Chapter 17 – Female Sexual Interest and Arousal Disorder (FSIAD)


Clinical presentation of vaginismus consists of severe pain with penetration or where penetration is impossible due to involuntary spasm/contraction/reflex of the muscles surrounding the entrance to the vagina. It is important to differentiate between primary vaginismus which is present from the first attempts at penetration, and secondary vaginismus where there has been a previous history of successful penetration. Primary vaginismus is often associated with a history of sexual abuse or sexual trauma. If sexual aversion disorder is also present referral for psychological counselling is required as well as the use of vaginal trainers to learn to relax the pelvic muscles.

The use of vaginal trainers or dilators as a desensitisation program is the first line treatment for both primary and secondary vaginismus. Refer the patient to a specialist physician, psychologist or pelvic floor physiotherapist who specialises in this treatment. Reasons for failure to progress with vaginal trainers may include the following:

relationship issues fear of pregnancy power dynamics lack of priority dislike of self-touch resentment at having to do this feelings of failure lack of belief in change

As a second line therapy, psychological counselling may be useful if any of the above is present.

Injection of botulinum toxin into the pelvic floor muscles is a third line option. This is performed ... Buy now