Will vaginismus remain a "lifelong" baby? Response to Reissing et al. (2014).

Abstract

Having just become a grandfather, I am very attuned to baby allusions. You can imagine my distress to think that I might have caused the demise of any baby let alone the‘‘vaginismus baby.’’ The ‘‘vaginismus baby’’ is very dear to my heart and I have tried to lovingly bathe her with as much attention as possible during my career. Admittedly, my attempts have been spasmodicandIpleadguilty tosplashingaroundineffectively in many research backwaters trying to get that‘‘vaginismus baby’’ clean. While appreciating my work (Binik, 2010) which contributed to the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) diagnosisofGenito-Pelvic/PainPenetrationDisorder(GPPPD), Reissing et al. (2014) raise significant and important criticisms of my‘‘splashy attempts’’ to understand what used to be called Vaginismus. I am very pleased with these criticisms because, during the DSM-5 process, there was a marked lack of response to the proposal to replace the diagnoses of Vaginismus and Dyspareunia with GPPPD and I worried that this was the result of lack of interest. I am heartened by the renewed interest and research and would like to address the important criticisms from both clinical and theoretical perspectives. Onapracticaldiagnostic level,Reissingetal. (2014)write the following: ‘‘...it should be clear that the diagnosis of lifelong vaginismus can no longer be made on the basis of DSM-5. The current diagnosis focuses on ‘difficulties...(with) vaginal penetration during intercourse’ (American Psychiatric Association, 2013, p. 437) but does not provide for the inability to experience intercourse. In the new DSM-5, women with lifelong vaginismus fall into a diagnostic void.’’ I am confused by this comment since previous classifications did not specifically deal with lifelong vaginismus as defined by Reissing et al. (2014), i.e.,‘‘...women who have never been able to experience intercourse.’’ The DSM-IV-TR (American Psychiatric Association, 2000) defined vaginismus as‘‘Recurrent or persistent involuntary spasm of the outer third of the vagina that interferes with sexual intercourse’’(p. 515). Sufferers could then be subtyped as lifelong or not. Nowhere did it specify a group of womenwhohaveneverbeenabletoexperienceintercourse.The new GPPPD diagnosis can account for this lifelong group as well or as badly as previous classifications. Women can be diagnosed with GPPPD if they are characterized with‘‘recurrent and persistent difficulties’’ with vaginal penetration during intercourse. The subtype of lifelong can then be applied. The name has changed but there is no other difference and no diagnostic void. I am particularly confused by Reissing et al.’s (2014) criticism that the DSM-5‘‘...does not provide for the inability to experience intercourse.’’The term‘‘inability’’is never used in any DSM criteria or in any other classification of which I am aware. Inmyview, it isnot usedbecause it suggests that there is a category of women who cannot experience penile-vaginal penetration under any circumstances. This does not make sense tome.It ishorrible tocontemplate thisscenariobutabrutal rapist wouldprobablybeable topenetratealmost anywomansuffering fromlifelongvaginismus.Amorepalatableexampleisthebrilliant therapy outcome research by ter Kuile and colleagues (ter Kuile et al., 2009; ter Kuile, Melles, de Groot, Tuijnman-Raasveld, & van Lankveld, 2013), which elegantly demonstrated that women with lifelong vaginismus can experience penetration after a few hours of exposure. Such examples suggest that motivational and contextualfactorshaveanimportanteffectonawoman’ssuccessin Y. M. Binik Department of Psychology, McGill University, Montreal, PQ, Canada