Vaginismus is a painful spasm of the vaginal muscles during sexual intercourse. Although the patient is very afraid of having sex, thus limiting the total sexual response, sexual arousal is mostly uneventful, vaginal lubrication is normal, non-coital activities may be satisfying and enjoyable, orgasmic response is normal, the patient has a normal libido and is often distressed by the inability to have intercourse. It can occur in sexually active women of any age, but the incidence of vaginismus in the general population is unknown. Vaginismus is an involuntary spasm of the muscles that surround the vaginal opening and the outer third of the vagina. It interferes with normal sexual life because most patients have painful vaginal spasms during intercourse. Vaginismus may be due to a natural protective reflex caused by injurious pain at the vaginal opening, and repeated episodes of pain can form a conditioned reflex. Most vaginal spasms are caused by psychosomatic factors, such as the influence of certain religious concepts during childhood or adolescence, which form the concept of a negative activity. It can also be caused by previous severe traumatic sexual activity, which is more common in women who were raped in childhood or adolescence. In addition, vaginismus can be caused by sexually painful activities at any age. The diagnosis of vaginismus can often be determined from the medical history. In severe cases, vaginal tampons cannot be used even during menstruation. Although the history is supportive, a detailed pelvic examination is required to confirm the diagnosis (e.g., if involuntary spasms or narrowing of the muscles surrounding the lateral part of the vagina are found on examination). For treatment, the physician needs to provide the couple with information about the diagnosis of vaginismus, such as anatomy, possible causes and prognosis, and to discuss in detail the areas involved in vaginismus. Special emphasis should be placed on the involuntary nature of the vaginismus reflex, as the male partner often mistakes it as a deliberate attempt to prevent intercourse. The physician should instruct the patient to learn to perform pelvic muscle relaxation by telling the patient to tense the pelvic muscles as much as possible, hold them for a few seconds and then relax them. In this way, the patient initiates a strong contraction of the pelvic muscles and then enters a state of relative relaxation only because the contraction cannot be sustained. This is the easiest and most effective way to actively relax the pelvic muscles. Plastic dilators of various sizes can also be used to further treat abnormal muscle contractions in response to vaginal spasm. Etiology and pathology Western medicine 1. Non-organic factors: mainly psychological, such as wrong sex education, history of sexual trauma in early childhood, or fear of conception or sexually transmitted diseases. 2, organic factors: A few patients may have a natural protective reflex caused by organic lesions of the vulva or vaginal opening. The common organic causes are as follows: (1) abnormal hymen or vaginal development. (2) Genital herpes or other infections that cause ulceration of the vaginal opening or labia majora. (3) Obstetric and gynecological tumors. (4) Atrophic vaginitis. According to TCM, the disease is mainly located in the liver and kidney, and in the flushing of the body. Treatment The principle of treatment for this disease should be based on eliminating psychological barriers, understanding the rules of sexual life, encouraging both husband and wife to participate in the treatment, cooperating with each other, taking the initiative to take care of each other, correcting bad sexual habits, learning to cultivate a new cooperative and tacit sexual behavior through emotional communication, and the main means is using vaginal dilators. (1) Psychotherapy. The medical information about vaginal spasms such as anatomy and possible etiology should be given to the patient and the couple at the same time, and the involved parts of vaginal spasms should be discussed with them. (2) Perform “tensing-relaxation” exercises for the pelvic muscles. The patient is asked to tense the pelvic muscles, maintain them for 3-4 seconds and then relax them again, and then the pelvic muscles will be relatively relaxed. (3) Vaginal dilation. On the basis of the “tensing and relaxation” training, use a lubricated vaginal dilator (starting with the small one) four times a day for 10-15 minutes each time, and continue to do the “tensing and relaxation” exercises after inserting the vaginal dilator until it can be inserted smoothly. After insertion of the dilator No. 4, you can have intercourse until you are comfortable with the dilator No. 4.