Vaginismus is the spasms of the muscles around the opening to the vagina; if severe, may prevent intercourse. Vaginismus can affect females of all ages.
THE PUBOCOCCYGEUS (PC) MUSCLE GROUP
The pelvic floor muscles predominant in vaginismus are called the pubococcygeus (PC) muscle group. The PC muscle group plays a key role in the function of a woman's reproductive system, urinary tract, and bowels. The muscles enable a woman to urinate, have intercourse, orgasm, complete bowel movements, and deliver babies. Hence, they are also referred to as pelvic floor muscles, vaginal muscles, and love muscles.
With vaginismus, the mind and body have developed a muscle memory or conditioned response against penetration. The body has learned to expect or anticipate pain upon penetration, so that the powerful PC muscle 'flinches' or contracts to protect against the potential of intercourse pain. This can be equated to automatically blinking one's eyes and wincing when an object is hurled toward us. It is not something a woman thinks about doing - it just happens. Unfortunately, instead of preventing pain, the tightening of the PC muscle group ultimately causes pain; although acting as a defense mechanism against pain, the opposite effect results. The spasms cause burning or pain upon penetration or movement and may even completely block entry.
PC Muscles - The anatomy of the female pelvic floor area highlights the internal muscles called the pubococcygeus or PC muscle group. This is the muscle group that tightens involuntarily when vaginismus is experienced. The powerful muscle group surrounds both the entire vaginal area and the anus area.
The PC muscle group is large and very powerful. It encircles the urinary opening, vagina, and anus in a figure-eight pattern with one loop of muscles surrounding the vaginal area and the other loop surrounding the anal area. On each end, the muscles are attached to the skeleton and support and hold in place the abdominal and pelvic organs like a net, forming the pelvic floor.
Left Image: As the man approaches the woman to attempt intercourse, her PC muscle group (darkly shaded) involuntarily tightens the vaginal entrance making intercourse painfully impossible "like bumping into a wall. This type of vaginismus makes penetration impossible.
Right: Image: In other cases of vaginismus, penetration may be possible, but the woman experiences periods of involuntary tightness causing burning, discomfort, or pain. This can also be quite painful for the man and may result in both being "locked together" until the woman's muscles relax.
Never fully relaxed, but always partially contracted, the PC muscles are ready to spring into action the moment they sense the need, powerfully tightening even without the woman's awareness. For example, they enable a woman to retain urine or control her bowel movements until a convenient time without her thinking about it. In vaginismus, during attempted penetration, the PC muscles tighten involuntarily, without conscious intent (thought), and constrict the vaginal opening. This tightening is what makes intercourse uncomfortable, painful, or unachievable. The pain is often experienced without any awareness of the cause Frustration is often common as a woman knows that there is something wrong, but is unaware her problem is vaginismus and treatment is available.
FREQUENT SIGNS & SYMPTOMS
Vaginismus is the involuntary contraction of the muscle around the vagina and rectum. The vagina closes so tightly that the penis cannot penetrate for sexual intercourse. Also prevents the insertion of any object into the vagina, such as a tampon, diaphragm or speculum (used for medical examination).
Depending on the intensity of the involuntary muscle contraction, vaginismus symptoms can range from minor burning sensations with tightness to total closure of the vaginal opening with impossible penetration. The vaginal tightness results from the involuntary tightening of the pelvic floor, especially the pubococcygeus (PC) muscle group, although the woman may not be aware that this is the cause of your penetration or pain difficulties.
COMMON SYMPTOMS OF VAGINISMUS
A burning or stinging sensation with tightness during sexual intercourse.
Difficult or impossible penetration, pain upon entry, uncomfortable insertion of penis.
Unconsummated marriage (no sexual intercourse).
Ongoing sexual discomfort or pain following childbirth, yeast or urinary tract infections, sexually transmitted diseases (STDs), cancer, hysterectomy or other surgeries, rape, menopause, or other causes.
Ongoing sexual pain of unknown origin, with no apparent cause.
Difficulty inserting tampons or undergoing a pelvic gynecological exam.
Spasms in other body muscle groups, such as legs, lower back, etc., and / or halted breathing during attempts at intercourse.
Avoidance of sex due to pain and / or failure.
VAGINISMUS SYMPTOM SEVERITY RANGE
Vaginismus has been classified by Lamont according to the severity of the condition. The Lamont classification continues to be used and allows for a common language among researchers and therapists. He describes four degrees of vaginismus:
SEVERITY LEVEL SYMPTOMS 1. Minor discomfort or burning with tightness is experienced with vaginal entry or thrusting but may diminish. In first degree vaginismus, the patient has spasm of the pelvic floor which can be relieved with reassurance. 2. More significant burning and tightness is experienced with vaginal entry or thrusting and tends to persist. In second degree, the spasm is present but maintained throughout the pelvis even with reassurance. 3. Involuntary tightness of the vaginal muscles makes entry and movement difficult and painful. In third degree, the patient elevates the buttocks to avoid being examined. 4. Partner is unable to penetrate due to tightly closed vaginal opening. If entry is forced significant pain results. In fourth degree vaginismus (also known as grade 4 vaginismus), the most severe form of vaginismus, the patient elevates the buttocks, retreats and tightly closes the thighs to avoid examination.
Vaginismus has a wide range of manifestations, from impossible penetration, to intercourse with discomfort, pain or burning, all resulting from involuntary pelvic tightness. When a woman has never been able to have pain-free sexual intercourse due to penetration difficulties, it is generally classified as primary vaginismus. When a woman develops the vaginismus condition after having previously enjoyed problem-free sex, it is generally classified as secondary vaginismus. Depending upon the classification, there may be some minor differences in the way in which vaginismus is treated.
When a woman has never at any time been able to have pain-free intercourse (penetrative sex or any kind of vaginal penetration without pain) due to vaginismus tightness, her condition is known as primary vaginismus. It is commonly discovered in teenagers and women in their early twenties, as this is when many young women in the Western world will initially attempt to use tampons and experience problems with tampon insertion, have some form of penetrative sex, or undergo a Pap smear (gynecological exam). Typically, primary vaginismus will be discovered when a woman attempts to have sex for the very first time. The spouse/partner is unable to achieve penetration and it is like he just bumps into a 'wall' where there should be the opening to the vagina. Entry is impossible or extremely difficult. Primary vaginismus is the common cause of sexless, unconsummated marriages. The PC muscles constrict and tighten the vaginal opening making it uncomfortable or in many cases virtually impossible to have entry. When tightened, attempts to insert anything into the vagina produce pain or discomfort.
Women who have vaginismus may not be aware of their condition until they attempt vaginal penetration. It may be confusing for a woman to discover she has vaginismus. She may believe that vaginal penetration should naturally be easy, or she may be unaware of the reasons for her condition.
Some women also experience related spasms in other body muscle groups or even halted breathing. Generally, when the attempt to put something in the vagina has ended, the muscles relax and return to normal. For this reason, medical examinations often fail to reveal any apparent problems unless the tightness occurs and is noted during the pelvic exam.
A few of the main factors which may contribute to primary vaginismus include:
- Sexual abuse, rape, or attempted sexual abuse.
- Knowledge of (or witnessing) sexual or physical abuse of others, without being personally abused.
- Domestic violence or conflict in the early home environment.
- Having been taught that sex is immoral, vulgar, or demoralizing.
- Fear of pain associated with penetration, particularly the popular misconception of 'breaking' the hymen upon the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs.
- Being sexualized or told about sex in violent or inappropriately graphic terms before an age at which one is comfortable with such information.
- Any physically invasive trauma.
- Generalized anxiety.
- Occasionally, primary vaginismus is idiopathic.
Secondary vaginismus sexual pain can affect women in all stages of life, even women who have had many years of pain-free intercourse. Secondary vaginismus occurs when a woman who has previously been able to achieve penetration develops vaginismus.
Secondary vaginismus refers to the experience of tightness pain or penetration difficulties later in life, after previously being able to have normal, pain-free intercourse. It typically follows or is triggered by temporary pelvic pain or other related problems. It can be triggered by medical conditions, traumatic events, relationship issues, surgery, life-changes (e.g. menopause), or for no apparent reason. Secondary vaginismus is the common culprit where there is continued, ongoing sexual pain or penetration tightness where there had been no problem before.
Most commonly, secondary vaginismus strikes women experiencing physical causes such as temporary pelvic pain problems, urinary or yeast infections, pain from delivering babies (childbirth), menopause, or surgery. The initial pain problems are addressed medically, healed, and/or managed, yet women continue to experience ongoing sexual pain or penetration difficulties due to vaginismus. While the initial temporary pain was experienced, their bodies developed a conditioned response resulting in ongoing, involuntary vaginal tightness with attempts at intercourse.
Left untreated, vaginismus often worsens, because the experience of ongoing sexual pain further increases the duration and intensity of the involuntary PC muscle contraction. The severity of secondary vaginismus may escalate so that sex or even penetration is no longer possible without great difficulty. Some women will also experience difficulty with gynecological exams or tampon insertion. Vaginismus can also impede a woman's ability to experience orgasm during intercourse, as any sudden pangs of pain will abruptly terminate the arousal buildup toward orgasm.
The treatment for secondary vaginismus is the same as for primary vaginismus, although, in these cases, previous experience with successful penetration can assist in a more rapid resolution of the condition.
IMPOSSIBLE PENETRATION & UNCONSUMMATED RELATIONSHIPS
Vaginismus is by far the most common cause of unconsummated relationships (marriages) where the problem is due to female issues. Couples often describe their attempts at intercourse as there being a "wall" where the vaginal opening should be. It is baffling to some women as to how this condition originated in them if they had no prior sexual contact or pelvic problems. Intercourse is impossible and painful insertion attempts reinforce the vaginismus response. The conditioned reflex continues to happen every time there is potential for vaginal penetration. The muscles act rebelliously, refusing to allow entry even though the woman may truly want to consummate and receive her spouse vaginally. This is extremely frustrating. For the aroused man, it is like running into a brick wall. For the woman, it is like her body is no longer under her control.
Sex is an activity involving many complex conditioned responses. Bodies do not start out as skilled reactors to sexual stimulus. Successful intercourse is learned through experience and interaction. The nervous system and musculature discover and remember what feels good, works, and what is not comfortable. Normally, the transition to intercourse becomes more pleasurable after the first few experiences. The mind and body allow entry and learn to anticipate intercourse positively. Healthy messages result and they generate arousal in anticipation of intercourse. In a woman with primary vaginismus, the mind and body never get the chance to be trained through positive intercourse experiences. The process of learning how to have successful intercourse is cut short when the vaginal muscles spasm as a protective device against pain. With the absence of any direct conscious control on the woman's part, nerves controlling the vaginal muscles react to the anticipation of intercourse as a call to tightly constrict, brace, protect, and guard against the onset of potential penetration pain.
PREVALENCE OF VAGINISMUS
The prevalence of vaginismus has been reported to be 6 percent in two widely divergent cultures, Morocco and Sweden. The prevalence of manifest dyspareunia has been reported as low as 2 percent in elderly British women, yet as high as 18-20 percent in British and Australian studies.
By another study vaginismus rates of between 12 and 17 percent have been reported in women presenting to sex therapy clinics (Spector and Carey 1990). National Health and Sexual Life Survey, which used random sampling and structured interviewing, report that between 10 and 15 percent of women reported having experienced pain during intercourse during the last 6 months (Laumann et al. 1994).
The most recent study estimates of vaginismus range from 5 to 47 percent of people presenting for sex therapy or complaining of sexual problems, with significant differences across cultures (Reissing et al. 1999; Nusbaum 2000; Oktay 2003). It seems likely that society's expectations of women's sexuality may particularly impact on these sufferers.
An unconscious desire to prevent penile penetration because of emotional or psychological factors. These may include fear, anxiety, hostility, anger or a distaste for sex.
An insensitive sexual partner, insufficient or unskillful foreplay, or inadequate vaginal lubrication prior to attempted penetration.
Physical disorders (rare), such as infections, allergic reactions or a rigid, non-perforated hymen.
THE CYCLE OF PAIN
For many women, vaginismus comes as a surprise; unexplained tightness, discomfort, pain, and entry problems are unexpectedly experienced during intercourse attempts. The pain results from the tightening of the muscles around the vagina (PC muscles). Since this occurs without the conscious intent or control of the woman, it can be very perplexing.
Usually at the root of vaginismus is a combination of physical or non-physical triggers that cause the body to anticipate pain. Reacting to the anticipation of pain, the body automatically tightens the vaginal muscles, bracing to protect itself from harm. Sex becomes uncomfortable or painful, and entry may be more difficult or impossible depending upon the severity of this tightened state. With attempts at sex, any resulting discomfort further reinforces the reflex response so that it intensifies more. The body experiences increased pain and reacts by bracing more on an ongoing basis, further entrenching this response and creating a vaginismus "cycle of pain."
EXAMPLES OF PHYSICAL CAUSES Medical
Urinary tract infections or urination problems.
Sexually transmitted disease.
Genital or pelvic tumors, cysts or cancer.
Vulvodynia / vestibulodynia.
Pelvic inflammatory disease.
Eczema or psoriasis.
Vaginal prolapse, etc. Childbirth
Pain from normal or difficult vaginal deliveries. Childbirth complications.
Episiotomy, lacerations, perineal reconstruction. Vacuum or forceps extraction during delivery. Cesarean (c-section) deliveries.
Miscarriages (spontaneous abortion).
Medical abortion, etc. Age-Related
Menopause and hormonal changes.
Vaginal dryness / inadequate lubrication.
Vaginal atrophy. Temporary
Temporary pain or discomfort resulting from insufficient foreplay.
Inadequate vaginal lubrication, etc. Pelvic
Any type of pelvic surgery.
Difficult pelvic examinations.
Other pelvic trauma. Abuse
Sexual or physical abuse or assault. Medications
Side-effects of some medications may cause pelvic pain.
EXAMPLES OF NON-PHYSICAL CAUSES Fears
Fear or anticipation of intercourse pain.
Fear of not being completely physically healed following pelvic trauma.
Fear of tissue damage (i.e., "being torn").
Fear of getting pregnant.
Concern that a pelvic medical problem may reoccur, etc. Anxiety
Previous unpleasant sexual experiences.
Negative attitude toward sex.
Other unhealthy sexual emotions. Partner
Fear of commitment.
Anxiety about being vulnerable.
Anxiety about losing control. etc.
Insensitive or unskilled sexual partner. Traumatic
Past emotional / sexual abuse.
Witness of violence or abuse.
Repressed memories. Childhood
Overly rigid parenting.
Unbalanced religious teaching (e.g., "Sex is BAD").
Exposure to shocking sexual imagery.
Inadequate sex education. No Known
Sometimes there is no identifiable cause (physical or non-physical).
Since vaginismus can be triggered by physical events as simple as having inadequate foreplay or lubrication, or non-physical emotions as simple as general anxiety, it is important that it be understood that vaginismus is not the woman's fault. Once triggered, the involuntary muscle tightness occurs without conscious direction; the woman has not intentionally "caused" or directed her body to tighten and cannot simply make it stop. Women with vaginismus may initially be sexually responsive and deeply desire to make love but over time this desire may diminish due to pain and feelings of failure and discouragement. It is extremely frustrating to be unable to physically engage in pleasurable sexual intercourse.
Causes may trigger vaginismus in some women but not in other because life experiences vary dramatically from person to person. Some women's bodies react with vaginismus, while others with nearly identical experiences do not. The anticipation of pain, emotional anxieties, or unhealthy sexual messages can contribute to and reinforce the symptoms of vaginismus. Frequently, but not always, there are deep-seated underlying negative feelings of anxiety associated with vaginal penetration. Emotional triggers that result in vaginismus symptoms are not always readily apparent and require some exploration. It is important that effective treatment processes include addressing any emotional triggers so a full pain-free and pleasurable sexual relationship can be enjoyed upon resolution.
Vaginismus is often a complicating factor in the recovery from other pelvic pain conditions. Vaginismus may co-exist with other medical conditions, possibly triggered by temporary pelvic pain resulting from those conditions. Or, it can be the sole cause of sexual pain remaining after the original medical problems are addressed. When the underlying cause has been resolved or managed and ongoing pain, discomfort or penetration difficulties continue to remain, this is typically due to vaginismus.
In cases where there is clearly both vaginismus and another pelvic medical problem existing simultaneously, both problems will need to be treated to ensure full resolution. Without addressing the other medical condition, it will be difficult to resolve the vaginismus as it may continue to be triggered by pain from the other problem.
VAGINISMUS RISK INCREASES WITH
Vaginismus can strike any woman at any time at any age. Contributing factors could include:
Emotional distress, anxiety, fear, relational difficulties, or other similar emotions that relate to sex, intimacy, past trauma, or relationships.
First sexual experience.
Previous sexual trauma (incest, rape, sexual abuse).
Stress. The anticipation pelvic pain due to some past or present condition or situation.
Pelvic pain due to a medical condition, infection, physical trauma or assault, age-related changes, or painful physical events such as childbirth.
Pelvic examination by a health care provider and counseling prior to beginning sexual activity.
THE PELVIC EXAM
The pelvic exam as part of vaginismus diagnosis is one of the most important aspects of vaginismus diagnosis. It is thorough elimination of other possible physical or medical conditions that may be causing the symptoms that will help the practitioner to accurately diagnose with near certainty the likelihood of vaginismus. The process of elimination is a critical part of vaginismus diagnosis.
The diagnostic process will typically entail giving a medical and sexual history and undergoing a pelvic or gynecological exam. Be open and honest with your history. The practitioner will discuss the location and occurrence of pain to help render an accurate vaginismus diagnosis or may request some other tests to help rule out any other problems besides vaginismus.
Note: Some women feel more comfortable expressing themselves and being examined by female health care specialists. Where this is an issue, we encourage women to seek a referral with a female specialist. Taking a proactive, systematic approach will help a person get better care and treatment outcomes.
MoonDragon's ObGyn Procedures: Pelvic Exam
VAGINISMUS DIAGNOSIS CHALLENGES
Burning, tightness, and difficult penetration symptoms may not be at all noticeable during the pelvic exam. For some women, these symptoms occur only during intercourse attempts. For this reason, diagnosis must involve serious consideration of the woman's concerns which might be stated vaguely as "I'm having difficulty with sex." Sometimes, busy health care professionals will fail to recognize the signs of vaginismus and give standard (but unhelpful) advice to just "use more lubricant", "try to relax more", or "drink some wine". This may be due to a lack of familiarity with vaginismus or reliance on outdated literature on the condition.
Due to PC muscle tightness, some women with vaginismus find gynecological exams to be extremely painful and are unable to tolerate them. If a woman suspects she may have difficulty completing an exam, she should communicate this to her health care provider. There are adjustments (e.g. body positioning, size of speculum used, and nurse support) that can be made to contribute to a more positive experience. A health care provider who is familiar with the vaginismus condition will be more suited to providing a comfortable and sensitive environment.
When there is constant vaginal tightness for the duration of the pelvic exam, it may appear to the practitioner as though there is an unusually small vagina or a hymen abnormality problem. Instead of recognizing the vaginismus condition, a examining practitioner may falsely believe a woman's vagina is too small, when/if she is unable to complete a pelvic exam. This combined with the patient's urgent complaint that she cannot have penetrative sex with her spouse or that sex really hurts, may further lead to the false assumption that the vagina requires corrective surgery to enlarge the opening and allow entry. Though there may be rare exceptions, women with vaginismus typically have completely normal genitalia. The constriction of the vagina is due solely to the tight involuntary spasm of the pelvic floor muscles. Unfortunately, some health care provider continue to press forward with the pelvic exam causing great discomfort and pain for the woman. This traumatic experience in itself can contribute to the vaginismus condition.
GUIDE & SURVIVAL TIPS FOR A SMOOTH PELVIC EXAM
This is a list of some tried and true recommendations which can make a pelvic exam and Pap smear test much less distressing for you. This advice is based on scientific research as well as suggestions based on the experiences of many women who had vaginismus. If you are aware of what your rights are, then you will not feel as though you have to tolerate pain during an exam, or an obnoxious and insensitive health care provider. You will be able to acknowledge your body's fears, and have those fears validated and respected. This sense of empowerment alone can make many of your fears dissipate, which can reduce discomfort, trauma and pain during the exam. Remember that it is your body and it is your vagina! Although the health care provider is there to help you, you also have much to offer them in order to make a visit an empowering experience.
PART ONE - BEFORE THE APPOINTMENT
1. It is important to find a health care provider who knows about vaginismus. Unfortunately, it is a fact that it is way too common for a woman to find incompetent practitioner who have no clue about vaginismus or how to handle a woman's pain and fear during a visit. This is a main complaint by women with vaginismus when visiting their health care providers.
A visit and/or internal exam with an incompetent practitioner can be extremely traumatizing. This is especially true for virgins, women who have not yet tried any gradual insertions, or for those who have suffered from physical and sexual abuse in the past. To avoid this type of health care provider's visit, it has been advised by support groups to call a few practitioners beforehand and ask them whether or not they treat vaginismus or know anything about vaginismus. It may be hard to make that call if you never mentioned vaginismus out loud to anyone, so you may want to practice beforehand. It may take you some time before feeling comfortable even just asking a total stranger (and a health care provider) about this. Be ready for them to say "vaginis.. what?" !! Then you will know it is time to hang up and not use this practitioner for your exam. Try to call as many practitioners as you like until you find one who is qualified. If you cannot choose your own practitioner instead, for whatever reason, then there is a possibility that you will NOT have one who knows much about vaginismus. In that case, you may want take him/her some material to read about vaginismus. This may be your opportunity to teach your health care provider about vaginismus.
2. Inform your health care provider beforehand about your vaginismus. Once you have found a practitioner with whom you feel confident enough discussing your vaginismus, you may even go an extra step and write, e-mail or call that practitioner and let him/her know in more detail about what you are experiencing and what your special needs are during the exam (i.e. You could tell them that you may need extra time to talk before going through the Pap smear or that you would prefer a small size speculum). Then ask them if they can agree to these terms and only upon their agreement (which they will usually agree to), schedule your appointment.
3. Inform the health care provider that you would like extra time with him/her during your visit. In some practitioner offices and clinics, each appointment is allocated a certain amount of time. Often not much time. If you would prefer extra time (which is recommended) you can call the health care provider's office and tell them that you will need extra/double time during your visit. They should be able to allocate you a double appointment so that you can discuss your vaginismus and get more comfortable with the practitioner before going through with the actual examination.
4. Decide whether you would prefer a female or male practitioner. You have the choice to ask for a female practitioner. This is your right. Several polls and studies seem to suggest that at least half of women, and often more, prefer a female health care provider. Unfortunately, only a small percentage of all gynecologists are female, so you may not be given that choice. But if a woman is not available, you should still be offered the option of having a chaperoning female nurse or medical student present during the exam. You may feel more comfortable with a woman in the room, but you may prefer to be alone with the health care provider. You may have to fight your inclination to be a "people pleaser" more than once and kindly reject the offer of a chaperone if your feel you are not comfortable having more than one person hearing about your vaginismus symptoms and problems. So try not to feel bad about them, they are fine, they can take rejection, it is your choice and you have the right to be firm about whatever choice you make.
5. Know your rights regarding third parties present during the exam. A chaperone should be made available to you if you require it, that is the policy, however, research shows that many women prefer to do without a chaperone so don not feel afraid to say that you would rather not have another pair of eyes looking at you in such a private moment. Instead, having a third party of your choice (a friend, your mom or your partner) in the room with you is up to the discretion of the health care provider, but it should be possible to take someone with you during your exam especially if the chaperone was not available.
Sometimes, especially if you have a visit in a teaching hospital, they may ask you if you do not mind having an undergraduate medical student present during the exam. Although it is true that these students need experience, you do NOT have to feel obligated to have them in the room during your exam. There is no reason that women with vaginismus (or any other health problem for that matter) should feel even more uncomfortable than they already do, so if you do not feel comfortable, please just say in a calm voice, "No, thank you, I would rather not." Do not let anyone pressure you to accept.
6. Obtain a disposable plastic speculum to practice with at home beforehand. These are inexpensive and are available from many medical supply stores or you can obtain one from a health clinic. If you already know and trust your health care provider, you could ask him/her if he/she could give or sell you a speculum to practice inserting. (This could be done weeks or months before the actual appointment). Please know that this has been done before; you might even want to mention to the practitioner that other women have done this, and that it helped them a great deal to avoid pain and/or discomfort.
Although each speculum should be perfectly sterile, you may feel safer buying a new one. You can buy it online (Amazon.com has them). If you decide to practice with a speculum beforehand, you can choose to book an appointment only when you are very comfortable inserting it, and maybe even opening up a little bit.
7. It is important to empty your bladder before you are examined, so make sure you go to the toilet right before the exam. You might want to ask if you are required to give the health care provider a urine sample for analysis before using the restroom, just in case.
PART TWO - DURING THE EXAM
1. Ask for the smallest speculum available. There are some specula called "pediatric" or "virgin" specula which are used for children, and there are also small specula for adults called Pederson. Although it is a bit harder for health care providers to see well with them, they can still be used to have a perfectly valid pap-smear. So ask for that one if they do not think about offering.
2. He/She is the health care provider, but you are the boss. Remember that only YOU own your body. Even when you are naked in front of the best health care provider in the world, it is still YOUR body and YOUR vagina. You have very valid reasons for your fears and even more for the pain that you may have experienced or the fear that you may be re-experiencing. That means that a practitioner should not patronize you, belittle you, or tell you how you should be feeling or behaving. Here are a few things that you have every right to do during an exam:
- Tell the practitioner to stop at any time.
- Ask the practitioner to change positions.
- Put the exam off to another day.
- Change your mind half way through the exam and leave without feeling bad.
- Ask for some more time.
- Ask the practitioner to explain what exactly they are about to do and what instruments they will use.
- You also have the right to refuse any procedure, test, service, medication or any other recommendation.
3. You can self-insert the speculum or swab. You may ask the health care provider if you can insert the speculum by yourself. Having control over the insertion can make an enormous difference, especially psychologically. Health care providers should have NO objections to this if it makes you feel more comfortable.
Scientific research shows that there is no difference in the outcome of the exam if the woman does the insertion herself rather than the practitioner doing the insertion. Research also shows that self-insertion can improve the experience for a woman. You may want to show your health care provider these recent studies if he/she has reservations:
- Wright D et al (2005): Speculum 'Self-Insertion': A pilot study. Journal of clinical nursing. 14 (9): 1098-1111
- Chernesky, Max A PhD (2005): Women Find It Easy and Prefer to Collect Their Own Vaginal Swabs to Diagnose Chlamydia Trachomatis or Neisseria Gonorrhea Infections. Sexually Transmitted Diseases. 32 (12): 729-733
4. Use lots of lubrication. We know that some health care providers refuse to lubricate a speculum thinking it will negatively affect the exam. Well, truth is: speculum CAN be lubricated, and you can suggest that he/she uses lube during the exam. The lubricant can be applied to the vaginal opening as well as the speculum (feel free to apply the lubricant to your vaginal opening rather than having the practitioner do it if this makes you feel more comfortable, after all it is a sensitive area). Using lubricant can potentially make things a lot easier for you and scientific research shows that a lubricated speculum will not interfere with the pap-smear result. NOTE: If you are prone to vaginal infections you may want to ask for a glycerin-free lubricant. Glycerin is made up of sugars that can cause yeast overgrowth.
5. Warm up the speculum. If you prefer the lubrication not to be used (or for some odd reason the practitioner prefers not to use lube), you can ask your health care provider to at least warm the speculum up with warm water beforehand, it slides in better than if cold water or nothing at all is used.
6. Choose the position YOU are comfortable with. You may find that some health care practitioners use stirrups, whereas others do not. Some may have a small blanket to cover the area so you do not feel cold or too exposed; some even give you warm socks to wear! Whatever kind of bed you will find at the health care provider's, you have a right to choose a position that will make you feel the least vulnerable and the most comfortable (granted the position still allows your health care provider to examine you). An example would be that you can keep your knees together, not use the stirrups and/or ask for a blanket to cover your lower body, etc. Scientific studies have found that NOT using stirrups reduce women's sense of vulnerability.
7. Ask for a brochure or hand-out on vaginismus. In most cases they will NOT have information on vaginismus on-hand and may not even be able to refer you to a support group or any useful or objective websites. We still believe it would be a good idea for you to ask for it: information regarding vaginismus should be available in a practitioner's office and by asking them for this information, you will make them realize that they really SHOULD provide information for vaginismus sufferers. If they seem cooperative, you may even give them a brochure yourself and ask if you can leave a few in the waiting room or suggest that they print out or create a free brochure. You can also give them the name of the support group in your language that you found helpful. Hopefully they will be humble enough to take the suggestions.
GENERAL SUGGESTIONS & ADVICE
You may feel more comfortable wearing a long skirt; you could simply hike it up a bit without having to fully undress.
Try not to make an appointment when you have your period. It can get a bit messy for the examiner when menstrual blood is involved.
Do not have intercourse or put creams, medications (except lube) in your vagina for the 24 hours before the exam. The PH in the vagina may change and it may affect results.
If the exam is hurting at any point say "that hurts!" and if you would like them to stop say, "Please stop!" Do not be afraid or intimidated to say it if your health care provider is hurting you! Do not hold back. Let him/her know what you are feeling.
Ask questions throughout the visit and during the actual exam. The health care provider may be quiet while examining you, but that does not mean you have to be.
Shave if that will make you feel better, or remain as hairy as you are because it will not matter. Health care providers are used to seeing all kinds of hair-styles down there.
If you are experiencing an odor in the area due to a vaginal infection, you may want to wash before your exam, but do not try to cover up the odor with deodorants or hygiene spray. Make sure you tell the health care provider about the odor before the exam begins. This information is useful to the practitioner because they can often recognize the type of infection you may have based on the kind of odor.
When you talk to your health care provider, you can sit at the table, fully dressed, until you are ready for the exam. After the exam, you do not have to remain in the uncomfortable position that you were in during the exam. If you wish to talk further with your health care provider you may dress and sit comfortably in a chair.
A NOTE ABOUT HISTORY OF SEXUAL ABUSE
Most health care providers will not ask you if you were ever abused. They fear opening a can of worms that they may not be able to respond to so they prefer to avoid this question. This is terrible, because it is proven scientifically that when women are asked, they often tell, often for the first time. So health care providers are advised to ask women about this and women care practitioners are in a great position to do this. If they do not, you may feel like talking about this with your health care provider, it may be very helpful. Just make sure he or she is a compassionate person. There is much more to a health care provider than his or her titles, diplomas and credentials on the office wall.
Women often suspect they have vaginismus from their symptoms, but getting medical confirmation can be challenging. Confirming a formal diagnosis of vaginismus may take some planning and perseverance. No definitive medical test exists for the diagnosis of vaginismus so it may take a number of visits to several health care providers or specialists before a medical diagnosis is obtained. When health care providers are initially unable to find any specific medical problem (a common experience of vaginismus sufferers), no diagnosis or misdiagnosis is a common outcome of initial medical exams. Many practitioners are unfamiliar with vaginismus, so part of the process is simply finding a health care provider that is knowledgeable about the condition. A successful medical diagnosis of vaginismus is typically determined through patient history and description of the problem, gynecological examination and the process of ruling out the possibility of other conditions.
Talking to health care providers about sexual problems can be difficult. Embarrassment, shame and anxiety are often present, making it hard to communicate and obtain appropriate care. Women may need to strongly advocate for themselves, insisting on a full diagnosis from a knowledgeable professional to rule out any other medical condition and properly confirm the vaginismus diagnosis. A medical diagnosis is helpful in removing any doubts or anxiety related to identifying the condition and enables women to have more confidence in moving toward treatment solutions.
Sexual pain disorders like vaginismus are commonly misdiagnosed or left unaddressed. Women may need to be very courageous in persevering until their concerns are given due attention and a reliable medical diagnosis is reached. In some cases and locations, a solid medical diagnosis is not always available or possible. This is especially true in geographic regions with fewer health care options.
Misdiagnosis and the promotion of invasive or unhelpful surgeries are sometimes the unfortunate result of all this confusion. There is no surgery to cure vaginismus. It is very important to seek a second opinion if surgery to "widen" the vaginal opening has been recommended as this does not normally resolve the penetration problem, but instead may further complicate the problem. Unnecessary, invasive, and potentially harmful surgeries and medications have been suggested for women with vaginismus who have not been properly diagnosed. Vaginismus is a highly treatable condition that does not require any invasive procedures.
Many women seeking diagnosis are often simply left undiagnosed and turned away by practitioners who fail to find anything physically wrong and feel there is nothing more they can do. They may not consider a diagnosis of vaginismus due to simple lack of awareness.
TALKING WITH YOUR HEALTH CARE PROVIDER
To assist women in obtaining reliable diagnosis for their sexual pain, the following sample script includes helpful tips to prepare for a health care provider visit. The script provides examples related to the vaginismus condition, however, it can be easily modified to help communicate to your health care provider the details of any sexual or pelvic pain problem:
- Introduce the problem: "I have been having problems with pain during sex and hope you will be able to help me."
- Provide a description of the pain (be specific): "It happens when my husband tries insert his penis in my vagina" or "once he is inside and starts to move I feel burning and tighten up", etc.
- The pain is located "at the entrance to my vagina. My vagina is like a wall; he just cannot get it in." or "after he is inside I feel burning around the penis just inside the entrance", etc.
- The pain lasts "as long as he keeps trying, especially if we try forcing it in. Once he stops there is no pain."
- This has been happening since "our honeymoon two years ago and has continued to happen every time we try to have sex" (primary vaginismus) or "my hysterectomy eight months ago"(secondary vaginismus), etc. Note: Inform your health care provider if you have been able to previously have sexual intercourse without pain.
- It feels like "burning", "stinging", "like he's hitting a wall", "tightness during/on entry", etc.
- I have tried to reduce or eliminate the pain by "using lubricant, changing sexual positions, relaxing more."
- I am able / unable to "insert a tampon or complete a gynecological exam."
Mention any past problems:
- Have you previously had any sexually transmitted diseases, yeast infections, bladder problems, or any pelvic pain outside of penetration?
- Mention any past sexual abuse.
State what you think the problem is: "I think it may be vaginismus. My symptoms are similar to those outlined in an article I read. However, I have read there are other things that can cause pain during sex and would like to have them ruled out."
TYPES OF PRACTITIONERS
Gynecologists - A gynecologist is a medical doctor who has specialized training in diagnosing and treating female pelvic health issues. Not all gynecologists have experience with vaginismus diagnosis and treatment, but gynecologists are tremendously knowledgeable and will be able to help rule out other conditions, clarify health issues and may be a great ally in the road to restoration.
Physical Therapists - There are growing numbers of physical therapists specializing in pelvic floor and sexual pain disorders like vaginismus. Many physical therapists will work with patients to set up home programs allowing women to work at their own pace, in privacy, and at a lower cost.
Sex therapists, psychologists, and counselors - There are many other specialists who have varying degrees of experience with vaginismus.
CONVENTIONAL MEDICAL TREATMENT
Treatment will first take care of any medical problems, followed by therapy to eliminate the muscular spasms and psychological problems. Vaginismus is highly treatable. Successful vaginismus treatment does not require drugs, surgery, self-hypnosis, nor any other complex invasive techniques. Effective treatment approaches combine pelvic floor control exercises, insertion or dilation training, pain elimination techniques, transition steps, and exercises designed to help women identify, express and resolve any contributing emotional components. Treatment steps can often be completed at home, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider.
For muscular spasms, one type of therapy involves dilating the vaginal opening gently and gradually with rubber or glass dilators. Office treatments will probably be necessary 3 times a week, and you should practice at home at least twice a day.
Prior to dilation or attempted intercourse, sit in a tub of warm water for 10 to 15 minutes. Baths often relax muscles and relieve discomfort. Repeat baths as often as is helpful.
Psychotherapy or counseling is recommended, in addition to, or if dilating treatment is unsuccessful. This may include sensate focus and improving communication with your partner, plus therapy to resolve any conflicts in your life.
Before attempting intercourse, you and your partner should use a lubricant, such as K-Y Lubricating Jelly or a natural massage oil (olive, almond, etc.).
Vaginismus is considered one of the most successfully treatable female sexual disorder. Many studies have shown treatment success rates approaching nearly 100 percent. Treatment resolution follows a manageable, step-by-step process. The sexual pain, tightness, burning or penetration difficulties caused by vaginismus are completely treatable, with high success rates for treatment. Couples are often amazed by the sudden life-changing effects of treatment. Those with penetration difficulties, or pain during intercourse, normally transition to pain-free and pleasurable intercourse following a step-by-step approach.
Many of the steps to treat vaginismus may seem counter-intuitive and not immediately obvious. As failure at any point inhibits recovery (experiencing discomfort tends to intensify vaginismus) and can cause avoidance or abandonment of progress, it is best to approach vaginismus with an educated understanding to ensure success in dealing with it.
The self-help program is a straight-forward, step-by-step approach used by many treatment professionals to successfully guide women through the complete process of overcoming vaginismus. These treatment steps can usually be completed at home, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider or specialist. There are complete self-help vaginismus kits available with 10 step treatment program books, dilators and video instruction. The easy-to-follow instructions are supplemented with descriptive illustrations and helpful strategies, making the process a positive, successful experience. Vaginal dilator sets using medical-grade vaginal dilators with a smooth, comfortable design that are easy to handle and use. At the completion of the steps, pain and penetration problems due to vaginismus are typically fully resolved.
NOTE: Vaginal dilators are typically not effective when used without guidance. They should not be used without proper physical instruction, exercises, transitional steps, etc. Dilators are simply one aspect of the vaginismus treatment process, and if used without pelvic control techniques they will likely be very ineffective. Involuntary muscle reactions are what produces the tightness and pain of vaginismus. The main focus of proper dilator use is in retraining the pelvic floor, not on stretching the vaginal opening.
NOTE: Treatment for those who have never been able to have pain-free intercourse (primary vaginismus) usually requires all ten steps, while those with secondary vaginismus may be able to shorten or bypass some steps.
VAGINISMUS THERAPY STEPS
Retraining the PC muscle group to respond differently to the anticipation of intercourse is key to the successful treatment of vaginismus. The process of learning to take conscious control of this muscle group changes the conditioned reflex so involuntary tightness no longer occurs (modifying the muscle memories or conditioned responses). Effective program steps will comprehensively address both body and mind components to resolve all triggers so that when intercourse is attempted involuntary spasms no longer occur and pain is eliminated.
STEP 1 - UNDERSTANDING VAGINISMUS
Step 1 provides an overview of vaginismus and how sexual pain, tightness, burning sensations or penetration difficulties may result from it. This approach helps women to get started by being proactive about their sexual health as understanding vaginismus is fundamental to the process of overcoming it. Topics also include how to obtain a solid diagnosis, treatment methods, relationship issues, pelvic/relaxation techniques, conditioned responses and muscle memories.
STEP 2 - SEXUAL HISTORY REVIEW & TREATMENT STRATEGIES
A balanced approach is taken to help women review and analyze their history. Exercises help identify and evaluate any events, emotions, or triggers contributing to vaginismus sexual pain or penetration problems. Checklists and detailed exercises map out a woman's sexual history and pelvic pain events, working toward appropriate treatment strategies. Emotional reviews help detail any negative events, feelings, or memories that may collectively contribute to involuntary pelvic responses. Topics also include blocked or hidden memories and how to move forward when there have been traumatic events in a woman's past.
STEP 3 - SEXUAL PAIN ANATOMY
Women often lack complete information about their body's sexual anatomy, function, and the causes of pelvic pain and penetration problems. Confusion regarding problems with inner vaginal areas and vaginal muscles frequently lead to misdiagnosis and frustration. Step 3 educates about these sexual body parts with emphasis on their role in sexual pain and penetration issues. Topics include how to distinguish what kind of pain or discomfort is normal with first-time or ongoing sex and what physical changes take place during arousal to orgasm cycles in the context of sexual pain or penetration problems. Anatomy areas such as the hymen and inner vulva are explained and demystified (for example there are six diagrams of hymen varieties to help distinguish hymen problems).
STEP 4 - VAGINAL TIGHTNESS & THE ROLE OF PELVIC FLOOR MUSCLES
Female sexual pain and penetration difficulties typically involve some degree of involuntary tightening of the pelvic floor. This step focuses on the role of pelvic floor muscles, especially the pubococcygeus (PC) muscle group, explaining in great detail how once they are triggered they continue to cause involuntary tightness with attempts at intercourse. Effective vaginismus treatment focuses on retraining the pelvic floor to eliminate involuntary muscle reactions that produce tightness or pain. Learning how to identify, selectively control, exercise and retrain the pelvic muscles to reduce pain and alleviate penetration tightness and difficulties is an important step in vaginismus treatment.
STEP 5 - INSERTION TECHNIQUES
For women with penetration difficulties or pain, techniques must be learned to allow initial entry without pain. In this step, women practice pubococcygeus (PC) muscle control techniques as they allow the entry of a small object (cotton swab, tampon, or finger) into their vagina, working completely under their control and pace. Any involuntary muscle contractions that had previously closed the entrance to the vagina and prevented penetration are overridden. Women begin to take full control over their pelvic floor and learn how to flex and relax the pelvic floor at will, eliminating unwanted tightness and allowing entry.
STEP 6 - GRADUATED VAGINAL INSERTIONS
When used properly, vaginal dilators are effective tools to further help eliminate pelvic tightness due to vaginismus. Dilators provide a substitute means to trigger pelvic muscle reactions. The effective dilator exercises in Step 6 teach women how to override involuntary contractions, relaxing the pelvic floor so it responds correctly to sexual penetration. Graduated vaginal insertion exercises allow women to comfortably transition to the stage where they are ready for intercourse without pain or discomfort.
STEP 7 - SENSATE FOCUS & TECHNIQUES FOR COUPLES TO REDUCE PELVIC FLOOR TENSION
Helping with the transition to pain-free intercourse, this step explains sensate focus techniques for couples to use to reduce pelvic floor tension and increase intimacy. Couples begin to work together during this step as exercises teach how to successfully practice sensate focus (controlled sensual touch) and prepare for pain-free intercourse using techniques from earlier steps. The exercises are designed to build trust and understanding and assist in the process to adjust to controlled intercourse without pain.
STEP 8 - PRE-INTERCOURSE READINESS EXERCISES
Finalizing preparations for couples to transition to fully pain-free intercourse, this step completes pre-intercourse readiness. Couples review and practice techniques that eliminate pelvic floor tension and prepare to transition to full intercourse. Preparing ahead of time to be able to manage, control and eliminate pain or penetration difficulties, the exercises assist with the final transition to pain-free intercourse.
STEP 9 - MAKING THE TRANSITION TO INTERCOURSE
Step 9 explains the techniques used to eliminate pain and penetration difficulties while transitioning to normal intercourse. Many troubleshooting topics are covered (with supporting diagrams) such as positions to use to maximize control and minimize pain, tips to ensure more comfortable intercourse, etc.
STEP 10 - FULL PAIN-FREE INTERCOURSE & PLEASURE RESTORATION
The final step toward overcoming vaginismus includes penis entry with movement and freedom from any pain or tightness. Step 10 exercises are designed to educate, build sexual trust and intimacy, and complete the transition to full sexual intercourse free of pain. Couples can begin to enjoy pleasure with intercourse, initiate family planning, and move forward to live life free from vaginismus.
INFORMATION ABOUT USING VAGINAL DILATORS
As the prospect of future sexual intercourse alone can be daunting, this treatment is to enable you to eventually become more comfortable with sexual intercourse and also allow the use of tampons. If you have had vaginal surgery, depending on the particular procedure, dilator use may be necessary to help keep the vagina open. Once the health care provider has agreed for you to start dilation treatment, you would have been given an appointment at their dilation treatment service. There you will receive a set of vaginal dilators and basic instructions from the clinical nurse specialist on how to use and care for the dilators. You will also have a routine consultation with the psychologist to clarify any further concerns and discuss ways that other patients have found helpful (or you might even have found approaches for them to pass on to other patients). You will be asked to come back to the dilation treatment service after six weeks - sooner if you consider it appropriate - to review progress and discuss any concerns. There will usually be two further follow-ups. This is in addition to your regular reviews with the consultant(s).
Keep in mind that it takes 3 months or longer for the vagina to expand to any significant degree. As for all kinds of exercises, frequent short sessions will achieve better results than intensive sessions with long gaps in between. It is recommended that you use dilators twice a day for about 20-30 minutes if possible. Otherwise try and do this once a day during midweek and twice a day in the weekend. Once the dilation has worked, then it is usually only necessary to dilate about 3 times per week to keep the vagina open. You should be able to contact the nurse at any time if you have queries between appointments, or if you want to see the psychologist to talk about anything that might be worrying or upsetting for you. The psychologist will have a lot of experience in counseling women about physical, psychological and sexual health issues. Do ask her for any advice or opportunity for discussion.
BASIC INSTRUCTIONS FOR USING VAGINAL DILATORS
1. Go through your weekly routine and plan ahead for time and private space. Remember that if you do not plan, it will not happen.
2. Once in your private space, choose the correct size dilator as recommended by your health care provider or depending on the stage of your treatment and have a box of tissue handy.
3. Apply some KY jelly (or other recommended lubricant) to the tip of the dilator.
4. Lie on your back with your knees bent.
5. Apply some KY jelly (or other recommended lubricant) to the entrance of the vagina and insert the dilator slowly and gently in your vagina pointing towards your lower back, using a mirror if it helps. At first, it may not be possible to insert the dilator in one attempt. It helps to push the dilator as far as comfortably possible and twist gently to pull back. Repeat the process a few times. It will get easier with practice and as the vaginal muscles relax.
6. The dilator should be held in place for about 20-30 minutes. It helps at first if you were to lie down. You can also sit up or propped up on the sofa or bed. Later when you are comfortable with the dilator, you can put on tighter pants and a Lycra short to hold the dilator in place and move around if the dilator can be kept in. It would be helpful to use a panty liner, as KY jelly (or other lubricant) can be messy.
7. The dilators are usually made of light and easy to clean plastic (sometimes of other materials). They should be cleaned with soap and water, dried and put away after each use.
8. Record each practice session in the Progress Chart provided by the dilation treatment service and bring the Chart with you when you attend follow-ups. In time your records will give you encouraging feedback about the progress you have made. It will also help the health care provider to review progress with you and to discuss any problems or how best to continue.
1. It helps if you are relaxed. At the beginning you might want to use the dilators after a warm bath. It can also help to listen to relaxing music. If you feel tense we can also provide you with an audiotape that many psychologists routinely use to help people manage any physical or psychological tension.
2. If you lead a busy life, you can make use of these daily half hour slots to practice relaxation at the same time, to take a short nap or do something relaxing, such as reading a magazine, listening to music, watching TV or playing a game.
3. Because treatment is demanding of your time, you may find it more sustainable when combined with some other light activity that you have to do, such as catching up with your telephone calls or e-mail, writing a letter, making up a shopping list, and so on.
4. Dilator treatment means putting an object inside an intimate part of your body. Many girls and women may find the thought of dilation frightening particularly if they have been brought up never to look or touch their genitalia because of it being different and because of all the intrusive examinations and treatment they may have undergone.
5. This can feel intrusive, or it can feel nice - depending on the person, the situation, and what thoughts and feelings accompany the act. Give yourself permission to do what it takes to turn this into something positive.
6. Finally, it is normal to get a very small amount of vaginal bleeding or spotting as the vagina is stretched.
If this is the first time you have heard of or are considering using vaginal dilators, or if you have had a long gap without using dilators, it can feel daunting to start treatment. It is tempting to put it off. Once started, it might feel like a lot of effort for very little gain, you might be tempted to give up. This is understandable and that is why your health care provider(s) plan to give you a lot of support. You can talk to them even if you do not feel like taking up dilation treatment at the moment.
LAURAL PRESCRIPTIONS GUIDELINES
USING VENUS VAGINAL INSERTS
FOR THE MANAGEMENT OF VAGINISMUS
One type of vaginal dilators used by medical practitioners are the Venus Vaginal Inserts (from Laurel Prescriptions). By following the management guidelines below, they are inserted into the woman's vaginal opening in order to progressively stretch the contracted muscles.
The woman puts aside ten minutes twice daily to be private, preferably after 5 to 10 minutes with a bath, shower, or music, etc. During the ten minutes, she experiences introital touch initially and then begins insertion of the vaginal inserts. Many women with repeated pain from attempted penetration recognize simple introital touch or pressure as pain and, for them:
STAGE 1: Simply be in control of self-touch with a finger, or with the insert, touching at the introitus confirming that, with herself in control, she can perceive simply touch and not pain.
STAGE 2: Pass the insert into and through the introitus and leaving it in for 5 to 10 minutes, confident the sensation experienced is not pain, just pressure and awareness that there is something in the vagina and in the introitus.
STAGE 3: On other successive days, the woman gradually inserts more of the first insert and then moves through the rest of the series of 5 to 7 inserts at her own pace, never allowing pain, always withdrawing the insert slightly if true pain is perceived, such that a narrower diameter is present in the in the introitus and pain is absent. Sometimes it is necessary to go back to the previous size of insert and then progress again more slowly.
SEXUAL ACTIVITY: As she progresses through stages 1 to 3, if the patient has a partner, all non-penetrative sex is encouraged. Finally free of the threat of subsequent pain, many women feel perhaps for the first time sexual enjoyment, arousal, and climax that is without risk. Women who, as a consequence of the pain of vaginismus, have secondarily lost desire need to begin with very low-key sexual activity at their own pace, knowing nothing else is expected and that they are in control of everything that happens. If there is a partner, seeing him (or her) to explain the vaginismus and the concept of continuing with non-intercourse sex, or re-introducing non-intercourse sex, is very necessary.
STAGE 4: Once insert #5 or #6 is reached, the phenomenon of vaginismus in the presence of inserts is clearly over. So that vaginismus does not recur with penile penetration, it is important to encourage the couple to allow some penile/vulval contact without penetration and then, later, penile insertion only without thrusting. The vital pre-requisite is that the woman is aroused to the point of wanting penetration before she invites it and that she remain in control such that in these early stages she should decide on position, timing of insertion, slowness of insertion, and any movement that occurs. If penetration is attempted somewhat clinically "because it is the next stage now we have got to insert #6" the actual penetration may well be painless but later there would likely be discomfort from rubbing the non-aroused vagina.
The woman cannot insert even the smallest insert. It is suggested that, in the examining room, she, with guidance from her health care provider, or the health care provider, with her full permission, at each stage gently show how the insert can enter the introitus. This may take more than one visit, that is maybe just at the introitus on one visit but not through. It is suggested she would be sitting up, in control, with her partner present if she wishes, with a nurse present if the patient wishes, and that the practitioner night use diagrams or models to explain anatomy. In about 50 percent of women, this is the way the first insertion is done and, the other 50 percent are more comfortable with making that first insertion on their own at home.
The woman gets "stuck", for example at insert #2 or #3. Again, going back to the examining room one more time, and actually having the health care provider guiding the woman with her own insert, is necessary.
The woman develops cystitis. This is rarely reported from the first few insertions, very similar to the mechanism of "honeymoon" cystitis and is treated similarly. In medical experience, it is always short lived and a few prophylactic nitrofurantoin or one course of antibiotics will usually suffice.
For the woman with lowered desire who reaches the larger inserts but still does not wish intercourse, she should be congratulated by her health care practitioner that potentially she is now ready for sex inclusive of intercourse but it is, and will always be absolutely her right to say whether or not she wishes it to happen and that the current situation is that she wishes for it not to happen and that this will be respected. Again, help to guide the partner to give as low-key sexual touches, caresses, stimulation, that is desired will be given. The woman may stay at this stage for some months and, if there are relationship issues, perhaps indefinitely she will be at this stage with this particular partner. The choice, of course, is either to address the relationship or to accept that this is it's potential and that intercourse is reserved for the future with another person.
VAGINAL DILATOR INFORMATION
Information About Using Amielle Comfort Vaginal Dilators
Free Guide To Help You Self-Treat Vaginismus
Medication is usually not necessary for vaginismus, but mild sedatives or tranquilizers may be prescribed for short periods of time.
A relatively recent treatment for vaginismus is the use of Botox injections to relax the PC muscle to prevent spasms. Studies have shown that it is highly effective against vaginismus but dilation therapy combined with psychological therapy is still the standard for most sufferers.
Curable if the underlying cause can be cured or a coping method can be developed through medical treatment and psychological counseling. When treated by a specialist in sex therapy, success rates are generally very high.
VAGINISMUS TREATMENT STUDIES
There are a variety of factors that can contribute to vaginismus. These may be psychological or physiological, and the treatment required can depend on the reason that the woman has developed the condition. As each case is different, an individualized approach to treatment is useful. The condition will not necessarily become more severe if left untreated, unless the woman is continuing to attempt penetration, despite feeling pain. Some women may choose to refrain from seeking treatment for their condition.
According to the Cochrane Collaboration review of the scientific literature, "In spite of encouraging results reported from uncontrolled case series there is very limited evidence from controlled trials concerning the effectiveness of treatments for vaginismus. Further trials are needed to compare therapies with waiting list control and with other therapies." Although few controlled trials have been carried out, many serious scientific studies have tested and proved the efficacy of the treatment of vaginismus. In all cases where the systematic desensitization method was used, success rates were close to 90 to 95 percent and even 100 percent.
According to Ward and Ogden's qualitative study on the experience of vaginismus for women (1994), the three most common contributing factors to vaginismus are fear of painful sex; the belief that sex is wrong or shameful (often the case with patients who had a strict religious upbringing); and traumatic early childhood experiences (not necessarily sexual in nature).
Vaginismus patients are twice as likely to have a history of childhood sexual interference and held less positive attitudes about their sexuality whereas no correlation was noted for lack of sexual knowledge or physical abuse.
For some women, especially those with primary vaginismus, it is important to address the psychological aspects of the problem as well as the actual muscle spasm. A woman may choose to address the issue on her own terms, or she may avail the help of a therapist. Some women, especially those with secondary vaginismus, may rely on a physical rather than psychological treatment and also be successful. There are emotional difficulties associated with vaginismus, which can include low self-esteem, fears, and depression.
Physical treatment of the internal spasms may include sensate focus exercises, exploring the vagina through touch, and desensitization with vaginal dilators. Dilating involves inserting objects, usually phallic in shape, into the vagina. In treating the spasms through dilation, the objects used gradually increase in size as the woman progresses. Medical dilators may be obtained online, though they may be expensive.
Botox is a relatively new treatment for vaginismus, first described in 1997. Ghazizadeh and Nikzad reported on the use of botulinum toxin in the treatment of refractory vaginismus in 24 patients. In this study, Dysport (a type of Botox) 150-400 mIU (Ipsen Ltd, United Kingdom) was used. 23 patients were able to have vaginal examinations one week post procedure showing little or no vaginismus. One patient refused vaginal examination and did not attempt coitus. Of the 23 patients, 18 (75 percent) achieved satisfactory intercourse, 4 (17 percent) had mild pain and one patient was unable to have intercourse because of her husband's impotence. A second dose of Dysport was needed on one patient. There were no recurrences during the 2-24 month follow-up period.
A controlled study using Botox for one group of patients was compared to saline in another. 8 women treated with the Botox were able to achieve satisfactory intercourse whereas 5 women who were injected with saline controls showed no response. None of the 8 women who had Botox required any further treatment. The procedure is simple, easy, cost-effective, not time-consuming and can be achieved on an outpatient basis. No complications were reported.
If a woman suspects she has vaginismus, sexual penetration is likely to remain painful or truly impossible until her vaginismus is addressed. Women with vaginismus may be able to engage in a variety of other sexual activities, as long as penetration is avoided. Sexual partners of vaginismic women may come to believe that vaginismic women do not want to engage in penetrative sex at all, though this may not be true. Many vaginismic women strongly wish to engage in penetrative sex, but are deterred by the pain and emotional distress that comes with each attempt.
Many people do not realize that it is common, even in patients who do not suffer from vaginismus, for a woman to experience pain or discomfort if she attempts sexual penetration without first being sufficiently aroused. Most women acknowledge sexual arousal as vital to achieving comfortable penetration, so self-exploration of the vaginal area through masturbation can be beneficial in addressing vaginismus.
One of the problems which may accompany vaginismus is that a woman may be extremely hesitant to engage in penetrative sexual activity with others, due to a fear of pain associated with any kind of vaginal penetration. Solo masturbation, with or without penetration, can alleviate this fear, as well as the psychological pressure to "perform" sexually or become aroused quickly with a partner.
Despite popular belief, orgasm need not be the goal of masturbation. It may serve simply to increase comfort with the genital area, to explore various sensations through genital and clitoral touch, and to become aware of those sensations which are relaxing and pleasurable. Sexual arousal causes changes in the shape and color of the vulva, as well as in the vaginal lubrication produced. As a woman becomes more aware of her individual sexual response, she can learn which sensations are best for bringing her to a state of arousal. She will then be better equipped to teach her partner which sensations feel best for her. Vaginismus does not prevent a woman from achieving orgasm.
A wide range of emotions may surface during masturbation and other forms of genital exploration. Some women have negative associations with their genitals, including fears that their genitals are dirty, smelly, oddly shaped, or ugly. These associations can lead to negative emotions arising during any kind of sexual expression, including masturbation, and these emotions can take time to process. Especially in the case of a vaginismic woman, feelings of extreme shame, inadequacy or fear of being "defective" can be deeply troubling. If multiple attempts to penetrate are made before treating vaginismus, it may lead to fear of sexual intercourse, and worsen the amount of pain experienced with each subsequent attempt. Relaxation, patience and self-acceptance are vital to a pleasurable experience.
Psychological trauma caused by guilt, anxiety, loss of self-esteem and feelings of inadequacy, or interpersonal problems resulting from the disorder.
Vaginismus may lead to unsatisfying sex activity and tension in intimate relationships.
No special diet.
Gravel Root, also known as Queen of the Meadow, is used for kidney stones, cystitis, and pelvic inflammatory disease. Because it encourages the excretion of excess uric acid, it is also used to treat rheumatism and gout. Gravel Root is effective as a treatment for an inflamed prostate, spasmodic dysmenorrhea with irregular menstruation, it helps ease childbirth, and it helps eliminate fluid retention. It also works well in treating pharyngitis, sore throat, dysentery, ulcers, fistula inflammation of the middle ear, acute cystitis, and vaginismus. This herb has anti-lithic, anti-rheumatic, stimulant, tonic, astringent, and relaxant properties. Gravel Root comes in various forms and is an ingredient in many products. To take as a tea, 1 teaspoon of Gravel Root to 1 cup of boiling water. Drink 3 times a day. If using the tincture form, take 1 to 2 ml 3 times a day. For other formulations, read and follow product label directions.
Herbal Remedies: Queen of the Meadow Root (Gravel Root) Powder, 4 oz. Bulk
Herbal Remedies: Gravel Root Tincture, 2 fl. oz.
Herbal Remedies: Gravel Root Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Herbal Remedies: Gravel Root / Queen of the Meadow Information
Herbal Remedies: Gravel Root / Queen of the Meadow Supplements & Products
Ayurvedic gynecologists recommend henna in treatment of leucorrhea, cervicitis, ulcers on female genitalia and vaginismus (burning in vagina). In post-coital burning, henna is said to give relief to the female partner. It also has antispasmodic (relaxing) properties. Externally, Henna is applied as a paste or poultice made from powdered seeds and or leaves. Topical application is generally considered safe, although there are some cases of sensitivity or allergic reactions. Internal treatments should be used under a medical practitioner's direction.
Therapies that can help you relax physically and emotionally may be most useful or vaginismus. Aromatherapy is good to induce relaxation. Regular sensual massage (but avoid the genitals area) by a partner using essential oils of Ylang Ylang, Rose, Jasmine, Sandalwood or Rosemary blended in a carrier oil may help relaxation and build trust. Rosemary is believed to have uplifting properties that may help counter the tension underlying vaginismus.
Mountain Rose Herbs: Ylang Ylang Essential Oil, Certified Organic, 1/2 oz. To 16 oz. Size
Herbal Remedies: Ylang Ylang Essential Oil, 100% Pure, NOW Foods, 1 fl. oz.
Mountain Rose Herbs: Rose Absolute Oil, Cultivated Without Chemicals, 1/8 oz. To 1 oz. Size
Mountain Rose Herbs: Rose Essential Oil (Bulgarian), Certified Organic, 1/8 oz. To 1/2 oz. Size
Mountain Rose Herbs: Rose Essential Oil (Chinese), Cultivated Without Chemicals, 1/8 oz. To 1/2 oz. Size
Herbal Remedies: Rose Oil, 100% Natural Absolute In A 5% Base of Grape Seed Oil, NOW Foods, 1 fl. oz.
Mountain Rose Herbs: Jasmine Absolute Oil, Cultivated Without Chemicals, 1/8 oz. To 1 oz. Size
Herbal Remedies: Jasmine Essential Oil Blend, NOW Foods, 1 fl. oz.
Mountain Rose Herbs: Sandalwood Essential Oil (Sri Lanka), Wild Harvested, 1/4 oz. To 16 oz. Size
Mountain Rose Herbs: Sandalwood Essential Oil (Australian), Cultivated Without Chemicals, 1/4 oz. To 16 oz. Size
Herbal Remedies: Sandalwood Oil Blend, NOW Foods, 1 oz.
Mountain Rose Herbs: Rosemary Essential Oil, Certified Organic, 1/2 oz. To 16 oz. Size
Herbal Remedies: Rosemary Essential Oil, 100% Pure, NOW Foods, 1 fl. oz.
NOTIFY YOUR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of vaginismus, pain associated with intercourse or difficulties with successful vaginal penetration.
Symptoms do not improve after 3 weeks, despite treatment.
Symptoms recur after treatment.
HELPFUL RELATED LINKS
Vaginismus.com: Helping women overcome sexual pain. Toll Free: 1-888-426-9900
Vaginismus Online Support Group
Vaginismus Awareness Network
AMAZON.COM - BOOKS ABOUT VAGINISMUS
AMAZON.COM - VAGINAL DILATORS
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HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
If you see a suggested Amazon product "not there" as indicated by an orange box with the Amazon logo, this only means the specific product link has been changed by Amazon.com. Use the "click here" icon on the orange box and it will bring you to Amazon.com and you can do a search for a specific product using keywords and a new list of available products and prices will show. Their product and resource links are constantly changing and being upgraded. Many times there are more than one link to a specific product. Prices will vary between product distributors so it pays to shop around and do price comparisons.
Educational materials and health products are available through Amazon.com. Use the search box provided below to search for a particular item.
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