The Lamont Classification Revisited
Posted by: Peter T. Pacik, MD, FACS
Vaginismus continues to be under diagnosed by most health care professionals, including gynecologists. In patients who have aversion to GYN exams, inability to have intercourse and give a history of inability to use tampons, vaginismus should be part of the differential diagnosis.
Many of my patients who fail in their ability to have a speculum examination complain that they were told to “just relax” or that it is all in their head. Patients who have a more severe form of vaginismus (Lamont level 3 to 4) are often shunted from therapist to therapist over a course of many years and are unable to make any progress while their relationships are deteriorating. Vaginismus is the most common reason for unconsummated marriages.
Lamont, in 1978 (Ref 1) described four degrees of severity in his proposed classification. In the most severe form of vaginismus he describes the generalized retreat that takes place with the buttocks elevating and withdrawing and adduction of the thighs. My patients, many of whom are self diagnosed, are able to accurately classify themselves by reviewing the Lamont classification, and recording their level of vaginismus in the history they give me. Indeed, some of my patients suggest there should be a Level 5, manifested by sweating, nausea, vomiting, and “going unconscious”. In my practice the more severe cases of vaginismus are treated with Botox injections under anesthesia (Ref 2-4) and these patients show the same withdrawal behavior as the anesthesia is deepened. Attempted intercourse and hitting the “brick wall” they so often refer to is documented by severe vaginal muscular spasm, usually involving the bulbocavernosum, while the patient is deeply sedated.
There is a need for physicians to raise their awareness of vaginismus in treating these patients.
References: Lamont JA. Vaginismus. Am J Obstet Gynecol. 1978 Jul 15;131(6):633-6.
Pacik PT. Botox Treatment for Vaginismus. Plast. and Reconst. Surg. 124:
455e-456e, December 2009
Ghazizadeh, S. and Nikzad, M (2004). Botulinum Toxin in the Treatment of
Refractory Vaginismus. Obstet Gynecol 104, 922-925.
Abbott JA, Jarvis SK,
PMID: 686049
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