A 23 yr old nulliparous woman complains of painful coitus and informs that pain is located at the vaginal introitus. This is also accompanied by painful involuntary contraction of the pelvic muscles. The pelvic examination is normal. No obviouos local pathology could be seen. Of the following, what is the most common cause of this condition?
This patient has vaginismus. Genito-Pelvic Penetration Pain Disorder: GPPPD Dyspareunia : Persistent or recurrent pain with attempted or complete vaginal entry and/or penile vaginal intercourse. This is frequently associated with pelvic pathology such as endometriosis, pelvic adhesions, or ovarian neoplasms. Vaginismus: Persistent or recurrent difficulty to allow vaginal entry of a penis or other object, often with phobic avoidance,anticipation/fear/experience of pain, plus variable and involuntary pelvic muscle contraction. Involuntary reflexive contraction of pelvic muscles and often thighs, abdomen, buttocks, and even jaw, fists, and other muscle groups. The term was only correct when no local or pelvic pathology was present. The diagnosis of vaginismus was provisional until a very careful introital and vaginal examination was done. It may be generalized--the woman is unable to place anything in her vagina, even her own finger or a tampon It may be situational, maybe she can use a tampon and can tolerate a pelvic examination but cannot have intercourse These 2 terms, Dysparunia and Vaginismus, are now combined as mentioned above and called GPPPD. Treatment of vaginismus is graded Psychotherapy. This involves gradual assistance in making the patient aware of her anatomy and encouragement to allow self examination for a few days first and then examination by a gynecologist. Intercourse is not an option till the patient is comfoable with a pelvic examination.
Endometriosis
Psychological causes
Baholin's gland abscess
Vulvar atrophy
Infeility (Eggs'plantation!)