XI.
ON VAGINISMUS.
We have had in Martha Ward recently several cases of vaginismus; and a case of secondary vaginismus forms the text of this lecture.
What is vaginismus? It is one of the numerous diseases that occur in two forms, either primary or secondary. When the disease is primary it is a pure neurosis—that is, we can find nothing visible or tangible to account for it. When it is secondary it is not a pure neurosis; it is a neurosis, but it is a neurosis for which we can in some degree account. This vaginismus is a neurosis of motility, and it consists of spasm. It may be called spasm of the vagina, for that is the part that is affected or changed. The spasm of vaginismus is, so far as it affects the voluntary muscles, a tonic spasm. The voluntary muscles that it affects are the constrictor vaginæ and the anterior part, if not the whole, of the levator ani. One result of the spasm of these muscles is complete closure of the vagina as a passage. This tonic spasm of the voluntary muscles has generally been regarded as the whole of the spasmodic part of the disease; but the affection in a bad case is so severe that I am inclined to think there may be other spasms, of involuntary muscles, concurring to produce the condition of a woman suffering from vaginismus, which I shall immediately describe to you. In the diseases of women there are many spasms of involuntary muscle: the most violent spasms producing the
