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ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 2  |  Page : 509-513

Prevalence of vaginismus in Delta, Egypt


1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Dermatology, Andrology and STDs, Belbes General Hospital, Sharqia, Egypt

Date of Submission29-Dec-2019
Date of Decision14-Feb-2020
Date of Acceptance23-Feb-2020
Date of Web Publication30-Jun-2021

Correspondence Address:
Shaimaa S El-Sahy
MBBCh, Shebin El-Kom, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_398_19

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  Abstract 


Objective
To study the prevalence of vaginismus in Delta, Egypt, and its effect on human sexual life.
Background
Sexual dysfunction in women is an important public health problem worldwide. Vaginismus is defined as a penetration disorder in which any form of vaginal penetration is often painful or impossible. It has traditionally been referred to as an involuntary contraction of the pelvic floor muscles. The prevalence of vaginismus is poorly understood and relatively unknown.
Patients and methods
This cross-sectional study included 200 women of different ages. This study was performed on women in Delta, Egypt, in the period from April 2019 till October 2019.
Result
The findings of the study indicate that vaginismus is a common sexual problem, as its prevalence in Delta, Egypt, according to the present study is 20%. This result depends on that vaginal penetration and vaginal examination is impossible and has not occurred in 20% of cases. Vaginismus causes distress to both partners, where 72.5% of the cases' partners showed no response, 12.5% got angry, and only 15% supported. Regarding affection of pain to life, 77.5% of cases had no effect, 7.5% decrease sexual desire, 5% had depression, 7.5% had low physical and emotional satisfaction, and 2.5% had phobic anxiety. Regarding the female sexual function index, mean desire score was 3.36, arousal score was 3.97, lubrication score was 3.36, orgasm score 3.75, satisfaction score was 3.95, pain score was 3.98, and mean female sexual function index was 22.86.
Conclusion
Vaginismus is a common and significant sexual problem that causes distress and frustration for both partners.

Keywords: Delta, dyspareunia, female sexual dysfunction, prevalence, vaginismus


How to cite this article:
Gaber MA, El-Sahy SS. Prevalence of vaginismus in Delta, Egypt. Menoufia Med J 2021;34:509-13

How to cite this URL:
Gaber MA, El-Sahy SS. Prevalence of vaginismus in Delta, Egypt. Menoufia Med J [serial online] 2021 [cited 2024 Mar 28];34:509-13. Available from: http://www.mmj.eg.net/text.asp?2021/34/2/509/319732




  Introduction Top


Vaginismus is defined as a penetration disorder in which any form of vaginal penetration is often painful or impossible. It has traditionally been referred to as an involuntary contraction of the pelvic floor muscles owing to actual or anticipated pain associated with vaginal penetration. The definition of vaginismus has recently changed, and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders characterizes it as a subset of 'Genito-Pelvic Pain/Penetration disorder' rather than vaginismus [1],[2].

The symptoms of vaginismus vary between individuals. They may include painful intercourse (dyspareunia), with tightness and pain that may be burning or stinging, penetration being difficult or impossible, long-term sexual pain with or without a known cause, pain during tampon insertion, pain during a gynecological examination, generalized muscle spasm, or breathing cessation during attempted intercourse. Pain can range from mild to severe and from discomfort to burning in sensation. Vaginismus does not prevent people from becoming sexually aroused, but they may become anxious about sexual intercourse, so they try to avoid sex or vaginal penetration [3].

The findings of vaginal muscle spasm may help differentiate vaginismus from other sexual pain disorders. The diagnosis of this disorder is primarily made through a comprehensive history and physical examination. To stratify the severity of vaginismus, Lamont described four grades of vaginismus based on the patient's history, their behavior during a routine gynecologic examination, and 'physical demonstration of perineal muscular spasm' [4].

Treatment will aim to reduce the automatic tightening of the muscles and the fear of pain and to deal with any other type of fear that may be related to the problem. Treatment may involve different specialists depending on the cause. Any possible underlying causes, such as an infection, may need to be ruled out or treated first, before focusing on the vaginismus. Treatment usually includes a combination of the following: pelvic floor control exercises, education and counseling, emotional exercises, reducing sensitivity to insertion, insertion or dilation training, and psychological support [3].

The aim of the study to know the prevalence of vaginismus in Delta, Egypt and its effect on human sexual life.


  Patients and methods Top


This cross-sectional study includes 200 women of different ages, different cultures, different level education, and different socioeconomic level recruited from April 2019 to October 2019. After approval of the study by the local ethical committee, formal consent was taken from every woman regarding being healthy, being free to accept participation in the interview, and willing to fulfill the questionnaire; all participants were assured of confidentiality. We included in our study patients who were literate enough to complete the questionnaire, women of different age groups, and women with absence of underlying diseases. We excluded patients with chronic medical illnesses like diabetes mellitus, hypertension, hyperthyroidism, hypothyroidism, liver disorders, neuropsychiatric diseases, endocrinal disorders, as these disorders may harm sexual functions; patients using drugs that affect sexual behaviors (antihypertensive drugs, thiazide diuretics, antidepressants, antihistamines, barbiturates, amphetamines, diazepine, and cocaine), stressors in the recent 6 months (parental separation, death of first-degree relatives, etc.); women with marital conflict; and subjects who refused to cooperate. The questionnaire consisted of questions about demographics, in which we asked about age, educational level (reads and writes, secondary school, university degree), occupation, and residence. Questions about female sexual function index (FSFI) included the frequency of intercourse, desire to have sex, lubrication, orgasm, sexual satisfaction, and pain. Questions about vaginismus included frequency, first time felt pain, site of pain if vaginismus interfered with sexual intercourse, avoidance of sexual intercourse, motives to engage in sex, interference with sexual arousal, if it affects sensation of lubrication and satisfaction with body image and genitalia, how vaginismus affects participant life, whether circumcised or not, and whether the participant seeked medical advice. Partner's attitude toward vaginismus. Permission to carry out the study was obtained from the ethical committee at the Department of Dermatology, Andrology, and STDs at the Faculty of Medicine, Menoufia University.

Results were collected and entered into the computer using Statistical Package for Social Science program for statistical analysis (version 20; SPSS Inc., Chicago, Illinois, USA). Descriptive statistics in the form of mean, SD, number, and percentage were applied.


  Result Top


This study was conducted on 200 cases with a mean age was 35.45 years, with 72.5% aged less than or equal to 45 years and 27.5% more than 45 years, with minimum–maximum of 23.0–49.0 years. Overall, 27.5% of cases were nulliparous, 22.5% were parity 2 or 3, 15% were parity 1, 7.5% were parity 4, and 2.5% were parity 5.

Regarding mode of delivery, 42.5% had a vaginal delivery and 30% had CS. Overall, 85% of patients were premenopausal and 15% postmenopausal. The mean duration of marriage was 5.63 years, with 85% of cases married for less than or equal to 10 and more than 10 years in 15%, with minimum–maximum. of 1.0–20.0. Overall, 65% of cases had no history of using hormonal treatment, and 35% used hormonal treatment. Moreover, 82.5% were circumcised and 17.5% were not.

Regarding FSFI, mean desire score was 3.36, arousal score was 3.97, lubrication score was 3.36, orgasm score 3.75, satisfaction score 3.95, pain score was 3.98, and mean FSFI was 22.86 [Table 1].
Table 1: Descriptive analysis of the studied cases according to the female sexual function index (n=200)

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Regarding the results of questions about FSFI, low desire (<5) score presented in 10 cases and high desire score (≥5) presented in 90 cases, low arousal score presented in 40 cases and high arousal score presented in 160 cases, low lubrication score presented in 30 cases and high lubrication score 170 cases, low satisfaction score presented in 35 cases and high satisfaction score presented in 165 cases, low pain score presented in 50 cases and high pain score presented in 150 cases, low orgasm score presented in 10 cases and high orgasm score presented in 190 cases, and regarding the total score, sexual dysfunction presented in 45 cases and normal sexual dysfunction presented in 155 cases [Table 2].
Table 2: Results of questions about female sexual function index (n=200)

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Regarding the frequency of sex, patients had sex daily in 25% of cases, 30% had sex once per week, 32.5% had two to three times per week, 2.5% had once per month, and 10% less than that. Regarding sexual desire, 25% of cases had sexual desire almost always or always, 20% had more than half the times, 7.5% had about half the times, 32.5% had less than half the times, and 15% had rarely or never.

Regarding becoming wet, 27.5% of cases almost always or always became wet, 22.5% more than half the times, 12.5% about half the times, 30% less than half the times, and 20% rarely or never.

Regarding reaching orgasm, 30% of cases reached orgasm almost always or always, 20% more than half the times, 12.5% about half the times, 30% less than half the times, and 7.5% rarely or never.

Regarding satisfaction with sexual relationship, 42.5% of cases were satisfied with their sexual relationship, 15% were moderately satisfied, 22.5% were about equally satisfied and dissatisfied, and 20% were very dissatisfied.

Regarding frequency of feeling pain, 47.5% had no pain at all, 5% had pain less than half the times, 27.5% more than half the times, and 20% almost always or always all the times, and regarding site of pain, the most common site of pain was superficial in 20% of cases, 5% had deep pain, and 7.5% had both.

Regarding the possibility of intercourse at present, 20% of cases had pain that makes intercourse not possible at present and pain makes them avoid intercourse.

The questionnaire result showed that the penetration occurred in 80% of cases, but in 20%, no penetration occurs. The vaginal examination was not performed in 20% of cases [Table 3]. The vaginismus was found in 20% of cases [Table 4]. Overall, 72.5% of the cases' partners showed no response, 12.5% got angry, and 15% supported. Regarding affection of pain to life, 77.5% of cases had no effect, 7.5% decrease sexual desire, 5% had depression, 7.5% had low physical and emotional satisfaction, and 2.5% had phobic anxiety. Regarding seeking medical advice, 10% of cases were seeking medical advice and 90% of cases were not seeking medical advice.
Table 3: Distribution of the studied cases according to penetration and vaginal examination (n=200)

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Table 4: Prevalence of vaginismus (n=200)

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  Discussion Top


Vaginismus, along with dyspareunia, makes one of the most prevalent sexual dysfunctions in women, and according to the most recent definition declared by the diagnostic and statistical manual of mental disorders, fifth edition, it has been categorized as 'genito-pelvic pain disorder penetration disorder.' The patients often avoid intercourse, feel involuntary pelvic muscle contraction, and anticipate or have fear of pain along with its experience that persists. The definition clarifies that the experience of pain is not essential for the diagnosis. Moreover, the disorder does not necessarily impair sexual response or the ability to experience pleasure through stimulation [5]. The relevance of vaginismus is beyond its disabling effect, on the woman's sexual life alone, and these patients are more likely to underrate appropriate health care. Studies report uneasiness in using several types of contraception and tampons. Women's complaints in this regard include unsatisfactory sexual relations, painful or difficult penetration, nonconsummating marriage, or even just a difficult gynecological examination [6]. In the current study, we aimed to assess the prevalence of vaginismus in Delta, Egypt, and its effect on human sexual life. A total of 200 cases were included with mean age was 35.45 years. This was higher than that founded in the study by Konkan et al. [7], which showed that mean age was 24.92 years in vaginismus group and 25.35 years in control group.

Another study by Fadul et al. [8] showed that the women in both groups had a mean age of 28.15 years, SD = 6.5, with ages ranging from 18 to 44 years. The mean age of the women studied by Akhavan-Taghavi et al. [5] was 29 ± 5 years (range, 19–45 years). An Egyptian study in Sohag by Hassanin et al. [9] showed that most of the patients were in the age groups 30–39 years and 40–50 years (36.8 and 25.0%, respectively). In the current study, we found that 27.5% of cases were nulliparous, 22.5% were of parity 2 or 3, 15% were of parity 1, 7.5% were of parity 4 and 2.5% were of parity 5. In comparison with other studies, Chedraui et al. [10] showed that the mean parity of surveyed women was 2.9. In the current study, we found that regarding mode of delivery, 42.5% had a vaginal delivery and 30% had a cesarean section. Overall, 85% of patients were premenopausal and 15% postmenopausal. In consistence with our result, Hassanin et al. [9] showed that most were premenopausal (84.9%). In the current study, we found that the mean duration of marriage was 5.63 years, with 85% of cases married for less than or equal to 10 and more than 10 years in 15%, with minimum–maximum of 1.0–20.0. This is higher than in Akhavan-Taghavi et al. [5]. Most of the marriages' duration was between 1 and 3 years (43%). Another study by Ibrahim et al. [11] showed that 30.6% of the studied women were found to been married for 1–5 years now, 25.9% have been married for 5–10 years, and 29.3% have been married for more than 10 years.

In the current study, we found that 65% of cases had no history of using hormonal treatment, 35% used hormonal treatment; moreover, 82.5% were circumcised, and 17.5% were not. In contrast, Ibrahim et al. [11] showed that the use of hormonal therapy was present among 18.9% of the participants, and most of the females were circumcised (71.7%). The most common contraceptive method was found to be IUCD (40.5%), whereas 9.8% did not use any method of contraception. In the current study, we found that the mean desire score was 3.36, the arousal score was 3.97, the lubrication score was 3.36, the orgasm score was 3.75, the satisfaction score was 3.95, the pain score was 3.98, and the mean FSFI was 22.86. Similarly, Ibrahim et al. [11] showed that the assessment of FSFI shows that the lowest mean score was reported for orgasm score (2.1) and desire score (2.8) with 49.2 and 45.5% of participants below median score for each domain, respectively. They have found that 269 women (52.8% of the participants) have sexual dysfunction according to total FSFI score of 26.55 as the cutoff.

In the current study, we found that regarding satisfaction with sexual relationship, 42.5% of cases were satisfied with your sexual relationship, 15% were moderately satisfied, 22.5% were about equally satisfied and dissatisfied, and 20% were very dissatisfied. Similarly, in the study by Hassanin et al. [9], sexual dissatisfaction was reported by 322 (53.6%). In the current study, regarding the frequency of feeling pain, 47.5% had no pain at all, 5% had pain less than half the times, 27.5% more than half the times, and 20% almost always or always all the times, and regarding site of pain, the most common site of pain was superficial in 20% of cases and 5% had deep pain, and 7.5% had both. In contrast, Hassanin et al. [9] showed that sexual pain was reported by 385 (64.1%) women.

In the current study, we found that regarding the possibility of intercourse at present, 20% of cases had pain that makes intercourse not possible at present and pain makes them avoid intercourse. This is explained in Özcan et al. [12] as the anticipation and fear of pain have been noted as characteristic of vaginismus in many clinical descriptions. There is often (phobic) avoidance and anticipation/fear/experience of pain, along with variable involuntary pelvic muscle contraction. This phobic reaction makes attempts at coitus frustrating and painful. In the current study, we found that the penetration occurred in 80% of cases, but in 20%, no penetration occurs, and vaginal examination cannot be done in 20% of females. We conclude that the prevalence of vaginismus among studied females was 20%. In clinical settings, the prevalence of the condition ranges widely depending on the context, from 0.5 to 1% [13]. One study of 54 Turkish women with sexual dysfunctions who attended a psychiatric department found that over three-quarters (75.9%) experienced lifelong vaginismus [14], and this was higher than our prevalence, which could be owing to lower number of women included in this Turkish study.

Another study also had a higher level than our result by Khajehei et al. [15] in India, who reported that 40% experienced vaginismus after their delivery. However, only 15% of those women reported experiencing the condition before pregnancy. Prevalence and incidence studies of vaginismus in Latin America are scarce. One Brazilian study with 57 women found that 14% fulfilled the diagnostic criteria of vaginismus [16], and this lower than our percentage [17]. These discrepancies in results may be owing to differences in cultures and traditions in our country, owing to which many women do not seek medical advice. In the current study, we found that regarding seeking medical advice, 10% of cases were seeking medical advice and 90% of cases had no medical advice. In the study by Akhavan-Taghavi et al. [5], 26 (27%) of the couples had been attending the family health clinic for the first time and the remaining had histories of attending specialist clinics before, with the highest share for the urologists (19%), followed by gynecologists (13%). Only 1% of the participants had ever consulted a general practitioner. Our data are also consistent with the results of Berman et al. [18] who reported that 40% of women did not seek help from a physician for their sexual difficulties, whereas 54% reported that they would like to do so.


  Conclusion Top


Vaginismus is a common and significant sexual problem that causes distress and frustration for both partners.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Dogan S. Vaginismus and accompanying sexual dysfunctions in a Turkish clinical sample. J Sex Med 2009; 6:184–192.  Back to cited text no. 14
    
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Berman L, Berman J, Felder S, Pollets D, Chhabra S, Miles M, et al. Seeking help for sexual function complaints: what gynecologists need to know about the female patient's experience. Fert Steril 2003; 79:572–576.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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