Sexual dysfunctions are inextricably linked with mental health, which - these days, is undergoing a serious crisis among the public. In gynecological and psychological surgeries, the buzzwords such as vaginismus, vulvodynia and dyspareunia are becoming more common (Lew-Starowicz et al., 2017). All three dysfunctions differ in their symptoms, while affecting the same sphere of life - sexual activity. What is the diagnosis and what is the treatment?
Vaginismus
The first of the psychosexual dysfunctions discussed - vaginismus, prevents sexual intercourse. In most cases, it has a psychogenic origin. The entrance to the vagina closes involuntarily by the spasm that occurs, blocking the possibility of penetration (Baszak-Radomańska et al., 2023)
Symptoms of vaginismus
Vaginismus is characterized by specific symptoms, so diagnosis is usually quick and simple (Baszak-Radomanska et al., 2023). These include:
- inability to penetrate - as a result of muscle spasm, insertion of the penis is not possible, or causes a lot of pain and discomfort
- problem with tampon application - attempting to place a tampon, or even a finger or any object, is not possible, or very difficult, which is also accompanied by pain on approach
- difficult to perform gynecological examinations - due to muscle spasm, internal gynecological examinations can be significantly difficult and painful, or impossible
- experiencing fear of intercourse - due to previous experiences of pain during intercourse or unsuccessful attempts at intercourse
- tightening of muscles without emerging pain - there are cases of patients who do not feel pain, but show other symptoms indicating vaginismus
- lordosis
- squeezing of the thighs
Types of vaginismus
Vaginismus can be divided into two types - primary and secondary. If the problem has already appeared at the first attempts at intercourse and does not go away, we speak of primary vaginismus. In this case, the psychological area plays a key role. The anxiety that maintains and exacerbates the symptoms can have various causes: fear of pregnancy, trauma related to sexual violence, negative perceptions of one's sexuality, distorted self-image, an overly controlling and conservative environment, religious beliefs, being a witness to violence or too early contact with pornography (Debowska et al., 2022).
In the case of women in whom the problem appeared suddenly, and before that they had sexual intercourse without pain or discomfort, we speak of secondary vaginismus. It can be caused by both biological (inflammatory conditions, endometriosis and others), psychological and concomitant problems.
Treatment methods for vaginismus
In the treatment of vaginismus, in addition to physiotherapy and/or urological treatments, which may be necessary in some cases, it is also recommended to undertake psychotherapy and a variety of therapeutic and supportive methods. A particularly recommended strand of psychotherapy in this case is cognitive-behavioral therapy (Ravinskaya, 2022). The therapist and the patient establish a realistic goal for therapy, and with professional therapeutic tools, the client is able to get to the source of the problem and then learn about favorable solutions. By working on his own and with a psychologist, the patient slowly reduces the hindering symptoms, improves his functioning and satisfaction with his sexual and private life, and prevents the recurrence of anxiety and the appearance of dysfunction. He tames his emotions and learns to control unfavorable thoughts and beliefs.
In addition, treatment can be assisted by a variety of alternative methods: meditation, yoga, use of CBD oils, mindfulness training, Schulz autogenic training, Jacobson relaxation training, massages, including tantric massage, and exercises to help relax vaginal muscles (Debowska et al., 2022).
I wrote more about this in the article: How to treat vaginismus.
Vulvodynia
Another of the dysfunctions, vulvodynia, is characterized by the sensation of vulvar pain, and the resulting considerable discomfort. There are unpleasant sensations of burning, vaginal itching and stinging in the intimate area (Baszak-Radomańska et al., 2023). This condition not only negatively affects the satisfaction or possibility of intercourse and general well-being, but if left untreated, it also threatens to develop into the so-called painful vulva syndrome. Patients with diabetes and multiple sclerosis are particularly prone to vulvodynia. The causes of this dysfunction can range from genetics to nerve damage or an excessive density of nerve endings.
Symptoms of vulvodynia
A correct diagnosis of vulvodynia allows you to quickly implement treatment and prevent the development of vulvar pain syndrome. If you notice some of the following symptoms in yourself, see a gynecologist as soon as possible (Baszak-Radomańska et al., 2023):
- hypersensitivity and/or vaginal dryness
- discomfort lasting at least 3 months
- pain during intercourse
- redness of the female genitalia
- burning, itching, pain in the vulva, urethral outlet, perineum and/or anus
Types of vulvodynia
There are several different types of vulvodynia (Lew-Starowicz et al., 2017). If we consider the place where the unpleasant symptoms appear, the condition can be described as: vestibulodynia (for vaginal prepuce pain), clitorodynia (for clitoral pain) and hemivulvodynia (for pain in the clitoral area).
We also distinguish between provoked or unprovoked vulvodynia. The first is associated with the occurrence of discomfort only when touching the diseased area. The second - unprovoked vulvodynia, manifests itself in a variety of intensities and locations of pain.
Treatment methods
The treatment process for a condition such as vulvodynia should be comprehensive. This means using the help of a gynecologist, as well as a psychologist. If the attending physician finds other forms of treatment additionally helpful - for example, urological physiotherapy - it is worth taking advantage of the recommendations.
Why does psychological support play a significant role? Pain symptoms that are long-lasting in nature give rise to difficult emotions in patients - fear, helplessness, irritability, disappointment. This can also lead to the appearance of depression. Accumulating negative emotions, fear and anxiety, aggravate the problem. Cognitive behavioral therapy is particularly recommended in this case (Rawinskaya, 2022). Some patients also praise the results of using hypnosis as an additional, supportive form. Because the disease affects sexual experience, as well as overall well-being, couples therapy can be used in addition to individual therapy. Developing proper communication, compassion and understanding are crucial for both parties in a relationship. During this difficult time, the support of a partner/partner is invaluable.
Dyspareunia
The last of the dysfunctions discussed - dyspareunia, shows up during sexual intercourse, causing the woman pain or discomfort. Unpleasant symptoms can occur during or after intercourse (Baszak-Radomańska et al., 2023). As with previous conditions, dyspareunia can lead to depression, diminished or disappearing satisfaction with sexual life and partner relationships, chronic anxiety and helplessness.
Symptoms of dyspareunia
Pay special attention to the following symptoms:
- pain that occurs when attempting penetration
- pain after intercourse (can last up to several hours after intercourse)
- pain during gynecological examinations and/or tampon use
- discomfort and pain in the pelvic floor muscles
- burning sensation accompanying pain
- vaginal dryness
- localization of pain in the pelvic and/or genital areas
- the appearance of unpleasant sensations during all intercourse or during selected sexual positions
Types of dyspareunia
During diagnosis, various variables are taken into account to determine the exact type of dyspareunia:
1. the timing of the appearance of symptoms during intercourse:
- Early dyspareunia - discomfort occurring from the beginning of intercourse.
- Late dyspareunia - symptoms manifest at the end of intercourse
2 Location of pain:
- Superficial dyspareunia - pain in the vestibule of the vagina
- Deep dyspareunia - pain in the vaginal vault
- Generalized dyspareunia - pain over the entire vaginal area
3 Chronology of the disease:
- Primary dyspareunia - symptoms appear with the first sexual contact
- Secondary Dyspareunia - symptoms appear later, during sexual activity, and not from the first contact
Treatment methods
A visit to a gynecologist, is the first step to rule out other diseases and diagnose a specific case. With proper diagnosis, the doctor is able to point to likely causes and treatment. He rules out or confirms infections that can be mistaken for dysfunctions. Another specialist that a gynecologist can send us to is a physiotherapist and psychologist. In the case of dyspareunia, as with vaginismus and vulvodynia, specialists look for psychogenic causes, which have an undeniable influence on the appearance or maintenance of symptoms. Therefore, the use of psychotherapy, psychoeducation and/or the help of a sexologist is recommended (Ravinskaya, 2022). Since this dysfunction affects sexual and private life, it is worth considering couples therapy, during which a psychologist or sexologist works with both parties.
All sexual dysfunctions discussed above, have a common denominator - pain and discomfort occurring in the intimate area. Depending on the specific affliction, these symptoms can show up in different times, severity and form Baszak-Radomanska et al, 2023). Undoubtedly, these ailments negatively affect sexual satisfaction, the appearance of the risk of depression, as well as physical and mental well-being on a daily basis. Correct diagnosis and the inclusion of treatment, with an emphasis on undertaking psychotherapy and/or any form of psychological treatment, make it possible to regain satisfaction with physical intercourse and permanently get rid of pain, discomfort and anxiety. Modern medicine and psychology offer effective solutions. If you notice troubling symptoms in yourself, get help from specialists.
| Dyspareunia | Vaginismus | Vulvodynia | |
| SYMPTOMS | Dyspareunia is the pain experienced when attempting penetration. Women avoid intimate intercourse because it is associated with the fear of intercourse and the discomfort associated with it. Dyspareunia may be accompanied by a burning sensation in addition to pain. The pain is located in the genital or pelvic area. Painful symptoms may be experienced when attempting penetration throughout intercourse or when there is deep penetration of the vagina by the penis. This dysfunction can occur every time intercourse occurs or in selected sexual positions. Sometimes it is limited to specific sexual partners. | Vaginismus is manifested by involuntary muscle contraction around the entrance to the vagina, causing it to close and the inability to have sexual intercourse. It affects the muscles that surround the outer third of the vagina (perineal muscle, anal lever muscle), thigh adductor muscles, rectus abdominis muscles and gluteal muscles. The most common symptoms of vaginismus are pain, reflex contraction of the vaginal entrance muscles and pelvic floor muscles of a defensive nature, squeezing of the thighs, lordosis, anxiety about intercourse. Pain is associated with penetration, but can also occur during gynecological examination or tampon application. Although vaginismus is a condition mainly associated with pain, experiencing it is not necessary for a diagnosis. | Vulvodynia is manifested by pain and discomfort in the vulvar area. In the inner or outer areas, labia, clitoris, vaginal vestibule, a woman feels stinging, burning, vaginal itching and even burning, making intercourse impossible. Recurrent vulvodynia can develop into painful vulva syndrome. It's an ailment that's difficult to diagnose, because aside from discomfort at the vulva, there are no skin and mucosal changes. The only visible symptom may be an overproduction of white vaginal discharge. |
| ETIOLOGY | Dyspareunia often occurs in women between the ages of 30 and 40 and is associated with pregnancy and the postpartum period, especially when a woman returns to sexual intercourse too soon. Problems arise in breastfeeding mothers who struggle with estrogen deficiency, which affects the condition of the vaginal mucosa. Dyspareunia can also have a psychological basis, when childbirth was a trauma for the woman. Too dry vaginal mucosa may also be responsible for pain during intercourse. The problem can affect older women in menopause, but also younger women using hormonal contraception. Sometimes pains occur even a few days after intercourse, because microtrauma occurs on the dry and delicate vaginal walls, which can become the cause of infection. | It's hard to find conclusive sources on the incidence of vaginismus - this is due to the difficulty in making a diagnosis. Vaginismus may or may not result from fungal and bacterial infections of the genitals, hypersensitivity of the muscular and nervous systems, atrophic changes of the vagina, trauma and damage from violent sexual intercourse or masturbation. The causes can also be emotional: insufficient foreplay, lack of arousal, conflicts with the partner or lack of emotional bonding with him. | Some scientific studies have shown that the causes of vulvodynia may have a genetic background, result from nerve damage or from too high a density of nerve endings, which can give an image of hypersensitive skin of the vulvar area. More often, patients with multiple sclerosis and diabetes suffer from vulvodynia. |
| TYPES | It can be divided by: location of pain: *superficial (pain in the vaginal vestibule) *deep (pain in the vaginal vault) *generalized (pain involves the entire vagina). | Vaginismus can be primary when it occurs in adolescents who are beginning their sexual lives (who feel fear of intercourse, loss of virginity or unwanted pregnancy) and young women, especially those living under stress or constant tension, as well as those who have been victims of sexual crimes, undergone serious trauma or witnessed rape. | Based on the location of the complaint, vulvodynia can be described as generalized or partial, i.e. westibulodynia (vaginal vestibular pain), clitorodynosis (clitoral pain) or hemivulvodynia (pain in the clitoral area). |
| PSYCHOLOGICAL TREATMENT | Psychological or relational factors may also underlie dyspareunia. Treatment of this sexual dysfunction involves psychotherapy conducted, for example, by a psychotherapist-sexologist or couples therapy. Pain during intercourse resulting from psychogenic factors is treated with months of psychotherapy. | In the treatment of vaginismus, pharmacotherapy is used, which includes the administration of anti-anxiety medications. Anesthetic gels and pain-relieving ointments are also applied. Psychotherapy plays an important role in treating vaginismus, helping to alleviate the fear of intercourse by addressing past traumas and difficult experiences. | The treatment of vulvodynia is complex and multi-step, often not yielding the expected results. Effective therapeutic methods include cognitive-behavioral therapy and hypnosis. Couples therapy is also important, particularly for women in relationships. |
| MEDICAL TREATMENT | The treatment of dyspareunia depends on its cause. Differential diagnosis includes conditions such as vaginismus, insufficient lubrication, atrophy, or vulvodynia. If dyspareunia is caused by inflammation or infections, appropriate pharmacotherapy is necessary. | The treatment of vaginismus may include pharmacotherapy, urogynecological physiotherapy, and in some cases, the use of dilators. In extreme situations, surgical interventions may be considered, though they are rarely used. | The treatment of vulvodynia is often multifaceted and includes the use of pain-relieving, anesthetic, hormonal medications, and, in extreme cases, surgical interventions. |
Bibliography:
Baszak-Radomańska, E., Jakima, S. (2023). Seksualne zespoły bólowe [Sexual pain syndromes.]. Wydawnictwo Lekarskie PZWL.
Dębowska, M., Gałęcki, P., Szulc, A. (2022). Seks a zdrowie psychiczne [Sex and mental health]. Wydawnictwo Medyk.
Lew-Starowicz, M., Lew-Starowicz, Z., Skrzypulec-Plinta, V. (2017). Seksuologia [Sexology]. Wydawnictwo Lekarskie PZWL.
Rawińska, M. (2022). Zaburzenia seksualne a psychoterapia poznawczo-behawioralna [Sexual disorders and cognitive-behavioral psychotherapy]. Wydawnictwo Lekarskie PZWL.
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https://www.termedia.pl/Vulvodynia-diagnosis-and-therapy-Part-2,4,19638,1,1.html
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