Year : 2012  |  Volume : 54  |  Issue : 4  |  Page : 391--392

Successful management of vaginismus: An eclectic approach


T Harish, M Krishna Prasad, Pratima Murthy 
 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore - 560 029, Karnataka, India

Correspondence Address:
T Harish
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore - 560 029, Karnataka
India




How to cite this article:
Harish T, Prasad M K, Murthy P. Successful management of vaginismus: An eclectic approach.Indian J Psychiatry 2012;54:391-392


How to cite this URL:
Harish T, Prasad M K, Murthy P. Successful management of vaginismus: An eclectic approach. Indian J Psychiatry [serial online] 2012 [cited 2019 Nov 12 ];54:391-392
Available from: http://www.indianjpsychiatry.org/text.asp?2012/54/4/391/104845


Full Text

Sir,

Vaginismus is defined in DSM IV-TR [1] as recurrent or persistent involuntary spasm of musculature of the outer third of vagina that interferes with coitus causing distress and interpersonal difficulty. Prevalence rates of 5-17% are noted in sexual dysfunction clinics. [2] We describe a successful approach of managing vaginismus based on Keith Hawton's model. [3]

A 25-year-old woman sought consultation with the psychiatry outpatient services for tightness of vagina and introital pain while attempting sex with her husband for 3 months after marriage. She had become fearful about having sexual intercourse. Immediately after engagement, she had expressed apprehensions about having painful sexual intercourse. After the wedding, the patient had postponed attempts at penetrative intercourse for 10 days. Whenever penetration was attempted, she would not part her legs and begin to cry complaining of spasmodic introital pain. The couple began to engage only in foreplay. She had consulted gynecologists who diagnosed the condition as primary vaginismus, underwent hymenectomy under general anesthesia. After about 6 weeks, couple consulted psychiatry services on advice of the gynecologist. She was described to be shy and sensitive by nature. There was no history of sexual abuse. The family of origin was religious; sex was not openly discussed, the environment was not restrictive. She had normal menstrual history. Physical examination was unremarkable, and she did not permit a local examination. Her mental status examination revealed depressed affect, ideas of hopelessness. She was diagnosed to have vaginismus and moderate depressive episode without somatic syndrome. She was advised behavior therapy and tab Escitalopram 10 mg HS.

The patient underwent five weekly sessions of sex therapy with the first author being the primary therapist. The sessions were based on the model provided by Keith Hawton. [3] The sessions included the husband and the couple initially participated jointly in educative sessions with the primary therapist. The exercises were carried out at home by the couple. In the first session, normal reproductive anatomy and physiology of the sexual act were explained. The patient was made comfortable with her genitals by asking her to see them in the mirror. She was taught Kegel's exercises that help control pubococcygeus muscle which surrounds the entrance to the vagina. In the next couple of sessions, she was advised to insert her fingers into her vagina and move them around, initially one finger, later two fingers. Penetrative sexual intercourse was prohibited during the period. Only after the patient became comfortable with these over three sessions, vaginal containment with lubrication and local anesthesia provided by 5% lignocaine jelly was advised. Vaginal containment involved the patient in female superior position, guiding penile penetration with her hands and the couple remaining still, concentrating on the pleasant sensations they experience. After a month of initiating therapy, the patient was able to indulge in normal sexual intercourse without the need for local anesthesia. Her depression also improved. In subsequent follow-up, the antidepressant dose was tapered and stopped over the next 9 months. Vaginismus is a disabling condition that results in significant distress to the couple. A multidisciplinary approach would result in appropriate diagnosis and management. Our case illustration highlights the importance of application of appropriate psychological interventions along with psychopharmacological treatment.

References

1American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4 th Ed. Washington, DC: American Psychiatric Association; 1994.
2Crowley T, Richardson D, Goldmeier D. Recommendations for the management of vaginismus: BASHH Special Interest Group for Sexual Dysfunction. Int J STD AIDS 2006;17:14-8.
3Hawton K. Sex therapy: A practical guide. Oxford: Oxford University Press; 1985.