The Pain View

In a recent review article, Reissing et al. have raised the question as to the extent to which the existing concept of vaginismus is correct (5). Is the increased pelvic floor muscle tension actually characteristic of vaginismus? In their view, the role of the pelvic floor muscles in vaginismus is identical to the role of the muscles in chronic tension headaches: an important symptom, but not of decisive importance to the diagnosis. Does this apply to the experience of pain? They believe that in vaginistic patients, until now the pain or the changed sensations (dysesthesia) have been unjustly bypassed. Is vaginismus therefore a phobic reaction to penetration? This is indeed the case in some vaginistic women, but it is not clear whether this fear is cause or consequence. In their view, women with vaginismus are suffering from an aversion/phobia for vaginal penetration, or from a genital pain problem, or both. If the aversion/phobia lies in the forefront, then cognitive behavioral therapy and pharmacological intervention are the obvious choice. In contrast, a genital pain problem requires a multidisciplinary approach, such as is also the case with other chronic pain syndromes.

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