SEXUAL PERFORMANCE PROBLEMS: VAGINISMUS AND DYSPAREUNIA

Vaginismus and Dyspareunia Two specifically female sexual problems are vaginismus and dyspareunia. These problems do not involve direct physical shutdown of any single aspect of the sexual response cycle, but they are nonetheless quite painful and frustrating.
Vaginismus is a condition in which the muscles in the outer one-third of the vaginal canal automatically spasm in reaction to any attempted vaginal penetration. This condition can vary in severity. Some women experience vaginal tightening during attempted intercourse. This proves to be uncomfortable for both partners and makes intromission (insertion of the penis into the vagina) difficult to attain. Other women experience vaginal spasms so severe that no degree of intromission is possible. Such women even have difficulty undergoing a pelvic medical examination and often find it impossible because the vaginal muscles have developed a conditioned spasm reaction to any attempts at penetration.
Vaginal spasms can often be reconditioned so that pelvic exams and intercourse are possible. Treatment for this condition typically involves learning relaxation techniques, which are used in conjunction with gradually inserting one's own fingers, or vaginal dilators of progressively larger diameters. However, some women do not experience improvement from this technique because their vaginal spasm is rooted in discomfort that is caused by physical, not psychological, factors. These factors might involve infection, a vaginal lesion, uterine pain experienced during sexual arousal, or thinning of vaginal walls secondary to aging. For such women, relaxed vaginal musculature may be possible, but pain during intercourse, or dyspareunia, may be present. Dyspareunia can be caused by psychological factors, but this condition most often signals the existence of some physical problem. The specific nature and location of pain during intercourse can provide valuable information in diagnosing the cause of dyspareunia. Does the pain occur only during deep penile penetration, or immediately upon shallow penetration? Is pain limited only to certain intercourse positions? Once lubrication occurs, does the pain lessen? The answers to these questions help a physician to accurately diagnose the cause of dyspareunia and thus to treat the condition most effectively.
If you are experiencing either vaginismus or dyspareunia, it is especially important to have a thorough gynecological examination before attempting any behavioral or psychological forms of treatment. I recommend that you seek a thorough medical evaluation as a first step in dealing with any sexual performance difficulties, and this recommendation is strongest with reference to these two conditions.
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