Vaginismus, a Component of a General Defensive Reaction. An Investigation of Pelvic Floor Muscle Activity during Exposure to Emotion-Inducing Film Excerpts in Women with and without Vaginismus

Abstract

This study investigates the mechanism underlying vaginismus, which may be part of a general defense mechanism. Exposure to a threatening situation will evoke an increase in muscle activity. This muscle reaction will not be restricted to the pelvic floor but will also occur in postural muscles, such as in the trapezius region. Women with and without vaginismus were exposed to four stimuli: excerpts from threatening, erotic, neutral and sexual-threatening films. Subjects were 45 physician- or self-referred patients with vaginismus and 32 controls with no sexual or pelvic floor complaints. The activity of the pelvic floor muscles and of the muscles in the trapezius region was recorded with surface electrodes. There were no differences between women with and without vaginistic reactions. EMG measurement of both the pelvic floor muscles and the trapezius muscle showed an increase in muscle activity during the threatening and sexual-threatening excerpts in women with and without vaginismus. This increase of involuntary pelvic floor muscle activity is part of a general defense mechanism that occurs during exposure to threatening situations. This reaction is not restricted to a situation with a sexual content. The results of this study shed new light on the concept of vaginismus as a primarily sexual dysfunction.

Disgust and Contamination Sensitivity in Vaginismus and Dyspareunia

“…There is evidence that involuntary contraction of the pelvic floor muscles is part of a general defense mechanism (van der Velde, Laan, & Everaerd, 2001) that may be elicited by (the anticipation of) fearful and/or painful occurrences (e.g., van der Velde & Everaerd, 2001). It seems reasonable to assume that similar defensive circumvaginal contractions can be elicited or potentiated by disgust-related appraisals (e.g., Yartz & Hawk, 2002).…”

A model for critical review of literature – with vaginismus as an example

“…Articles in languages other than English were also excluded (n ¼ 21), as well as book chapters (n ¼ 7) and review articles (n ¼ 5). The present review is based on 22 papers [2,4,8,13,16,[18][19][20][21][23][24][25][26][27][28][29][30][31][32][33][34][35].…”

Understanding sexual pain: A cognitive-motivational account

“…Hence, critical for the development of dyspareunia is the lack of genital arousal that is marked by insufficient lubrication and driven by anticipation-anxiety. In support of this model, research has shown that women react with involuntary pelvic floor muscle activity in response to threatening sexual stimuli [34] and impeded genital arousal -as measured through vaginal pulse amplitude signals -in response to appraisal (i.e., suggestion that a female actor experiences pain) and pain threat (i.e., threat of electrical pulses on the ankle) manipulations [6,7].…”

“…Hence, critical for the development of dyspareunia is the lack of genital arousal that is marked by insufficient lubrication and driven by anticipation-anxiety. In support of this model, research has shown that women react with involuntary pelvic floor muscle activity in response to threatening sexual stimuli [34] and impeded genital arousal -as measured through vaginal pulse amplitude signals -in response to appraisal (i.e., suggestion that a female actor experiences pain) and pain threat (i.e., threat of electrical pulses on the ankle) manipulations [6,7].Genital responsiveness was, however, not different in women with dyspareunia compared to healthy controls, although they did report lower subjective sexual arousal. Note that such discordance between physiological (i.e., genital) and psychological (i.e., subjective experience of) sexual arousal is commonly observed in women [26].…”