Vaginismus, sometimes anglicized vaginism is the German name for a condition which affects a woman’s capability to engage in any form of vaginal penetration, including sexual intercourse, attachment of tampons, and the penetration involved in gynecological examinations. This is the result of a reflex of the pubococcygeus muscle, which is sometimes referred to as the “PC muscle”. The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration painful or impossible.

A woman struggling from vaginismus does not purposely control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The intensity of vaginismus and the pain during penetration, including sexual penetration, differs from woman to woman.

A woman is said to have main vaginismus when she has never been able to have penetrative sex or experience vaginal penetration without pain. It is generally discovered in teenagers and women in their early twenties, as this is when many young women in the Western world attempt to use tampons, have penetrative sex, or undergo a Pap smear. Women with vaginismus may be unaware of the condition until they attempt vaginal penetration. It may be confusing for a woman to discover she has vaginismus. She may believe that vaginal penetration should naturally be easy, or may be unaware of the reasons for her condition.

A few of the main factors which may contribute to primary vaginismus contain:

• a situation called vaginal vestibulair symptoms more or less synonimous to focal vaginitis a so called subclinical inflammation. No pain is perceived, until some form of transmission is tried.
• urinary tract infections or vaginal yeast infections.
• sexual abuse, rape, or attempted lovemaking abuse
• knowledge of (or witnessing) sexual or physical abuse of others, without being personally abused
• domestic violence or discord in the early home environment
• having been taught that sex is immoral, vulgar, or demoralizing
• fear of pain associated with penetration, particularly the popular misconception of ‘breaking’ the hymen upon the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs
• being sexualized or told about sex in violent or unnecessarily graphic terms before an age at which one is comfortable with such details
• any physically invasive trauma
• generalized anxiety
• stress

Occasionally, primary vaginismus is idiopathic.

Vaginismus has been categorized by Lamont according to the severity of the condition. He describes four degrees of vaginismus: In first degree vaginismus, the patient has spasm of the pelvic floor which can be relieved with reassurance. In second degree, the spasm is present but maintained throughout the pelvis even with reassurance. In third degree, the patient elevates the buttocks to avoid being examined. In fourth degree vaginismus, the most severe form of vaginismus, the patient elevates the buttocks, retreats and tightly closes the thighs to avoid examination. Pacik expanded the Lamont classification to include a fifth degree in which the patient experiences a visceral reaction such as sweating, hyperventilation, palpitations, trembling, shaking, nausea, vomiting, going unconscious, wanting to jump off the table or attacking the doctor. The Lamont classification continues to be used to the present and allows for a common language among researchers and therapists. However, it does not allow for a language in which a woman might be able to verbalise her concerns, pain or problems. A woman with a lot of trust in the doctor might be classified as 1 but experience severe pain. A woman with less trust or a woman who is or has been exposed to harsh examination, might be classified as four or five .

Though spasm of the pubococcygeus muscle is commonly thought to be the primary muscle required in vaginismus, Pacik recognized 2 additional included spastic muscles in treated patients under sedation. These include the entry muscle (bulbocavernosum) and the mid oral muscle (puborectalis). This accounts for the common complaint that patients often say when trying to have sexual intercourse “It’s like reaching a brick wall”.

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