VAGINISM GS AND REFLEX SPASM OF THE PELVIC FLOOR.
This only partially defines the affection, however, seeing that we do not often find a hyperEesthetic spot at the introitus whence emanates the reflex spasm.
So severe is the pain and the spasm, that women affected with vaginis mus cannot endure sexual intercourse, and shun it even as they would the rack. The affection is met with particularly in the newly-married. Ki wisch, Simpson and Sims were the first to call special attention to this affection, although it bad been frequently noticed before. Simpson gave it the name vaginodynia, Sims called it vaginismus, Kiwisch spasmus vagi nae. The latter considered it due to spasmodic contractions of the con strictor cunni, superadded to which, in aggravated cases, was a similar contraction of the sphincter ani and the sphincter vesime. It occurs frequently in hyperiesthetic women during coition, especially when they have no inclination for the act.
Sims believed vaginismus to be a neurosis, and not to be accompanied in very marked cases by inflammatory trouble—indeed that it had abso lutely nothing of an inflammatory nature about it. Hypertesthesia at a special spot in the introitus was the real test of vaginismus. Later, spasmus vagina' was rather considered to be due to spasm of the muscles, independently of special hypertesthesia in the introitus, and it is now definitely established that a spasm of the vagina, a tonic contraction of the sphincter vaginae and of the perineal muscles, may occur without any local hyperfesthetic spot.
It is necessary to describe briefly this most delicate of all topics which concern married life. As a rule, and it is a natural one, virgins are thrown into a state of great nervous excitement when a vaginal examina tion is made, and they object to it strenuously. They contract the mus cles as much as is in their power. If this happens when the finger is in serted, all the more does it occur at the first sexual commerce. When now there is superadded to the natural timidity of the woman the injury of her genitals, the result of lack of knowledge or nervousness on the part of the man, and whence the first contact may not effect intromission, the memory of all this may lay the foundation for vaginismus, and the in crease of the pain at the succeeding attempts at sexual commerce will simply intensify the affection, and lead to loss of desire on the part of the woman; in fact the act becomes repulsive to her, and I am satisfied that we find herein an explanation of vaginismus. Winckel has reached
a similar conclusion. It is certain that these ineffectual attempts at sex ual intercourse make the affection worse, since they add to the excita bility of the woman. It is further true, as was pointed out by Scanzoni, that a husband of weak powers may cause vaginismus through the irrita tion of the genitals, from futile attempts at sexual intercourse. Between nervous impotence of the husband and spasmus vagina of the wife, there is certainly a causal connection. The reverse conclusion, however, that in every case of vaginismus the cause lies in weakness of the man's sexual powers, is not tenable. It is self-evident, of course, that irritation and pain are more likely to occur in case there exists faulty inclination of the pelvis, where the nitroitus vagina is deep set under the symphysis. Schroeder has called attention to such cases, where the pubes extend even below the orifice of the urethra. The penis is in such cases directed too far backward, and strikes into the fossa navicularis instead of being di rected into the vagina. The mucous membrane of this locality is thence irritated, is the seat of great pain and causes the young wife to loathe the idea of cohabitation. Naturally there is often present redness, swelling of the follicles, excoriation, small fissures and papillary excrescences, and then the act of coition is positively unbearable to the woman. Can now inflammation be the cause of reflex spasm or not? In what does inflam mation in this locality consist ? In a catarrh with profuse discharge, and such are the accompaniments of the redness, the swelling and the exco riation. Acute catarrh is rarely met with, but the mucous membrane is generally swollen, reddened, and very sensitive. Purulent discharge is rarely seen. Gonorrhcea is not at the bottom of reflex spasm, although E. Martin claims that it is. It would be an absolutely false conclusion to consider the vaginismus of a young wife as dependent on a gonorrhoea of the husband. That reflex spasm will often find its explanation in a highly strung temperament, the so-called nervous, is very plausible, and is very evident from what we have already stated. West has seen vagi nismus accompany the nervous and hysterical temperament in individuals otherwise healthy, and according to him there is a causal relation be tween this affection and hysteria.