genital examination in vaginismus
Genital examination of a patient with vaginismus is usually carried out after several consultations.
- a patient may elucidate various degrees of anxiety - from verbal expressions of discomfort to refusal, pulling away, or screaming
- pain is commonly reported in the absence of abnormal physical findings
Before the examination:
- make the patient comfortable by reassuring that the examination will stop immediately if she wishes
- explain about the examination and what will be done during the examination
- tell her that she can ask questions at any point
- let the patient hold the smallest Cusco’s speculum to reduce her fear
- explain that the vagina has the potential to expand. However penetration becomes difficult due to muscle contraction caused by anxiety
- press your finger on her hand and in order to demonstrate the pressure you will be using during the examination
During the examination:
- be gentle, encourage the patient to relax her legs, do not force them apart
- place one finger on the external genitalia and get permission again to inspect the vulva
- check for vestibulodynia by using cotton wool swabs to elicit any point tenderness
- obtain permission again before inserting one finger into the vagina
- generous use of lubricants may be useful
- assess how well the patient tolerate this process
- if finger penetration is possible, feel the tightness in the levator ani
- try to identify the painful areas
- instruct the patient to squeeze and release her pelvic floor muscles.
- observe whether this increase the pain
- can the patient consciously relax the levator ani?
- discuss the possibility of speculum examination
Information gathered from the examination can be used to discuss regarding her experience of sexual intercourse.
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