Episiotomy is an aid done to prevent perineal tears, which may involve the anal sphincter and rectum. However, if not given judiciously, this can result in an increase in morbidity in patients. We present a case report of two young females who presented to our outpatient department with a complaint of vaginismus after their previous vaginal deliveries. The first patient had partial vaginal atresia and the second patient had complete vaginal atresia after an episiotomy repair. The complication arose due to mismanaged episiotomy repair that had a severe impact on their physical, sexual, and psychological well-being. They both underwent vaginal stricture release and adhesiolysis showed satisfactory outcomes during their follow-up. Though not recommended, prophylactic episiotomy continues to be widely performed. The approach adopted during the operative delivery stays unclear, as episiotomy execution is likely to be impacted by the physician\'s working environment, as well as maternal and fetal circumstances. Trained execution at rural or urban and private or public facilities is the need of the hour. Counseling regarding prophylactic or emergency episiotomy and its consequences during labor should be considered as a part of their antenatal care.

Vaginismus is a sexual dysfunction occurring in females presented as a contraction of the muscles around the vagina as a reflex, causing the failure of vaginal penetration. Although many psychological, social, and cultural factors that may cause vaginismus have been suggested, its underlying mechanisms are not clear. The aim of this study was to determine the sexual attitude, sexual self-awareness, and sociocultural status of women with and without lifelong vaginismus. This is a case-control study. A total of 148 women were included in the study: 74 women with a lifelong vaginismus diagnosis and 74 women without a history of vaginismus/painful sexual activity controls. Data were collected using a structured questionnaire, the Sexual Self-Consciousness Scale, and the Hendrick Brief Sexual Attitudes Scale. Sexual shyness (OR = 0.854), sexual self-focus (OR = 0.888) and birth control (OR = 1.279), communion (OR = 1.198), and instrumentality (OR = 1.330; the sub-dimensions of the Sexual Attitude Scale) were associated with (χ2 = 96.130, p < .001) vaginismus at the rate of 63%. Those who did not receive sexual information; those who obtained information about sexuality from the social media; those who had negative thoughts about sexuality due to religious reasons; those who found the genitals and sexuality as disgusting; and those having more feelings of fear and pain are more likely to have vaginismus. Some socio-cultural factors may negatively affect women and cause vaginismus. Women with vaginismus had low sexual self-consciousness and negative attitudes toward sexuality. It may be incomplete to consider vaginismus only as a vaginal entry problem. Therefore, in the treatment of vaginismus, women\'s sexual attitude, sexual self-awareness, and sociocultural factors should be evaluated in a holistic manner.

This study was conducted to assess dyadic adjustment, marriage, and sexual satisfaction as risk factors for women with lifelong vaginismus. This is a case-control study. A total of 142 women were included in the study: 71 women with a diagnosis of lifetime vaginismus constituted the study group and 71 women without a history of vaginismus/painful sexual activity constituted the control group. Data were collected using a questionnaire and the Revised Dyadic Adjustment Scale (RDAS), the Marriage Satisfaction Scale (MSS), and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Duration of marriage (OR = 1.344), frequency of sexual intercourse (OR = 0.059), marital satisfaction (OR = 1.450), sexual satisfaction (OR = 0.901), and consensus (OR = 1.749), which is a sub-dimension of RDAS, were found to be risk factors increasing likelihood of vaginismus by 83% (χ2 = 140.191, p < .001). In addition, those with low level of education, diagnosed with a psychological disorder (anxiety, depression, etc.), who found their spouse\'s body disgusting, who scored lower in MAS sub-dimensions, and who received lower total score in the RDAS and its satisfaction subdimension were more likely to have vaginismus (p < .05). Duration of marriage, sexual intercourse frequency, sexual satisfaction, marital satisfaction, and consensus are important risk factors for vaginismus. It may be incomplete to consider vaginismus only as a vaginal penetration problem. Women\'s demographic characteristics, dyadic adjustment, and marital and sexual satisfaction should be handled in a holistic manner.

BACKGROUND: Vaginismus is poorly understood and relatively unknown among health care providers. For those who understand and treat vaginismus, few make an assessment of the severity of this condition. The importance of classifying the severity of vaginismus impacts the clinician\'s ability to diagnose and treat vaginismus, and understanding of the patient\'s experience.
OBJECTIVE: The aims of this paper are to identify the distinguishing features of severe grade 5 vaginismus, determine if vaginal spasm is present in severe grade vaginismus, and to establish qualifications for the Pacik grade 5 classification.
METHODS: Assessment of 553 referred or self-referred women who were unable to tolerate intercourse completed a comprehensive pretreatment questionnaire. Of those women, 391 underwent a vaginal examination in a certified surgicenter using sedation and anesthesia as needed.
METHODS: The main outcome measures were to detect the presence of a visceral reaction with an intended or actual gynecologic examination in Grade 5 patients, and to identify vaginal spasm on examination.
RESULTS: A visceral response reaction to routine gynecologic examinations, as well as spasm of the bulbocavernosum, occurred in patients with severe vaginismus.
CONCLUSIONS: Severe vaginismus with visceral response manifestations to routine gynecologic examinations, inability to have intercourse, and spasm of the bulbocavernosum is newly defined as severe grade 5 vaginismus. Pacik PT, Babb CR, Polio A, et al.
METHODS: Redefining Severe Grade 5 Vaginismus. Sex Med 2019;7:489-497.

Although Vaginismus, or an involuntary contraction of the vaginal muscles, is one of the reasons sexual intercourse difficulty is relatively common in Iran, few studies have addressed it. This research is a single-case type (AB) design. Initially, a pretest was taken from all participants. The number of sessions was estimated between 4 and 6 sessions, and the duration of each session was 45-60 minutes. Couple therapy sessions were conducted by an individual with a PhD in sexual and reproductive health. An FSFI questionnaire was completed before counseling, just after counseling, and 4 weeks after the last counseling session. During each session, the therapist reviewed the homework assignments of the previous session regarding emotions, thoughts, and experiences, and at the end of each session, the therapist answered the couples\' questions. We introduce and follow up on five casesof couples who suffer from Vaginismus. The mean age for females was 29.5, and for males it was 32. The mean length of marriage was more than 5 years. The FSFI score of participants improved from baseline (A) after intervention (B). The study would appear to show that this treatment format may be a cost effective intervention for couples presenting with Genito-pelvic pain/penetration disorder (Vaginismus).

The objective of this case-control study was to identify psychosocial factors associated with vaginismus. One hundred twenty women were recruited and interviewed at the Institute of Human Sexuality, 40 with lifelong vaginismus, and 80 controls without vaginismus. Participants were matched for age, education, and date of admission. Women afraid of losing control during intercourse had 29.6 times greater likelihood of developing vaginismus (p < 0.01), as well as those afraid of suffering pain (p < 0.001) or being physically damaged (tearing) (p < 0.01). There is evidence that women have higher likelihood of vaginismus if they present fears of pain, injuries, bleeding, fear of losing control, and having a panic attack if they engage in sex with penetration.

OBJECTIVE: To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman\'s wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms.
METHODS: We report a series of cases of Malaysian women who had been suffering from vaginismus and \'infertility\'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety.
CONCLUSIONS: The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.

The aim of this study was to investigate attachment styles in a group of women and men with sexual dysfunction. We recruited 44 subjects (21 women and 23 men) with sexual dysfunction and 41 subjects (21 women and 20 men) with healthy sexual function as the control group. Validated instruments for the evaluation of male and female sexual dysfunctions (M/F SD) and a psychometric tool specifically designed to investigate attachment style were administered. In women, significant differences were found between subjects with sexual dysfunction and healthy controls. The scales indicating an insecure attachment showed: discomfort with closeness (FSD = 42.85 ± 11.55 vs CTRL = 37.38 ± 8.54; P < 0.01), relationship as secondary (FSD = 26.76 ± 2.60 vs CTRL = 18.42 ± 7.99; P < 0.01), and need for approval (FSD=26.38 ± 3.61 vs CTRL = 20.76 ± 7.36; P < 0.01). Healthy women also had significantly higher scores in secure attachment (confidence: FSD = 24.57 ± 3.89 vs CTRL = 33.42 ± 5.74; P < 0.01). Men with sexual dysfunctions differed from healthy men in confidence (MSD = 30 ± 6.33 vs CTRL = 36.05 ± 5.26; P < 0.01) and in discomfort with closeness (MSD = 39.08 ± 8 vs CTRL = 34.25 ± 7.54; P < 0.05). These results suggest that particular aspects related to insecure attachment have a determinant role in people with sexual dysfunctions. It is therefore fundamental to identify the attachment styles and relational patterns in patients receiving counselling and psychological treatments focussed on sexual problems.

Psychogenic purpura (Gardner-Diamond syndrome) is the occurrence and spontaneous recurrence of painful ecchymosis following emotional stress and minor trauma. Although the exact mechanism of this syndrome remains unknown, apart from skin lesions, different types of hemorrhaging have been reported, such as epistaxis, gastrointestinal bleeding, and bleeding from the ear canals and eyes. We report a psychogenic purpura case that presented with hematuria in addition to skin lesions. Based on the psychiatric evaluation she was diagnosed with major depressive disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Additionally, sexual pain disorder accompanied these disorders. With the help of antidepressant and supportive psychotherapy, the patient\'s ecchymosis and bleeding disappeared. During 8 months of follow-up the symptoms did not return. Vaginismus has not been reported in patients with psychogenic purpura. The presence of vaginismus, which is seen more frequently in eastern cultures and is thought to be related to sociocultural determinants, suggests that some cultural factors may be common to both psychogenic purpura and vaginismus. The aim of this case report was to call attention to a syndrome that is rarely seen and diagnosed, and to discuss its relationship to psychosocial factors. This syndrome should be considered in the differential diagnosis of not only ecchymotic lesions, but also various types of bleeding, including hematuria. Despite the fact that its etiology and treatment are not clearly understood, it should be noted that psychological factors play a role in this disease and therefore, psychopharmacological and psychotherapeutic approaches can be effective.

BACKGROUND: Previous research suggests that anxiety may play a large role in the symptoms of vaginismus.
OBJECTIVE: We aimed to (i) determine the degree of self-reported general anxiety in women with vaginismus; and (ii) establish whether general anxiety is a consequence of the condition or a predisposing factor.
METHODS: Participants reported state and trait anxiety, five-factor personality scores, history of anxiety disorders, and their perceptions of their symptoms and history.
METHODS: We compared responses of 244 self-identified women with vaginismus with a control group of 101 women using an online questionnaire.
RESULTS: The women with vaginismus were higher in trait anxiety and neuroticism, and lower in extraversion, than the controls. There was also a trend toward a greater prevalence of diagnosed anxiety disorders in the vaginismus group. Levels of state anxiety were high among the women with vaginismus, particularly when they felt unsupported by their partners or pressured to cure the condition.
CONCLUSIONS: Levels of general anxiety are elevated among women with vaginismus and the data suggest that anxiety-proneness may be a predisposing factor for the condition. We conclude that although vaginismus is a multidimensional condition, it may have common predisposing factors with anxiety disorders.