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Disease VAGINISMUS
   
Treatment Attempt at vaginal penetration causes reflex, involuntary spastic contraction of the vaginal entrance.

Couple may present thinking vagina is too small, or hymen is too thick. OR husband may present with erectile dysfunction, which is actually due to wife’s screams and resistance. Diagnosis is confirmed by P.V. examination, which also causes the same spasm, constriction of thighs and resistance.

The Cause:

1. Mainly psychological due to religious beliefs, past sexual trauma, guilt feeling or homosexual identity.

2. Rule out painful pelvic conditions like endometriosis and P.I.D.

Treatment:

1. Sexual education: explaining the sexual response cycle and it’s natural existence.

2. Vaginal relaxation by gradual dilation:

Step 1:

Give smallest cervix dilator and instruct the wife to insert it is in the vagina after proper lubrication, and relax. Practice it for several days and learn to relax.

Step 1:

On next visit, give slightly larger dilator. Repeat this over several weeks till the largest dilator can be accommodated. Alternatively, patient may use her own fingers & later 2 fingers to achieve the same result.

Step 3:

Now, the husband should insert the dilators, very gently and under her guidance for several days.

Step 4:

Finally coitus allowed, with proper lubrication and gentleness to avoid the pain factor.

Tab ALPRAX 0.25 mg HS or bd to reduce anxiety. (Alprazolam = 4D-8 = Tranquiliser)

Explain that the anxiety & spasm is mainly in anticipation of penetration. After penetration, the anxiety will immediately reduce.
ALPRAX 
   

 

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