis, the effects of these memories are neutralized to prevent the automatic contraction of the pelvic muscles. Relaxation helps the patient to relax and release his body muscles voluntarily, and as a result, he has more control over his pelvic muscles and prevents them from۲contracting. Couple therapy in combination with physical therapy, which includes pelvic floor exercises, can Help with vaginismus. Kegel exercises help the mother to monitor her pelvic muscles. Relaxation and breathing techniques are also prescribed, and gradual use of vaginal dilators is recommended. In mild vaginismus, women can use a hot tub or sit in a hot basin before intercourse. Sitting in water for about ۲۰ minutes can help relax the vaginal muscles and prevent excessive muscle contraction during penetration. One of the ways to treat vaginismus is to use a dilator. A dilator is a device for widening the opening of the vagina and other valves and channels of the body. This device is conical and has different sizes from small to large. In some cases, vaginismus can be treated with laser. Lears is a risk-free procedure without side effects. Using ultraviolet rays can help to cure this disease. One of the reasons that can lead to vaginismus is endometriosis. Endometriosis can cause part of the uterus to protrude and pain during sex. Endometriosis can be removed by examination and surgery. Botox injection as an effective way can deactivate the nerve of the muscles entering the vagina and, as a result, temporarily disable them. This injection is usually performed under general anesthesia on the inner surface of the vagina and behind the hymen or hymen ring. The durability of Botox is about ۵-۶ months, and during this time, a person can have sex, and after that, there is no need to repeat Botox injections. Treatment of vaginismus with (RF) is also a suitable method. This method, which uses RF or radio frequency energy, is often used for more severe cases. In this method, the radio frequency energy acts only on the level of the genital area and by touching the vaginal entrance muscles in the initial sessions. This energy is gradually applied in the following sessions, depending on the individual's response, on the vaginal muscles and about the first ۵ cm of the vagina. For this reason, the muscles become more relaxed and as a result, their spasms and contractions will disappear.Conclusion:Vaginismus has various causes and factors, the cause of which must be known first and then treated based on that. Treatment may last from several weeks to several months. In rare cases, surgery is needed.

کلیدواژه ها:

Vaginismus ، causes of vaginismus ، treatment of vaginismus