The management of vaginismus.

Vaginismus may be defined as an involuntary spastic contraction of the musculature investing the outer third of the vagina. This spasm is produced by imagined or real attempts at vaginal penetration. Though vaginismus may be suspected from the history, the definitive diagnosis is made on vaginal examination. Preparation and positioning of the patient for this examination are important. Where anxiety of the patient precludes examination, the patient may be first desensitized to penetration using behavioural modification techniques. The patient is then shown how to overcome the spasm using daily digital vaginal examination. When digital vaginal dilatation can be painlessly carried out, intercourse is attempted. In some women, vaginismus appears to be a somatic manifestation of unconsious psychological conflicts. These women may benefit from more intensive psychotherapy.