- 12
- Apr
I am going to write a brief series describing some of the types of sexual pain that women experience. (Men experience sexual pain also, but less frequently. I’ll address that later.) I want women who visit the blog who have painful sex to have a beginning, a place where they can start to name what might be wrong.
Vaginismus is a spasm of the muscles in the pelvic floor that causes the vaginal walls to tighten to the point that penetration is impossible. Vaginismus can be situational, that is, it might only occur when a woman has a pelvic exam, or only with intercourse. Its causes are varied, ranging from psychological strain, to repeated infections, to no known cause at all. Women who experience vaginismus find it frustrating and embarrassing. Often when they visit a gynecologist, they are told, “It’s nothing, just relax.” And actually, this may be all that some women need to hear. Others, however, have no idea what, exactly, they are supposed to do to relax that muscle down there.
We frequently see women with vaginismus at the Institute. Treatment can take 3-6 months and lots of patience with one’s self. The vagina, it seems, cannot simply be willed to cooperate sometimes. We use a combination of education about sexuality, cognitive therapy to address negative thoughts (”I’ll never have normal sex again!”) and distorted beliefs (”Sex is for men!”), relaxation, Kegel exercises, and the use of dilators, which are essentially rods that are graduated in size from very slender (smaller than a junior tampon) to larger, approximating the size of an average penis. The dilators are inserted and kept in place to help the muscle relax. If after a few weeks the dilators and other interventions are ineffective, we will recommend sessions with a physical therapist that specializes in pelvic floor work. We have started to incorporate hypnosis to help with relaxation and to facilitate relaxation of the pelvic floor. We also work with the woman’s partner, educating him and giving him support. He can also become a participant, inserting dilators into his partner. We work with the couple to help them find alternatives to intercourse, or what is known as “outer course”.
Vaginismus can be overcome, and we are here to help women who are unable to “just relax” and do it on their own.
