The DSM Diagnostic Criteria for Vaginismus

Abstract

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.

A Prospective 2-Year Examination of Cognitive and Behavioral Correlates of Provoked Vestibulodynia Outcomes

“…It is apparent that teasing apart the relationship between genital pain and sexual dysfunction in women with PVD will remain a needed focus of future research and the FSFI may not be the best scale with which to do this. There is certainly debate as to whether genital pain should be classified as a sexual dysfunction or a pain disorder 37 , although it will remain a sexual dysfunction in the DSM-5 38,39 .…”

DSM-5 Changes in Diagnostic Criteria of Sexual Dysfunctions

“…This decision was based on the conclusion that the two disorders could not be reliably differentiated, for two main reasons. Firstly, the diagnostic formulation of vaginismus as "vaginal muscle spasm" was not supported by empirical evidence [18]. Secondly, fear of pain or fear of penetration is commonplace in clinical descriptions of vaginismus [18].…”

“…Firstly, the diagnostic formulation of vaginismus as "vaginal muscle spasm" was not supported by empirical evidence [18]. Secondly, fear of pain or fear of penetration is commonplace in clinical descriptions of vaginismus [18]. Kaplan even describes it as «phobic avoidance» [6].…”

Critiques and Challenges to Old and Recently Proposed American Psychiatric Association's Website DSM 5 Diagnostic Criteria for Sexual Dysfunctions

“…As they are considered to be distinct disorders, diagnosis made for one of them would be expected to exclude the diagnosis of the other. However, there is no empirical evidence that superficial dysparenuia can reliably be differentiated from vaginismus both for research and clinical purposes (27,28). The significant overlap between vaginismus and superficial dysparenuia on symptom dimensions make it almost impossible to reliably differentiate one from the other leaving the clinicians to consider whether they might lie on the same continuum with superficial dyspareunia sometimes extending to vaginismus (29).…”