Self-diagnosis Test &
Symptoms Check-list for Vaginismus
The time before diagnosis can be the most frustrating aspect of vaginismus. There is no single test that can diagnose vaginismus (Reissing E. et al. 1999) and since some of its symptoms may be similar to those of other medical conditions causing dyspareunia (painful sex), it can be misdiagnosed as them. Also, as we've heard many times, since not too many gynecologists are knowledgable of this problem, it may be dismissed as not being a medical concern but only a psychological one and temporary.
So when you visit a healthcare professional about symptoms that may be vaginismus, its a good idea to be as aware as you can of:
- the many misconceptions about vaginismus
- the myths about hymens
- the limitations of official medical criteria of vag.
For a brief review of what the scientific literature wrote so far on vaginismus and some criticism of it, you can check this Literature Review of Vaginismus .
Vag. Symptoms check-list
The main clinical symptoms of vaginismus mentioned in various medical texts (mainly in the criticized DSM-IV psychiatric manual) are usually the following:
*Vaginal entrance muscle spasms
*Vaginal muscle spasms on starting sexual activity
*Vaginal muscle spasms on pelvic examination
*Impossible sexual penetration (after trying at least twice recently or 10 times overall)
*Impossible pelvic examination or tampon use
As you can see underlined in our critical Literature Review, there is not one symptom that even looks for the presence of PAIN, and yet Vaginismus is classified as a "Sexual Pain Disorder". And nowhere it is mentioned that a woman may just be so fearful and scared that she won't even ATTEMPT one of those experiences.
Thankfully, an international multi-disciplinary group has finally reviewed the evidence for traditional assumptions about vaginismus. (Basson R, Leiblum S, Brotto L et al. 2003). The group concluded that: "The anticipation and fear of pain characteristic of vaginismus has to be noted while the assumed muscular spasm is omitted given the lack of evidence."
Finally, a recommendation was made that all diagnoses be accompanied by descriptors relating to associated contextual factors.
Before this group added this important observation, the Psychiatric Manual suggested only the following biased criteria to diagnose vaginismus:
Women with this sexual dysfunction disorder experience otherwise unexplained recurrent or persistent involuntary contraction of the perineal muscles around the outer third of the vagina associated with penetration with any object
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.
So whether or not you get a diagnosis of vaginismus may depend on whether your doctor is aware of these pretty recent changes in the scientific literature.
Besides, from our experience talking with hundreds of women, symptoms of vaginismus are not the same for every person so the same woman may:
- experience pain during intercourse
- experience pain when inserting a tampon
- experience pain when having an internal gynaecological exam
- have never attempted intercourse, or inserting a tampon or a gynaecological exam out of fear of pain
- have never experienced pleasurable sexual intercourse
- have sudden gestures of withdrawal, like a reflex at being poked, when someone gets too close to your vaginal opening
- have avoided or put off sexual situations out of fear/pain
- have avoided or put off gynaecological examinations for years, out of fear/pain
- experience panic attacks when attempting intercourse or during a gynaecological visit (or at the sight of dilators!)
- feel (or be told by partner) that there is something like a brick wall at the entrance of your vagina
Classification of symptoms of vaginismus
There is no clear sub-classification of the degrees of severity of vaginismus in the official medical diagnostic criteria. However, usually a woman can:
experience few or many symptoms (Mild or Severe vaginismus)
at different moments of their lives, (Primary/Secondary vaginismus)
in different situations or with different partners (situational vaginismus) or all the time (global).
MILD/SEVERE: There is NO scientific definitions we could find of what a SEVERE case of vaginismus really means.
As a rule of thumb, a SEVERE case of vaginismus would be one where the woman cannot insert the smallest of dilators or a finger or smallest speculum nor a tampon in her vagina, out of pain but also out of fear or phobia at having anything inserted.
A MILD case would be a one where a woman can insert something (a finger or a tampon) or has managed to have successful internal exams or painfree intercourse in the past, but who cannot insert something bigger or for whom lately sex has become painful.
There is no basic difference in the treatment of severe or mild cases from our experience, we've seen all kinds of women with all kinds of degrees of severity being able to start dilating and treat this, but it is likely that mild cases may take less time to solve since there probably won't be issues with hymens, or with psychological barriers etc.
There are plenty of medical sources in lots of websites to describe this difference, so to sum things up for you:
It is defined as PRIMARY vaginismus if you were never able in your life to have painfree intercourse or if you were never able to have a painfree internal exam; basically if you had your symptoms for as long as you can remember and there wasn't a time in your life when sex or tampons or gynecological exams came easily.
Often the reasons for primary vaginismus are to be found in psychological issues or past traumas or abuse, negative upbringing re. sex etc. Or it could also be linked to a problematic hymen or lack of knowledge of one's vulva and of one's sexual rights.
SECONDARY: Secondary vaginismus is when you were able to have painfree sex before, (or insert tampons and have painfree pap tests) and now you don't! Usually secondary vag. is caused by more physical symptoms instead. For instance, a woman may have had no problem whatsoever with sex or tampons in the past and then quite suddenly, after a health problem of some description or after a specific life event which involved the sexual or intimate sphere, she finds that sex is impossible or that she can no longer insert anything without excruciating pain. In cases of secondary vaginismus it is usually easier to pin point a cause and usually, once the physical problem originating vaginismus has been dealt with, it will be easier to go through a treatment to solve vaginismus cause sex or your vulva are not uncharted territory.
SITUATIONAL: A woman may find sex impossible with a partner, and then have no problem with another one. Or more likely, a woman may find that gynecological exams are a breeze, but as soon as her partner attempts penetration, she tenses up and the brick wall gets in the way.
The opposite of Situational would be when your vagina clamps down or experiences pain whenever you try to insert something, basically a 'SEVERE' case of vaginismus. But as we said above, that is VERY common so don't despair. Doctors have to label everything and some labels sound more frightening than they really are. If your vagina is that defensive, there will be good reasons and it will be very empowering to get to know her and help her break down all those barriers one by one.
Check out further sources about classification of vag:
* Crowley, Tessa et al. 2006
* Reissing E. et al. 2004
Before you take the test
First of all, if your answers to the questions below should give you a hint that you may indeed have vaginismus, please don't despair.. Whats important for you to know is that this is a totally curable condition! Many women think theirs is a hopeless case but trust us, we said that too! And yes, we too REALLY thought our case was worse than everyone else!
So, there is much hope even for what are seen as hopeless cases, but most of all, what vaginismus can mean is that you probably have a very smart vagina! I know it could be impossible to see Vaginismus as anything but a handicap or curse right now, but trust us again, in some cases it is quite a beautiful life-changing realization to see that your vagina wasn't just being annoying and that you are quite a cool, special person for having this... (read more on this in Vaginismus: the Che-Guevara of sex!)
Now, the following questions are not exclusively related to sexual situations. That is because vaginismus can be situational, thats why it can happen that a woman may have no problem whatsoever going through a pap smear but may find it impossible to have painfree intercourse. And viceversa. For instance, you may find it weird to be able to insert fingers but not a tampon. After all, you may have had traumatic medical experiences in the past at a gynaecologic appointment and your mind may have started giving the command to your vagina to tense and clamp whenever a gynaecologist tries to insert a speculum, but you may have always found sex pleasurable and safe and not have any problem letting your partner in.
Remember that your vagina is probably being very smart and not at all irrational, although it may seem so at first&
As for the diagnosis, this is not a medical test but even medical ones are often not accurate since there has been little agreement until recently on what were the main symptoms of vaginismus and the presence of spasms was taken to be more important than the presence of phobic or defensive reactions and of pain, whereas now it's been established that the latter is definitely more common a symptom than the spasms. So unless doctors know this, they will fail to diagnose you properly.
We suggest you find a gynecologist who has experience with vaginismus if you want an accurate diagnosis.
So use this test only as a guide to give you a rough idea.
Self-diagnosis test for vaginismus
Please Note! A test specifically designed for virgins is in the section on Virgins and Vaginismus .
Answer with YES PARTIALLY NO
1. Are you able to insert a tampon without pain or extreme fear?
2. Are you able to have a gynaecological exam without pain or extreme fear?
3. Are you able to insert finger/s without pain or extreme fear?
4. Are you able to insert applicator/medications in the vagina without pain/phobia?
5. Are you able to have painfree sexual intercourse and without panic attacks?
If you replied NO or PARTIALLY to at least one of the 5 questions, it is likely that you may have vaginismus and we hope that the information on this website will be helpful to you to further explore what it really is, what it isn't, and if it was then confirmed by a doctor, we hope it will help you go through the best healing process and treatments.
Remember: this IS treatable and it CAN be a blessing in disguise!
When healthcare practitioners discount your symptoms
If your doctor should discount your symptoms or tell you you just have to relax or just find a caring partner (as they tend to do), or other things you feel are not quite right or helpful, you can change your doctor! Otherwise, the following are some suggested courses of action:
1. If they say you need a hymenectomy , say youll want a second opinion or look for one. You may read our sections on this treatment first.
2. If they suggest you see a mental health care professional, insist that your symptoms are real and ask to be given the name of a specialist in dyspareunia/vaginismus or pelvic pain disorders first. (Unless you like the idea of going through psycho-therapy of course, but remember you're not mad... )
3. If they say that nothing is wrong with you and that you just need to relax, or drink some wine before sex, or just find a gentle partner, you may ask them for practical tips on HOW you may relax, or on WHAT could your partner do exactly, to help you have less painful sex. Ask them to be specific.
4. If they go to the extreme of telling you that you are basically a child, a person with low tolerance for pain, a whiner, an immature woman, and that you should just put up with some pain, then you may consider telling them that evidently they are not able to help you and that they are saying those things only to put the blame on you. Then you can leave them or ask them to give you the name of other specialists who may have a different opinion.
5. If they suggest expensive treatments, you may want to ask them how exactly those expensive treatments differ from cheaper ones..
6. If they should offer you medicines of any kind, you should take your time and inquire whether those medicines (ex. Botox, Suppositories, etc.) are approved for vaginismus or by the FDA.
If the medicines are numbing ones (ie. Lidocaine jelly) or anti-depressants, you may want to ask yourself whether your vagina just needs to be numbed and calmed down so you can be penetrated, or whether its time to take your bodys message seriously and understand what your vagina is actually trying to tell you before it's too late.
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