Limitations of official diagnostic criteria
"a female sexual dysfunction, specifically a genital pain disorder, consisting of lifelong involuntary spasms of the vaginal muscles, not caused by a general medical condition, which interfere with intercourse causing distress and interpersonal difficulty"(APA 2000).
These are the official, disputed diagnostic criteria for 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
This definition has not been challenged for more than a century despite the fact that the diagnostic criteria of spasm has never been empirically evaluated until recently, and when they have, the presence of pain and fear/phobia has been found to be much more relevant than the actual presence of spasms.
• Van der Velde J. And Everaerd W. (2001) The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus Behaviour Research and Therapy 39: 395-408
• Van der Velde J. et al. (2001) Vaginismus, a component of a general defense mechanism: An investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with or without vaginismus. Urogynecology Journal and Pelvic Floor Dysfunction 12: 328-331
In addition, classifying vaginismus as a sexual dysfunction implies a disruption in the phases of the sexual act (desire, arousal, orgasm etc.), again this is not validated by scientific data and does not take into account how this disruption may be a natural result of experiencing or anticipating pain, the effect of sexual abuse or an acceptable defence mechanism rather than a stigmatizing sexual disorder (Kleinplatz 2005; Yitzchak et al. 2002; Shaw 1994; Silverstein 1989; Ohkawa 2001; Butcher 1999; Valins 1992; Van der Velde et al. 2001).
Finally, the focus of the definition is on its interference with intercourse, which led to largely ignoring sufferers’ problems in non-sexual situations such as insertion of tampons, specula, medications and dilators.
This focus has also led research to measure the success of treatments by the occurrence of pain free heterosexual penetration, which besides being a questionable outcome, has pathologised those women who may wish not to engage in penetrative sex (Ussher 1993; Tiefer 1999) but who may nevertheless want to solve their experience of pain at inserting a tampon, speculum etc.
Recently, 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.
• Definitions of women's sexual dysfunction reconsidered: advocating expansion and revision (Basson R, Leiblum S, Brotto L et al. (2003) in J Psychosom Obstet Gynaecol. 24(4):221-9.
Views partly extracted from the Literature Review submitted by the webmaster at the University of Melbourne for her postgraduate degree in Women's Health, 2006.
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|DISCLAIMER: This site is not designed to provide medical advice. All material is gathered from the experience of hundreds of women who experienced vaginismus but it is for information only and is not intended to be a substitute for professional or medical advice, diagnosis, and treatment. Please review the information contained on vaginismus-awareness-network.org carefully and confer with a health care professional specialized in vaginismus, as needed.|