{"id":820,"date":"2024-09-04T12:21:04","date_gmt":"2024-09-04T12:21:04","guid":{"rendered":"https:\/\/academiakineperineo.com\/?p=820"},"modified":"2025-10-17T08:20:56","modified_gmt":"2025-10-17T08:20:56","slug":"vaginismus-and-perineal-rehabilitation","status":"publish","type":"post","link":"https:\/\/academiakineperineo.com\/fr\/vaginismus-and-perineal-rehabilitation\/","title":{"rendered":"Vaginisme et r\u00e9\u00e9ducation p\u00e9rin\u00e9ale"},"content":{"rendered":"\t\t
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\n\t\t\t\t\t\t\t\t\n\t\t\t\tVaginismus and Perineal Rehabilitation \n\t\t\t<\/h1 > \n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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DOI: <\/b>10.26717\/BJSTR.2024.55.008640<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Alexandra Tufa* and Silvia Teodorescu<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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National University of Physical Education and Sports, Faculty of Physical Education and Sport, Romania.<\/p>\n

*Corresponding author:<\/span> Alexandra Tufa, National University of Physical Education and Sports, Faculty of Physical Education<\/p>\n

and Sport, Bucharest, Romania<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t

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ARTICLE INFO<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Received: <\/b> January 16, 2024<\/span><\/p>

Published: <\/b> February 12, 2024<\/span><\/p>

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Citation: <\/b>Alexandra Tufa and Silvia Teo- dorescu. Vaginismus and Perineal Reha- bilitation. Biomed J Sci & Tech Res 55(1)- 2024. BJSTR. MS.ID.008640.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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ABSTRACT\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Vaginismus is an involuntary contraction of the muscles of the pelvic floor following an attempt or anticipation of sexual intercourse, penetration by a finger, or by an object. Vaginismus is characterized as a disorder of penetration, thus making any penetration painful, if not impossible.<\/span><\/p>

Hypothesis: <\/b>Physiotherapy treatment has favorable results in a case study of primary vaginismus present in<\/span><\/p>

a 27-year-old young woman following the failure of several other therapies.<\/span><\/p>

Methods: <\/b>It was first necessary to create a ground of trust with the patient and to explain to her the anatomy and physiopathology of the perineum. Different physiotherapy means of perineal rehabilitation have been used: electrotherapy to relax and antalgic the spastic muscles of the pelvis, stretching and softening of the tendino-muscular complex of the pelvis and lower limbs; then a progressive vaginal approach with perineal manual therapy, dilators, electrotherapy and positive biofeedback (vaginal probe) and especially negative biofeedback for awareness of muscle relaxation; the technique contract \/ release with breathing.<\/span><\/p>

Results: <\/b>The patient began to have intercourse with vaginal penetration positively impacting her quality of life and the couple\u2019s quality of life improved.<\/span><\/p>

Conclusions: <\/b>Perineal rehabilitation had favorable results in the context of primary vaginismus in a young 27-year-old patient.<\/span><\/p>

Keywords: <\/b>Vaginismus; Physiotherapy; Perineal Rehabilitation<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Introduction<\/b><\/h1>

Sexual health is framed by rights and is defined by the WHO [1] as \u201ca state of physical, emotional, mental and social well-being in re- lation to sexuality, not just the absence of disease, dysfunction or in- firmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free from coercion, discrim- ination and violence. To achieve and maintain good sexual health, the Human Rights and Sexual Rights of all people must be respected, protected, and fulfilled\u201d. Vaginismus is an involuntary contraction of the muscles of the pelvic floor following an attempt or anticipation of sexual intercourse, penetration by a finger, or by an object [2]. Vag- inismus is characterized as a disorder of penetration, thus making any penetration painful, if not impossible. Vaginismus is a common pathology whose prevalence varies between 5 and 17% [3]. Vaginis- mus has a significant impact on the quality of life from a psychologi<\/span>cal, social, couple life and fertility point of view. Several studies have shown that it causes marked distress or interpersonal difficulties in the women concerned [4] and is moderately correlated with the level of stress [5].<\/span><\/p>

As with other sexual dysfunctions, it can lead to marital and in- terpersonal problems [6-7], and it is likely to lead to infertility. Vag- inismus has been associated with high risk of marital relationship disruption, anxiety, depression, and low self-esteem. The most con- sulted specialists in case of vaginismus are often multidisciplinary to optimize the results: general practitioner, gynecologist, psychol- ogist, sexologist and physiotherapist or midwives specialized in the rehabilitation of the perineum. \u201cPerineal re-education, carried out endovaginally, promotes relaxation of the muscles that the patient contracts voluntarily or involuntarily: re-education is therefore ori- ented towards relaxation which improves the quality of sexual life. The perception of contractions favors the perception of the receptors\u00a0<\/span>of vaginal sensitivity: the tenso and the presso-receptors which are stimulated by the contraction of the pelvic muscles; this stimulation is identical when it is produced by the pressure of a penis, a finger or any other object. Thanks to this awareness of the sensitivity of the superficial and deep receptors, the woman can act on her perineal relaxation, on the rise of her genital sexual arousal and of her sexual pleasure [8].<\/span><\/p>

Before this perineal re-education by vaginal route, which proves impossible during the first sessions, the role of the physiotherapist is first of all to create a ground of trust with the patient based on listen- ing, empathy, explanations on anatomy, physiopathology and course of treatment; then begin rehabilitation with an \u201cexternal\u201d approach until the patient is ready for an endovaginal approach.<\/span><\/p>

Types of Vaginismus<\/b><\/h2>

Primary: <\/b>Vaginismus is said to be primary if penetration has always proved impossible or difficult. The primary form represents the highest frequency of vaginismus. It appears at the beginning of a woman\u2019s sexual life.<\/span><\/p>

Secondary: <\/b>Vaginismus is said to be secondary if it appears af- ter a satisfying sex life without any particular problems. Following a physical or psychological trauma, infection, hormonal change due to menopause or pelvic pathologies, penetration becomes impossible [9].<\/span><\/p>

Vaginismus can be classified into four degrees based on severity [10]:<\/span><\/p>

  1. Levators spasm, disappearing by reassuring the patient;<\/span><\/li>
  2. Levators spasm, persistent during gynecological examina-<\/span><\/li><\/ol>

    tions;<\/span><\/p>

    1. Levators spasm, contraction of the buttocks during any at-<\/span><\/li><\/ol>

      tempt at examination;<\/span><\/p>

      1. Levator spasm, dorsal arch contraction, thigh adduction, de-<\/span><\/li><\/ol>

        fensive movements, and lower limb retraction;<\/span><\/p>

        Grade XO<\/b><\/h2>

        Grade 4 associated with vegetative manifestations, refusal of any examination. In severe cases of vaginismus, the adductors of the thighs, the rectus abdominis and the gluteal muscles may have a reflex contraction that is triggered by imagined or anticipated attempts to penetrate the vagina or during sex [11]. Vaginismus can also be clas- sified as total or partial\/situational. It is total when the introduction of any body or object into the vagina is impossible (sanitary tampon, finger, medical material, etc.). It is partial or situational when penetra- tion is impossible or difficult and painful especially during attempts to penetrate the penis, while the introduction of other objects is pos- sible and does not generate spasms or pain.<\/span><\/p>

        In the literature there are several therapeutic approaches, often combined:<\/span><\/p>