First AD

Second AD

D. Female Sexual Interest/Arousal Disorder

In DSM-5, the spasm-based definition of vaginismus was dropped, and 

 was combined with dyspareunia, the other “sexual pain disorder,” which resulted in genito-pelvic pain/penetration disorder (GPPPD). A number of factors motivated these changes. The most important perhaps was that research did not support the premise that vaginal spasm was the 

While such spasms can occur in some women, they account for 

 What actually prevents intercourse appears to result from a variety of factors, including an intense fear of vaginal penetration or of pain during vaginal penetration, the experience of pain during penetration, and hypertonicity of the pelvic floor muscles.

A consideration of what typically happens during a gynecological examination to diagnose vaginismus may help to elucidate some of the historical confusion and current changes. What often happens during the examination is that the woman exhibits much distress, shuts her legs, turns away, and refuses to be examined. Not wishing to cause further distress or pain, the gynecologist reasonably does not force an examination and makes a diagnosis of vaginismus without ever verifying the presence of spasm.

 systematically videotaped gynecological examinations for vaginismus and coded women’s facial expressions and behavior, it became apparent that the “vaginismic” woman was reacting phobically in the presence of the feared stimulus.

 The phobic stimulus was vaginal penetration. There was pelvic floor hypertonicity and sometimes spasm but probably as a result of the fear, just as a person with arachnophobia might tense up in the presence of a spider.

The DSM diagnostic criteria for vaginismus

 2010;39:278-291.
2. Reissing ED, Binik YM, KhalifÃ© S, et al. 

Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus

 2004;33:5-17.
3. Lahaie MA, Amsel R, Khalife S, et al. 

Can fear, pain, and muscle tension discriminate vaginismus from dyspareunia/provoked vestibulodynia? Implications for the new DSM-5 diagnosis of genito-pelvic pain/penetration disorder

Sexual & Sexuality

Quizzes

The inability or difficulty to experience vaginal penetration is most similar to which DSM-5 disorder? Find out in this quiz.

Mini Quiz: OCD? Phobia? Or Something Else?

Samara Perez

Yitzchak M. Binik, PhD