Archives of Sexual Behavior

, Volume 39, Issue 2, pp 278–291 | Cite as

The DSM Diagnostic Criteria for Vaginismus

  • Yitzchak M. BinikEmail author
Original Paper


Vaginal spasm has been considered the defining diagnostic characteristic of vaginismus for approximately 150 years. This remarkable consensus, based primarily on expert clinical opinion, is preserved in the DSM-IV-TR. The available empirical research, however, does not support this definition nor does it support the validity of the DSM-IV-TR distinction between vaginismus and dyspareunia. The small body of research concerning other possible ways or methods of diagnosing vaginismus is critically reviewed. Based on this review, it is proposed that the diagnoses of vaginismus and dyspareunia be collapsed into a single diagnostic entity called “genito-pelvic pain/penetration disorder.” This diagnostic category is defined according to the following five dimensions: percentage success of vaginal penetration; pain with vaginal penetration; fear of vaginal penetration or of genito-pelvic pain during vaginal penetration; pelvic floor muscle dysfunction; medical co-morbidity.


DSM-V Vaginismus Dyspareunia Sexual pain Muscle spasm 



The author is a member of the DSM-V Workgroup on Sexual and Gender Identity Disorders (Chair, Kenneth J. Zucker, Ph.D.). I wish to acknowledge the valuable input I received from members of my subworkgroup (Lori A. Brotto, Cynthia Graham, and R. Taylor Segraves) and Kenneth J. Zucker. Feedback from DSM-V Work Group Advisors John Bancroft, Sophie Bergeron, Marta Meana, Caroline Pukall, and Leonore Tiefer is greatly appreciated as is feedback from Seth Davis, Melissa Farmer, Alina Kao, Tuuli Kukkonen, Marie Andrée Lahaie, Caroline Maykut, Laurel Paterson, and Sabina Sarin. Preliminary versions of the this paper were presented at the 2009 meetings of the Society for Sex Therapy and Research (Arlington, Virginia, April) and the International Academy of Sex Research (San Juan, Puerto Rico, August). Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.


  1. American College of Obstetricians and Gynecologists. (1995). ACOG technical bulletin: Sexual dysfunction. International Journal of Gynaecology and Obstetrics, 51, 265–277.CrossRefGoogle Scholar
  2. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  4. Basson, R. (1996). Lifelong vaginismus: A clinical study of 60 consecutive cases. Journal of the Society of Obstetricians and Gynecologists of Canada, 18, 551–561.Google Scholar
  5. Basson, R., Leiblum, S., Brotto, L., Derogatis, L., Fourcroy, J., Fugl-Meyer, K., et al. (2004). Revised definitions of women’s sexual dysfunction. Journal of Sexual Medicine, 1, 40–48.CrossRefPubMedGoogle Scholar
  6. Blazer, J. A. (1964). Married virgins: A study of unconsummated marriages. Journal of Marriage and the Family, 2, 213–214.CrossRefGoogle Scholar
  7. Bollapragada, S. S., & Melrose, E. B. (2008). Extreme phobia for gynaecological examination. International Journal of Clinical Practice, 62, 1122–1123.CrossRefPubMedGoogle Scholar
  8. Byford, H. T. (1902). Hyperesthesia and vaginismus. In H. T. Byford (Ed.), Manual of gynecology (pp. 575–578). Philadelphia: P. Blakiston’s Son.Google Scholar
  9. Crowley, T., Goldmeier, D., & Hiller, J. (2009). Diagnosing and managing vaginismus. British Medical Journal, 339, 225–229.Google Scholar
  10. Crowley, T., Richardson, D., & Goldmeier, D. (2006). Recommendations for the management of vaginismus: BASHH special interest group for sexual dysfunction. International Journal of STD and AIDS, 17, 14–18.CrossRefPubMedGoogle Scholar
  11. Davis, S., Binik, Y. M., & Carrier, S. (2009). Sexual dysfunction and pelvic pain in men: A male sexual pain disorder? Journal of Sex and Marital Therapy, 35, 182–205.CrossRefPubMedGoogle Scholar
  12. de Kruiff, M. E., ter Kuile, M. M., Weijenborg, P. T., & van Lankveld, J. J. (2000). Vaginismus and dyspareunia: Is there a difference in clinical presentation? Journal of Psychosomatic Obstetrics and Gynaecology, 21, 149–155.CrossRefPubMedGoogle Scholar
  13. Drenth, J. J. (1988). Vaginismus and the desire for a child. Journal of Psychosomatic Obstetrics and Gynaecology, 9, 125–137.CrossRefGoogle Scholar
  14. Engman, M. (2007). Partial vaginismus–definition, symptoms and treatment. Unpublished doctoral dissertation, Linkoping University, Linkoping, Sweden.Google Scholar
  15. Engman, M., Lindehammar, H., & Wijma, B. (2004). Surface electromyography diagnostics in women with partial vaginismus with or without vulvar vestibulitis and in asymptomatic women. Journal of Psychosomatic Obstetrics and Gynaecology, 25, 281–294.CrossRefPubMedGoogle Scholar
  16. Engman, M., Wijma, B., & Wijma, K. (2008). Post-coital burning pain and pain at micturition: Early symptoms of partial vaginismus with or without vulvar vestibulitis? Journal of Sex and Marital Therapy, 34, 413–428.CrossRefPubMedGoogle Scholar
  17. Engman, M., Wijma, K., & Wijma, B. (2007). Itch and burning pain in women with partial vaginismus with or without vulvar vestibulitis. Journal of Sex and Marital Therapy, 33, 171–186.CrossRefPubMedGoogle Scholar
  18. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). User’s guide for the Structured Clinical Interview for the DSM-IV Axis 1 Disorders–Clinician version (SCID-CV). Washington, DC: American Psychiatric Press.Google Scholar
  19. Frasson, E., Grazziotin, A., Priori, A., Dall’Ora, E., Didone, G., Garbin, E. L., et al. (2009). Central nervous system abnormalities in vaginismus. Clinical Neurophysiology, 120, 117–122.CrossRefPubMedGoogle Scholar
  20. Huguier, P. C. (1834). Dissertation sur quelques points d’anatomie, de physiologie et de pathologie. Medical thesis, Paris.Google Scholar
  21. Johnson, E. W. (1989). The myth of skeletal muscle spasm [Editorial]. American Journal of Physical Medicine and Rehabilitation, 68, 1.CrossRefPubMedGoogle Scholar
  22. Kaneko, K. (2001). Penetration disorder: Dyspareunia exists on the extension of vaginismus. Journal of Sex and Marital Therapy, 27, 153–155.CrossRefPubMedGoogle Scholar
  23. Kaplan, H. S. (1974). The new sex therapy. New York: Brunner/Mazel.Google Scholar
  24. Klassen, M., & ter Kuile, M. M. (2009). Development and initial validation of the Vaginal Penetration Cognition Questionnaire (VPCQ) in a sample of women with vaginismus and dyspareunia. Journal of Sexual Medicine, 6, 1617–1627.CrossRefGoogle Scholar
  25. Lahaie, M.-A., Binik, Y. M., Amsel, R., & Khalifé, S. (2008, March). Fear and pain vs. muscle spasm as the main diagnostic criteria for vaginismus. Paper presented at the annual meeting of the Society for Sex Therapy and Research, Chicago.Google Scholar
  26. Lamont, J. A. (1978). Vaginismus. American Journal of Obstetrics and Gynecology, 131, 633–636.PubMedGoogle Scholar
  27. Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. London: Little, Brown.Google Scholar
  28. McNeil, D. W., & Rainwater, A. J. (1998). Development of the fear of pain questionnaire-iii. Journal of Behavioral Medicine, 21, 389–410.CrossRefPubMedGoogle Scholar
  29. Merskey, H., & Bogduk, N. (Eds.). (1994). Classification of chronic pain (2nd ed.). Washington, DC: IASP Press.Google Scholar
  30. Morin, M., Gravel, D., Bourbonnais, D., Dumoulin, C., Ouellet, S., & Pilon, J.-F. (in press). Application of a new method in the study of pelvic floor muscle passive properties in continent women. Journal of Electromyography and Kinesiology. Google Scholar
  31. O’Sullivan, K., & Barnes, J. (1978). Vaginismus: A report on 46 couples. Irish Medical Journal, 71(5), 143–146.PubMedGoogle Scholar
  32. Ohkawa, R. (2001). Vaginismus is better not included in sexual pain disorder. Journal of Sex and Marital Therapy, 27, 191–192.CrossRefPubMedGoogle Scholar
  33. Pedersen, B. L., & Mohl, B. (1992). Vaginismus–iatrogenic precipitation and maintenance. Acta Obstetricia et Gynecologica Scandinavica, 71, 525–528.CrossRefPubMedGoogle Scholar
  34. Reamy, K. (1982). The treatment of vaginismus by the gynecologist: An eclectic approach. Obstetrics and Gynecology, 59, 58–62.PubMedGoogle Scholar
  35. Reissing, E. D., Binik, Y. M., Khalifé, S., Cohen, D., & Amsel, R. (2004). Vaginal spasm, pain, and behavior: An empirical investigation of the diagnosis of vaginismus. Archives of Sexual Behavior, 33, 5–17.CrossRefPubMedGoogle Scholar
  36. Reissing, E. D., Brown, C., Lord, M. J., Binik, Y. M., & Khalife, S. (2005). Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. Journal of Psychosomatic Obstetrics and Gynaecology, 26, 107–113.CrossRefPubMedGoogle Scholar
  37. Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389.PubMedGoogle Scholar
  38. Rust, J., & Golombok, S. (1998). The GRISS: A psychometric scale and profile of sexual dysfunction. In C. M. Davis, W. L. Yarber, R. Bauserman, G. Schreer, & S. L. Davis (Eds.), Handbook of sexuality-related measures (pp. 192–194). Thousand Oaks, CA: Sage Publications.Google Scholar
  39. Shafik, A., & El-Sibai, O. (2002). Study of the pelvic floor muscles in vaginismus: A concept of pathogenesis. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 105, 67–70.CrossRefPubMedGoogle Scholar
  40. Simons, D. G., & Mense, S. (1998). Understanding and measurement of muscle tone as related to clinical muscle pain. Pain, 75, 1–17.CrossRefPubMedGoogle Scholar
  41. Sims, J. M. (1861). On vaginismus. Transactions of the Obstetrics Society of London, 3, 356–367.Google Scholar
  42. Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). STAI manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologist Press.Google Scholar
  43. Sullivan, M. J. L., Bishop, S., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7, 524–532.CrossRefGoogle Scholar
  44. ter Kuile, M., van Lankveld, J., Vlieland, C. V., Willekes, C., & Weijenborg, P. T. M. (2005). Vulvar vestibulitis syndrome: An important factor in the evolution of lifelong vaginismus? Journal of Psychosomatic Obstetrics & Gynecology, 26, 245–249.CrossRefGoogle Scholar
  45. Trotula of Salerno. (1940). The diseases of women (W. Mason-Hohl, Trans.). Los Angeles: The Ward Ritchie Press. (Original work published 1547)Google Scholar
  46. van der Velde, J. (1999). A psychophysiological investigation of the pelvic floor: The mechanism of vaginismus. Unpublished doctoral dissertation, University of Amsterdam.Google Scholar
  47. van der Velde, J., & Everaerd, W. (2001). The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behaviour Research and Therapy, 39, 395–408.CrossRefPubMedGoogle Scholar
  48. van der Velde, J., Laan, E., & Everaerd, W. (2001). Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion-inducing film excerpts in women with and without vaginismus. International Urogynecology Journal and Pelvic Floor Dysfunction, 12, 328–331.CrossRefPubMedGoogle Scholar
  49. Walthard, M. (1909). Die psychogene aetiologie und die psychotherapie des vaginismus. Muenchener Medizinische Wochenschschrift, 56, 1997–2000.Google Scholar
  50. Ward, E., & Ogden, J. (1994). Experiencing vaginismus sufferers’ beliefs about causes and effects. Sexual and Marital Therapy, 9, 33–45.Google Scholar
  51. Wijma, B., & Wijma, K. (1997). A cognitive behavioural treatment model of vaginismus. Scandinavian Journal of Behaviour Therapy, 26, 147–156.Google Scholar
  52. Wolpe, J., & Lang, P. J. (1964). A fear survey schedule for use in behaviour therapy. Behaviour Research and Therapy, 2, 27–30.CrossRefPubMedGoogle Scholar
  53. World Health Organization. (1992). Manual of the international statistical classification of diseases, injuries, and causes of death (10th ed.). Geneva: Author.Google Scholar

Copyright information

© American Psychiatric Association 2009

Authors and Affiliations

  1. 1.Department of PsychologyMcGill UniversityMontrealCanada
  2. 2.Sex and Couple Therapy ServiceMcGill University Health CenterMontrealCanada

Personalised recommendations