Vaginismus
Author: Maura Coyle
What is Vaginismus?
Vaginismus is the involuntary tightening of the pelvic floor muscles at the entrance to the vagina which makes penetrative sex painful and often impossible to achieve. Some women may experience primary vaginismus, in which they have never had any form of vaginal penetration, including sexual intercourse, use of tampons, gynaecological exams or smear tests.
Others may experience secondary vaginismus, in which they will have had sexual intercourse in the past but are unable to do so now. Reasons may include a history of infections, physical trauma such as difficult childbirth or psychological trauma from an abusive relationship or experience. Other reasons may include painful intercourse from lack of arousal or interest, stress, anxiety or physical changes post menopause or as a result from cancer treatment.
This is a condition that is usually not known about until a female attempts penetrative sex, and even then, can be ignored or worked around in various ways until it begins to have a negative effect on their relationship, there is a decision to have a baby, or new relationships are avoided.
Often a woman will not have been able to use tampons. She may have not had a smear test or had a failed attempt, which may have been her first inkling there was a problem. A woman can often feel she is “broken” and not normal, and may never have spoken to anyone about this. She may feel unacceptable because she cannot have “sex”.
Despite this being a very common problem, because it (and sexual concerns in general) is not talked about, women and their partners often feel that they are the only ones unable to consummate their sexual relationship.
What causes Vaginismus?
There is no one known definitive cause – there may be some trauma in childhood, either physical, psychological or emotional, the learning about men as a girl grows up, the roles of men and women in relationships, religious learning, first experience sexually may be negative, a difficult birth (in the case of secondary vaginismus). This is not a full list as each case is unique and different but a programme can be adapted very successfully to treat Vaginismus with positive outcomes in the majority of cases.
Treatment
Vaginismus can be treated in a female attending alone or with a partner.
Due to the complexity of a vaginismus diagnosis, time must be spent trying to identify what the unique situation is with each client in order to attempt to identify what made them vulnerable to having the difficulty, what may have caused it and what is maintaining it.
Part of this is establishing clear goals and encouraging a female to work on changing for herself rather than solely for a partner.
Clients are given work to do in the privacy of their own homes and their experience of this is then brought to the therapy room for discussion.
Pressure is taken off of being sexual, instead focusing on sensuality and learning to be in the moment. Sexual education will happen throughout the programme.
Women are guided and supported through the use of size-graduated dilators or fingers in her own time at home. And this process and any issues that may arise is supported in the therapeutic relationship.