To the Editor:
Superficial dyspareunia is present in most vaginismic women [1,2]. Even so, vaginismus is assumed to be a psychosomatic disorder [1-5] rather than a pain-elicited muscle spasm. I report a patient with complete vaginismus in whom hyperesthetic but otherwise normal introital skin areas could be identified. Application of a lignocaine gel abolished hyperesthesia and resolved vaginismus.
A 17-yr-old woman could not have coitus or use vaginal tampons because of introital pain and vaginismus. On gynecological examination, no vulvar skin abnormalities were visible. A skin area 2 x 2 mm2 to the left of the urethral meatus was extremely painful when touched lightly. The pelvic muscles were tightly contracted, and insertion of one finger was not possible. Without the patient being informed about its anesthetic property, a 5% lignocaine gel was applied to the hyperesthetic skin area. Within 20 s, the pain could not be elicited, and the muscle spasm resolved, whereupon three fingers could be painlessly inserted into the vagina. A pelvic examination was normal. She later reported successful intercourse with prior application of the lignocaine gel.
The present case suggests that primary vaginismus may be a pain-elicited muscle spasm and that topical anesthestics may be useful in the treatment of vaginismus associated with superficial dyspareunia.
Bjornar Hassel, MD, PhD
Department of Neurobiology; The Babraham Institute; Cambridge CB2 4AT, UK
1. Steege JF. Dyspareunia and vaginismus. Clin Obstet Gynecol 1984;27:750-9.
2. Fuchs K. Therapy of vaginismus by hypnotic desensitization. Am J Obstet Gynecol 1980;137:1-7.
3. Masters WH, Johnson VE. Human sexual inadequacy. Boston: Little, Brown & Co, 1970:250-65.
4. Fordney DS. Dyspareunia and vaginismus. Clin Obstet Gynecol 1978;21:205-21.
5. Kaplan HS. The new sex therapy. Middlesex: Penguin Books Ltd, 1981:455-74.