Vaginismus (Not Due to a General Medical Condition)
Diagnostic Features
The essential feature of Vaginismus is the recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted (Criterion A). The disturbance must cause marked distress or interpersonal difficulty (Criterion B). The disturbance is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a general medical condition (Criterion C). In some females, even the anticipation of vaginal insertion may result in muscle spasm. The contraction may range from mild, inducing some tightness and discomfort, to severe, preventing penetration.
Subtypes
Subtypes are provided to indicate onset (Lifelong versus Acquired), context (Generalized versus Situational), and etiological factors (Due to Psychological Factors, Due to Combined Factors) for Vaginismus.
Associated Features and Disorders
Sexual responses (e.g., desire, pleasure, orgasmic capacity) may not be impaired unless penetration is attempted or anticipated. The physical obstruction due to muscle contraction usually prevents coitus. The condition, therefore, can limit the development of sexual relationships and disrupt existing relationships. Cases of unconsummated marriages and infertility have been found to be associated with this condition. The diagnosis is often made during routine gynecological examinations when response to the pelvic examination results in the readily observed contraction of the vaginal outlet. In some cases, the intensity of the contraction may be so severe or prolonged as to cause pain. However, Vaginismus occurs in some women during sexual activity but not during a gynecological examination. The disorder is more often found in younger than in older females, in females with negative attitudes toward sex, and in females who have a history of being sexually abused or traumatized.
Course
Lifelong Vaginismus usually has an abrupt onset, first manifest during initial attempts at sexual penetration by a partner or during the first gynecological examination. Once the disorder is established, the course is usually chronic unless ameliorated by treatment. Acquired Vaginismus also may occur suddenly in response to a sexual trauma or a general medical condition.
Differential Diagnosis
Vaginismus must be distinguished from a Sexual Dysfunction Due to a General Medical Condition. The appropriate diagnosis would be Sexual Dysfunction Due to a General Medical Condition when the dysfunction is judged to be due exclusively to the physiological effects of a specified general medical condition (e.g., endometriosis or vaginal infection). This determination is based on history, laboratory findings, or physical examination. Vaginismus may remain as a residual problem after resolution of the general medical condition. If both Vaginismus and a general medical condition are present but it is judged that the vaginal spasms are not due exclusively to the direct physiological effects of the general medical condition, a diagnosis of Vaginismus, Due to Combined Factors, is made.
Vaginismus may also occur in association with other Sexual Dysfunctions (e.g., Hypoactive Sexual Desire Disorder). If so, both should be noted. Although pain associated with sexual intercourse may occur with Vaginismus, an additional diagnosis of Dyspareunia is not given. An additional diagnosis of Vaginismus is usually not made if the vaginal spasms are better accounted for by another Axis I condition (e.g., Somatization Disorder). The additional diagnosis may be made when the vaginal spasms predate the Axis I disorder or are a focus of independent clinical attention.
Diagnostic criteria for 306.51 Vaginismus
A. Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.
B. The disturbance causes marked distress or interpersonal difficulty.
C. The disturbance is not better accounted for by another Axis I disorder (e.g., Somatization Disorder) and is not due exclusively to the direct physiological effects of a general medical condition.
Specify type:
Lifelong Type
Acquired Type
Specify type:
Generalized Type
Situational Type
Specify:
Due to Psychological Factors
Due to Combined Factors