title: Vaginismus and subfertility: case reports on the association observed in clinical practice.
abstract: OBJECTIVE
  To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman's wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms.
  
  
  METHODS
  We report a series of cases of Malaysian women who had been suffering from vaginismus and 'infertility'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety.
  
  
  CONCLUSIONS
  The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.
authors.affiliation: Department of Psychiatry, Kulliyah of Medicine, International Islamic University of Malaysia (IIUM), Kuantan, Pahang. (Ramli Musa, Nora Mat Zin).
authors.forename: M
authors.initials: M
authors.lastname: Ramli
authors.affiliation: Department of Psychiatry, Kulliyah of Medicine, International Islamic University of Malaysia (IIUM), Kuantan, Pahang. (Ramli Musa, Nora Mat Zin).
authors.forename: Mz
authors.initials: M
authors.lastname: Nora
authors.affiliation: Department of Obstetrics & Gynaecology, Kulliyah of Medicine, IIUM, Kuantan, Pahang. (Roszaman Ramli).
authors.forename: R
authors.initials: R
authors.lastname: Roszaman
authors.affiliation: Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), 56000 Cheras, Kuala Lumpur, Malaysia. (Hatta Sidi).
authors.forename: S
authors.initials: S
authors.lastname: Hatta
keywords: Case reports; Malaysian women; infertility; psychological approach; vaginismus