Vaginismus and Dyspareunia. A Case Report From Clinical Practice

The article deals with the following clinical case. Female patient Z., 27 years old, not married, currently has no sexual partner. For 2 years she has had muscle contractions that prevent the penis from entering the vagina, accompanied by contractions of the thigh muscles. There is also pain when trying to penetrate the penis into the vagina. These phenomena are connected with a fear of their occurrence during sexual intercourse. The examination allowed us to assume that in this case we are talking about psychogenic vaginismus and psychogenic dyspareunia (in ICD-10 codes F52.5 and F52.6 – vaginismus and dyspareunia of non-organic origin). In ICD-11, this disorder is represented by the code HA20 (Sexual pain-penetration disorder). This diagnosis is common to these pathologies. The following correction was carried out: (1) measures to help the female patient understand her problem and its origin; (2) cognitive techniques to mitigate the perception of one’s disorder, in particular, the “matching by contrast” technique proposed by us; (3) hypnosuggestive therapy (programming and modeling) [13 sessions]; (4) the “swing” technique modified by us from the arsenal of neurolinguistic programming [one session conducted]; (5) sex therapy (sexual behavioral training) – insertion of vibrators into the vagina with increasing depth of immersion; (6) pharmacotherapy: tranquilizer gidazepam and muscle relaxant sirdalud 1-1.5 hours before attempting sexual intercourse or inserting a vibrator. The given therapy led to the complete elimination of vaginismus, which made it possible to perform vaginal sexual intercourse, and a significant reduction in the severity of dyspareunia. The female patient notes that the pain during insertion of the penis into the vagina has significantly decreased. There is no discomfort during friction. She can also now have sex in different positions. Previously, this was impossible because the penetration of the penis into the vagina was accompanied by greater pain in some of them. In addition, she notes that now it takes much less time to insert the penis into the vagina (but not because of the absence of muscle spasm, which she has already gotten rid of), but because of the reduced fear of pain during penetration.