The current definition of vaginismus is problematic. First, the vaginal muscle spasm criterion has never been empirically validated and it appears that vulvar pain and the fear of pain or of vaginal penetration characterizes most women currently diagnosed with vaginismus. Moreover, vaginismus cannot be reliably differentiated from superficial dyspareunia. A recent consensus definition reflects these conclusions and defines vaginismus as: 'persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, finger and/or any object, despite her expressed wish to do so. There is variable (phobic) avoidance, involuntary pelvic muscle contraction and anticipation/fear/experience of pain. Structural or other physical abnormalities must be ruled out or addressed'. Binik has also recently proposed a new conceptualization that combines vaginismus and dyspareunia into a single genito–pelvic pain/penetration disorder characterized by persistent or recurrent difficulties for 6 months or more with at least one of the following:
Inability to have vaginal intercourse/penetration on at least 50% of attempts;
Marked genito–pelvic pain during at least 50% of vaginal intercourse/penetration attempts;
Marked fear of vaginal intercourse/penetration or of genito–pelvic pain during intercourse/penetration on at least 50% of vaginal intercourse/penetration attempts;
Marked tensing or tightening of the pelvic floor muscles during attempted vaginal intercourse/penetration on at least 50% of occasions.
Women's Health. 2010;6(5):705-719. © 2010
Future Medicine Ltd.