Vestibulitis OR vaginismus? (dr. m. goetsch)

[Guest guest]

Also passing this on....

I believe it was written by another member originally.

Dee~

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The NVA (Nat'l Vulvodynia Assoc) Winter 2006 issue published an article by Dr. Martha Goetsch out of Oregon Health and Services Univ titled:

Vulvar Vestibulitis: Dual Sources of Pain?

She's essentially comparing Vaginismus (the diagnostic term for involuntary spasm of the muscles around the entrance of the vagina) and Vestibulitis. :

Dr. Goetsch observed and compiled detailed records of 111 women she performed surgery on. All women suffered from severe Vestibulitis and underwent a superficial modified Vestibulectomy.

Surgery success rate is 85% cured, 10% improved, and 5% unchanged.

The story about the muscles only comes after the story of the surface tenderness.

Surgeons like to hope that surgery for Vestibulitis will provide a full cure. One patient called back reporting that she experienced pain that felt exactly the same as her pre-surgery pain. Dr. Goetsch was amazed and wondered what was painful now? Upon examination, Dr. Goetsch discovered that the muscles around the vagina were tense and vagina was snug from her inability to relax those muscles.

She said that was her clinical introduction to Vaginismus, and when sex is painful, many women cannot discern whether the location of the pain is the vestibule or the internal muscles.

The official psychiatric definition of Vaginismus doesn't even mention pain, but rather a spasm of muscles. Perhaps Vaginismus is a severe form of Vestibulitis.

Because of it's longstanding psychiatric implications, Dr. Goetsch restricted her use of the diagnostic term 'Vaginismus' and tends to use the term 'pelvic floor myalgia' (muscle pain). This is helpful b/c many insurance companies reject coverage for Vaginismus b/c it's viewed as a sexual/emotional dysfunction. Myalgia is a physical condition.

Continued pain after surgery may now relate to muscles rather than Vestibulitis.

Study Findings

69% of patients had tight or tender pelvic floor muscles, as assessed before or after surgery, but only half sought help from a physical therapist, even though she strongly suggested they consider it.

The appropriate test of a Vestibulitis cure is whether the vestibule is non-tender after treatment. After surgery, touch testing demonstrated no vestibule tenderness in 85% of patients, but not all of the 'successes' subsequently experienced pain-free sex.

All women who continued to have pain with sex, but whose vestibules were now non-tender, had examination findings of tight or tender internal muscles. This suggests that the continuing pain with sex was due to muscles.

Lessons about muscle pain

Experience with patients taught Dr. Goetsch that she should always advise women with Vestibulitis that it is likely they will need physical therapy for pelvic floor muscles. She also learned that when intercourse pain varies from episode to episode, it likely stems from the muscles, since Vestibulitis does not generally vary from week to week.

She began suggesting to her Vestibulitis patients that they also be evaluated by a PT specifically trained in pelvic floor relaxation, noting that different skills are necessary to teach relaxation of the pelvic floor muscles.

Today, psychologists who study Vaginismus have called for a better clarification of its relationship to Vestibulitis. The arbitrary separation of Vaginismus delayed answering the question of whether it is actually a severe form of Vestibulitis, in which prominent muscle-clenching and avoidant behavior have overshadowed the role of unbearable tenderness in the vestibule.