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Vaginismus, sometimes called vaginism, is the physical or psychological condition that affects a woman's ability to engage in any form of vaginal penetration, including sexual intercourse, manual penetration, insertion of tampons or menstrual cups, and the penetration involved in gynecological examinations (pap tests). This is presumed to be the result of an involuntary vaginal muscle spasm, which makes any kind of vaginal penetration painful or impossible. While there is a lack of evidence to definitively identify which muscle is responsible for the spasm, the pubococcygeus muscle, sometimes referred to as the "PC muscle", is most often suggested. Other muscles such as the levator ani, bulbocavernosus, circumvaginal, and perivaginal muscles have also been suggested. A woman with vaginismus does not consciously control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The severity of vaginismus, as well as the pain during penetration (including sexual penetration), varies from woman to woman. ==Primary vaginismus== A woman is said to have primary vaginismus when she is unable to have penetrative sex or experience vaginal penetration without pain. It is commonly discovered in teenage girls and women in their early twenties, as this is when many girls and young women in the Western world first attempt to use tampons, have penetrative sex, or undergo a Pap smear. Women with vaginismus may be unaware of the condition until they attempt vaginal penetration. A woman may be unaware of the reasons for her condition.〔 A few of the main factors that may contribute to primary vaginismus include: * a condition called vulvar vestibulitis syndrome, more or less synonymous with focal vaginitis, a so-called sub-clinical inflammation, in which no pain is perceived until some form of penetration is attempted * urinary tract infections * vaginal yeast infections * sexual abuse, rape, other sexual assault, or attempted sexual abuse or assault * knowledge of (or witnessing) sexual or physical abuse of others, without being personally abused * domestic violence or similar conflict in the early home environment * fear of pain associated with penetration, particularly the popular misconception of "breaking" the hymen upon the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs * chronic pain conditions and harm-avoidance behaviour * any physically invasive trauma (not necessarily involving or even near the genitals) * generalized anxiety * stress * negative emotional reaction towards sexual stimulation, e.g. disgust both at a deliberate level and also at a more implicit level * strict conservative moral education, which also can elicit negative emotions Primary vaginismus is often idiopathic. Vaginismus has been classified by Lamont according to the severity of the condition. Lamont describes four degrees of vaginismus: In first degree vaginismus, the patient has spasm of the pelvic floor that can be relieved with reassurance. In second degree, the spasm is present but maintained throughout the pelvis even with reassurance. In third degree, the patient elevates the buttocks to avoid being examined. In fourth degree vaginismus (also known as grade 4 vaginismus), the most severe form of vaginismus, the patient elevates the buttocks, retreats and tightly closes the thighs to avoid examination. Pacik expanded the Lamont classification to include a fifth degree in which the patient experiences a visceral reaction such as sweating, hyperventilation, palpitations, trembling, shaking, nausea, vomiting, losing consciousness, wanting to jump off the table, or attacking the doctor. The Lamont classification continues to be used to the present and allows for a common language among researchers and therapists. A simplified and more versatile version of the classification includes symptoms that vary over four ranges. The first involves minor discomfort that may diminish during intercourse. In the second range, burning and tightness persist. In the third, entry and movement are painful, and in the fourth penetration is impossible and forced entry is extremely painful. Although the pubococcygeus muscle is commonly thought to be the primary muscle involved in vaginismus, Pacik identified two additionally-involved spastic muscles in treated patients under sedation. These include the entry muscle (bulbocavernosum) and the mid-vaginal muscle (puborectalis). Spasm of the entry muscle accounts for the common complaint that patients often report when trying to have intercourse: "It's like hitting a brick wall". 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「vaginismus」の詳細全文を読む スポンサード リンク
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