DEFINITION.—This affection, which was first called vaginismus by our distinguished countryman the lamented J. Marion Sims, consists in a hyperæsthesia or peculiar sensibility of the site of the hymen and vaginal outlet, associated with involuntary spasmodic contraction upon irritation of the sphincters of the vagina.
ETIOLOGY.—Predisposing Causes.—This is sometimes an idiopathic affection, but more frequently is symptomatic of some other disorder. When idiopathic, it is due to a diathesis generally termed hysterical, or an excessive nervous irritability affecting the entire system. The symptomatic causes are quite numerous—more frequently some insignificant local disorder than any grave form of disease. The more common causes are irritated or inflamed carunculæ myrtiformes, excoriation, and irritable ulcers and eruptions about the vulva, vaginitis, uterine catarrh, inflammation, growths and fissures of the urethra, disorders of the bladder, fissure of the anus, and inflamed hemorrhoids. Other less frequent causes have been mentioned by writers, as neuromata, an unusually rigid perineum, and a disproportionately large male organ. Neftel of New York asserts that lead-poisoning has been the cause of some cases under his own observation.9 It is sometimes associated with or apparently caused by congestive dysmenorrhoea and uterine displacements and engorgements.
9 N. Y. Med. Journ., vol. ix. p. 81.
Emmet's views regarding the etiology and pathology of this affection differ from those of the majority of writers on the subject. He regards it as purely a symptom denoting reflex irritation, and says that with it he has never failed to find some condition, as a displacement, a limited cellulitis, or a fissure in either the rectum or the neck of the bladder, as the exciting cause.10
10 The Principles and Practice of Gynæcology, by Thomas Addis Emmet, M.D., 2d ed., Philada., 1880, p. 607.
SYMPTOMATOLOGY, COURSE, DURATION, TERMINATION, AND COMPLICATIONS.—The most prominent symptom is excessive pain upon the sexual intercourse; this is often so marked that subsequent attempts, or even a digital examination, will throw the patient into a state of extreme nervous trepidation and apprehension. If attempts at coition are persevered in, the symptoms are further intensified, so that the spasm and violent contraction of the sphincter vaginal muscles induce agonizing pain. Besides having the characteristic pain, patients with this disorder are, as a rule, sterile. If a physical examination be made in a well-marked case of vaginismus, it frequently occurs that the slightest touch on the part of the physician about the site of the hymen will bring on painful contraction of the vagina and sphincters, and cause the patient to spring up and show much nervous disturbance. In the same class of cases it may be brought on by walking. Thomas says that "in some cases a marked tendency to spasm will have been noticed upon sudden changes of position or washing the genital fissure."11
11 Op. cit., p. 206.
Barnes remarks that in some women the irritability of the nervous centres becomes so great, the sensitiveness of the peripheral nerves at the vulva so acute, and reflex action thereby so intensified, that the attempt at intercourse will induce convulsion or be followed by syncope.12
12 Edis, Diseases of Women, p. 533.
One case came under the writer's observation where the sensitiveness was so marked that a slight touch with cotton or a camel's-hair brush would bring on severe painful contraction.