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What is it?

This condition is commonly called 'vaginismus'. It refers to the occasional painful contractions of the lower vaginal muscles that can occur in some women without their control. These may happen during sexual penetration, vaginal examination, or insertion of a tampon into the vagina.

What causes it?

Vaginismus may be due to birth defects, infections or local trauma of the vagina. It is however mostly due to psychological factors, when it is interpreted as a rejection of sex. The reasons for this are varied and may include sexual problems in the relationship and negative early conditioning such as sexual assault in childhood or adolescence and very strict upbringing (with restrictions on sexual expression).

What problems can it cause?

Vaginismus leads to non-consummation of a relationship. This often leads to relationship difficulties including hostility, frustrations, distrust and sometimes sadly a complete breakdown of the relationship.

How is it treated?

Treatment of any cause that is found may correct the problem. The treatment of vaginismus that is caused by psychological factors is 'deconditioning'. Childhood problems may need to be addressed and dealt with appropriately. Psychotherapy, consisting of reassurance and education, is useful for deep-seated psychological problems. This may be in form of behaviour modification, systematic desensitisation or deconditioning.

• Behaviour modification - is the process of looking at and trying to change behaviour that has contributed to the problem.

• Systematic desensitisation - is a systematic approach to reduce the sensitivity that surrounds the issues.

• Deconditioning - may be achieved by the use of vaginal dilators of increasing size under the direction of a doctor or other healthcare worker. These may be combined with relaxation exercises. Sex is only attempted after the largest vaginal dilator can be passed with ease and without pain.

Where sexual difficulties cause problems within the relationship, these will also be explored and appropriate treatment offered to the partners.

Myths

It is not true that all women with vaginismus are sexually unresponsive. Some may achieve sexual arousal and even orgasm by other means.

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