Perhaps the most important resource used in the evaluation of the vaginismus patient is the detailed Vaginismus patient questionnaire. Most of my patients find a GYN exam to be very difficult if not impossible. Patients with the more severe grades of vaginismus cannot be examined unless sedation or anesthesia is used. Therefore the history becomes very important in making the diagnosis.
The diagnosis of vaginismus is more often accomplished by a good history than by physical examination.
Most severe vaginismus patients (Lamont grades 3 and 4, Pacik grade 5 vaginismus) have vaginal spasm, especially of the entry muscle, the bulbocavernosum. The less severe patients do not have this degree of spasm, or the vaginal tightness is less but still present. Either way, the patient often complains that intercourse is like “hitting a wall”. Any muscle in the body that is forcefully stretched causes pain. The pain is described as “burning pain”. This is exactly what happens in the vaginismus patient. The vaginal entry muscle looks and feels like a tightly closed fist that has no opening. (This is seen in the operating room even after the patient has been sedated.) In some patients the burning lasts for hours. A few describe that the pain lasts for days. Little wonder these patients are afraid of intercourse. No one looks forward to pain.
When you fill out the vaginismus patient questionnaire
This is a time for “soul searching” and for you to let go. I am willing to listen to you. Each questionnaire tears at my own soul. I have learned so much from my vaginismus patients and I have spent years being committed to these women. The detail, as painful as it may be, is important. This is a time to tell your story. In the process the correct diagnosis can be made and the correct treatment instituted. It is helpful to involve your husband when filling out the questionnaire. Vaginismus is a two way street and the man is “afflicted” also.
When the vaginismus questionnaire is too difficult for the woman to fill out
Some patients are so “freaked out” by their condition that they cannot even get themselves to fill out the questionnaire. I received the following email from a patient’s husband:
Husband’s email
“I wanted to thank you for speaking with me over the phone about Vaginismus. It’s difficult for us to even talk about this subject together let alone someone else. We have been married for close to ten years and have had sex only a couple of times. My wife has tried dilators but everything seems to be getting worse. Since you have sent the material by e-mail I have been speaking with her about the treatment. I just hope our relationship hasn’t been damaged to a point of divorce and this condition is curable. I have printed the forms for my wife to look over but she hasn’t touched them as of yet. My wife claims that she needs to pursue a cure for level 4 Vaginismus and seems determined to go through with the procedure, it’s just she doesn’t want to think about it right now. We both know that we can’t do this alone and your 90% success rate of a cure are good odds to escape this emotional Hell called Vaginismus. Thanks again for the information and as we get closer to her exam date I’m sure you’ll being hearing from us again.”
The unwillingness of the afflicted vaginismus patient to fill out forms is fairly common, especially among the more severe vaginismus patients. The forms open painful wounds and create too much fear and anxiety to even consider taking the first steps needed. Even when patients fill out the forms themselves, the questions bring back many uncomfortable memories.
Advice to the husbands who fill out the forms
Fill out as much of the questionnaire as possible. Provide as much detail as you can. I will be happy to accept the forms from you, just indicate that you were the author. Every so often discuss some of the content with your wife to involve her and to include information that you are not familiar with. From just the history, I can usually make a diagnosis and recommend treatment. Any attempted physical exam of the pelvis is usually impossible in these patients and this is why I rely heavily on a detailed history.
When this is done, send the completed forms to the office. I will then review them.
After the two of you have read the book, “When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy” a remote consultation by telephone or Skype can be arranged. It is best if each of you read one chapter at a time and discuss this information before moving on. One of my patients who struggled with multiple failed treatments for fifteen years took 3 months to complete the book with her husband. When they did, they were ready for the next step.
I have many patients and their husbands who have become strong advocates, who are willing to communicate with you and your wife. Let me know when she is ready.
I also recommend that the two of you spend some time on the Forum. This is a strong community of vaginismus patients who support each other. Each patient has lived in a world of isolation and surrounded by walls of silence. They suffer from shame and embarrassment. They think they are the only ones with this problem. The Forum helps tear these walls down and allows women and their partners to feel “normal”. The treatment completes the process.
Questionnaires can be obtained by completing our contact us form or by calling the office at 1 (603) 669-0290 or 1 (800) 640-0290 (U.S. only).
Our office hours are Monday through Thursday 9 AM to 4 PM.