Vaginismus; Definition, Causes And Treatments

Vaginismus is a condition involving a muscle spasm in the pelvic floor muscles. This makes it painful, difficult to have sexual intercourse, to undergo a gynaecological exam, and to insert a tampon. The vagina tightens up because of an involuntary contraction of the pelvic floor muscles. This leads to a generalised muscle spasm, pain and temporary breathlessness. Eventually, this spasm can occur even when the woman is touched near the vaginal area.

The most common pelvic floor muscle group affected is the Pubococcygeus (PC) muscle group. These muscles are also responsible for urination, intercourse, orgasm, bowel movements and childbirth. These are situations in which these muscles should contract and tighten properly. So, remember that the pelvic floor muscles are never fully relaxed.


Vaginismus doesn’t interfere with sexual arousal, but it can prevent penetration. A gentle pelvic exam typically shows no cause of the contractions. Vaginismus can have additional symptoms, including fear of vaginal penetration and decreased sexual desire related to penetration. Women with vaginismus often report a burning or stinging pain when anything is inserted into the vagina.

It is important to note that in vaginismus, vaginal muscles tighten up despite the woman’s desire for sexual intercourse. If you have vaginismus, it doesn’t mean that you’ll stop enjoying sexual activities altogether. Women who have the condition can still feel and crave sexual pleasure and have orgasms. For a clinical diagnosis of vaginismus, all of these symptoms must be present at least 50% of the time while having intercourse.

Let's start meaningful discussions at the WORLD'S BEST Mental Health, Sexual Health and Addiction/De-addiction forum: https://www.thehappytreehospital.com/forum


Prevalence

Although the population prevalence remains unknown, the prevalence rates in clinical settings have been reported to range between 5–17% of women. The wide range of reported prevalence rates most likely has a sociocultural cause, since the highest reports come from conservative countries where women’s rights and freedoms are often curtailed.

Types

Primary Vaginismus

This is a lifelong condition in which the pain has always been present. It is experienced by women during their first attempt at intercourse. The male partner is unable to insert his penis into the vagina. He may describe a sensation like “hitting a wall” at the vaginal opening. The symptoms are reversed when the attempt at vaginal entry is stopped.

Secondary Vaginismus

This develops after a woman has already experienced normal sexual functioning. It can occur at any stage of life, and it may not have happened before. It usually stems from a specific event, such as an infection, menopause, a traumatic event, development of a medical condition, relationship issues, surgery, or childbirth. Even after any underlying medical condition is corrected, pain can continue if the body has become conditioned to responding in this way.

Global Vaginismus

Vaginismus is always present, and any object will trigger it.


Situational Vaginismus

This occurs only in certain situations, or with certain partners.

The symptoms of vaginismus vary in severity with different women. For example:

  • Some women are unable to insert anything into their vagina.

  • Some women can insert a tampon and undergo a complete a gynaecological exam, but intercourse isn't possible.

  • Other women can try to have intercourse, but it is very painful.

  • Some women are able to have intercourse, but tightness and pain prevent orgasm.

  • Some women experience years of occasional difficulty with sex and have to be constantly ready to control and relax their vagina when the symptoms occur.

Causes

Vaginismus is a condition which can be caused by physical stressors, emotional stressors, or both. It can become anticipatory, so that it happens because the person expects it to happen.


Emotional Triggers

Let’s discuss the fear-avoidance model of vaginismus. Vaginismus usually begins when women first attempt to have sexual intercourse. However, it sometimes develops later, for example, when another factor makes intercourse painful for the first time or when women attempt intercourse while they are emotionally distressed.

Because intercourse may be painful physically, emotionally, or both, women begin to fear it. This fear makes muscles even tighter and causes or increases pain when sexual intercourse is attempted. A reflex reaction develops so that when the vagina is pressed or sometimes even just touched, the vaginal muscles automatically (reflexively) tighten. However, most women with vaginismus enjoy sexual activity that does not involve penetration.

Emotional Triggers Include:

  • fear of pregnancy

  • anxiety, about performance or because of guilt

  • relationship problems, for example, having an abusive partner or feelings of vulnerability

  • traumatic life events, including rape or a history of abuse

  • childhood experiences, such as the portrayal of sex while growing up or early exposure to sexual images and videos

Having difficulty understanding sex, or having feelings of shame or guilt around sex could make you feel uncomfortable if:

  • You've had a very strict upbringing where it was never discussed.

  • You have been told that sexual desire is wrong or sex is painful.

  • You are affected by cultural or religious taboos around sex.

Physical Triggers

In a lot of physical conditions, a lack of vaginal lubrication and elasticity makes intercourse painful, stressful, or impossible. In others, pelvic floor muscle dysfunction, i.e., some physical problem in the normal functioning of the pelvic floor muscles, leads to hypertonicity (increased tone) and reduced muscle control.


These include:

  • infection, such as a urinary tract infection (UTI), yeast infection or trichomoniasis, which is a parasitic infection

  • health conditions, such as cancer or lichen sclerosis

  • childbirth

  • menopause

  • inadequate foreplay

  • medication side effects

  • previous surgery to the genital area

  • radiotherapy to the pelvic area

Let's start meaningful discussions at the WORLD'S BEST Mental Health, Sexual Health and Addiction/De-addiction forum: https://www.thehappytreehospital.com/forum


Treatment

gif

The aim of treatment will be to reduce the automatic tightening of the vaginal muscles and the fear of pain, and to deal with any other type of fear that may be related to the problem.


Education

Education typically involves learning about your anatomy and what happens during sexual arousal and intercourse. you'll get information about the muscles involved in vaginismus, and understand why you're having pain.This can help you understand how the parts of body work and how your body is responding.


Sex Therapy and Counselling

Counselling may involve you alone or with your partner. Working with a counsellor who specialises in sexual disorders is the key. Sex therapy can help the person identify, express, and resolve any emotional factors (including past sexual trauma) that may be contributing to vaginismus.

As well as advising you on self-help techniques, your therapist may offer you:

  • Counselling to address any underlying psychological issues (such as fear or anxiety)

  • Cognitive behavioural therapy to change any irrational or incorrect beliefs about sex

Relaxation Exercises

A bath, massage and breathing exercises are good ways to relax while you get to know your body.

You may also practice a technique called jacobson’s progressive muscle relaxation. This involves tensing and relaxing different muscles in your body in a particular order. Here is how:

  1. Breathe in, and tense the first muscle group (hard but not to the point of pain or cramping) for 4 to 10 seconds.

  2. Breathe out, and suddenly and completely relax the muscle group (do not relax it gradually).

  3. Relax for 10 to 20 seconds before you work on the next muscle group. Notice the difference between how the muscles feel when they are tense and how they feel when they are relaxed.

  4. When you are finished with all of the muscle groups, count backward from 5 to 1 to bring your focus back to the present.

Try these exercises half an hour before sexual activity and feel the difference.

Kegel Exercises

gif

Contract and relax

  • Contract your pelvic floor muscles for 4 to 10 seconds.

  • Relax for 4 to 10 seconds.

  • Repeat the contract/relax cycle 10 times.

  • Keep other muscles relaxed. Don't contract your abdominal, leg, or buttock muscles, or lift your pelvis.

  • Place a hand gently on your belly to detect unwanted abdominal action.

Aim high: Try to do at least 30 to 40 Kegel exercises every day. Spreading them throughout the day is better than doing them all at once.

Diversify: Practice short, 2 to 3 second contractions and releases (sometimes called "quick flicks") as well as longer ones.

Sensate Focus

The most widely researched self care method is the Sensate Focus Technique. This technique is based on a Behaviour Therapy called Gradual Desensitisation. You can use this technique the following way:

  1. Get to know your body. Have some time to yourself to explore your body and what feels good for you. Make sure you are relaxed, and start feeling yourself around the genital area. Get used to what it feels like in and around the outer part of your vagina (the vulva) before trying to penetrate yourself. Once you are comfortable and relaxed with that, try inserting your finger gently inside your vagina. It may take days or weeks to get to a stage where you feel comfortable enough to do this. Once you can do this, feel around inside your vagina with your finger, pushing further in very gently.

  2. If this doesn’t work, you can try inserting a lubricated tampon instead. Use the same method, making sure you’re calm and relaxed before inserting anything.

  3. If you have a sexual partner, both of you agree not to have penetrative sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area or breasts.

  4. Set aside a time when it is just the two of you. Massage, touch or stroke each other, with or without clothes on. Explore your bodies, knowing that you will not have intercourse.

  5. After the agreed period of time has passed, you can begin touching each other's genital areas. You may want to spend several weeks gradually increasing the amount of time spent touching the genital areas. If comfortable, you can also begin to use your mouth to touch your partner’s genitals.

  6. It will probably take time before you feel comfortable enough to be penetrated by your partner’s finger.

  7. When you reach a stage where you want to try sexual intercourse, take things slowly and don’t rush anything.

  8. If these methods do not help, contact your doctor. Your doctor may recommend learning to use vaginal dilators under the supervision of a professional. Place the cone-shaped dilators in your vagina. The dilators will get progressively bigger. An insert is left in for 10 to 15 minutes. This helps the vaginal muscles stretch and become flexible. To increase intimacy, have your partner help you insert the dilators. Once you can insert the cone without causing pain, your sexual activity can include touching your genital area with your partner's penis, but without it entering the vagina.

  9. Only after completing these steps should you try intercourse again. Doctors usually recommend that women hold their partner’s penis and place it partly or completely in their vagina in the same way that they placed the insert. This process may make some men overly cautious and too reluctant to push, or they may lose their erection. They may benefit from a phosphodiesterase inhibitor/Viagra (such as sildenafil, tadalafil, or vardenafil).

Let's start meaningful discussions at the WORLD'S BEST Mental Health, Sexual Health and Addiction/De-addiction forum: https://www.thehappytreehospital.com/forum

Pharmacotherapy

Three main types of pharmacological treatment have been proposed for vaginismus: local anaesthetics (e.g., lidocaine), muscle relaxants (e.g., nitroglycerin ointment and botulinum toxin) and anxiolytic medication.

  1. Local anaesthetics, such as lidocaine gel, have been proposed based on the rationale that muscle spasms are due to repeated pain experienced with vaginal penetration and, hence, the use of a topical anaesthetic aimed at reducing the pain is hypothesised to resolve the spasm.

  2. A topical nitroglycerin ointment is used to treat the muscle spasm by relaxing the vaginal muscles. Botulinum toxin, a temporary muscle paralytic, has been recommended in the treatment of vaginismus with the aim of decreasing the hypertonicity (stiffness) of the pelvic floor muscles. This involves repeated injections of botulinum neurotoxin type A into the levator ani muscle.

  3. Treatment with anxiolytics, such as Diazepam, Lorazepam and Etizolam in conjunction with psychotherapy, is based on the hypothesis that vaginismus is a psychosomatic condition resulting from past trauma and, thus, anxiety-reducing medication will resolve the symptoms.

Surgery

In some cases, surgery may be a treatment option for vaginismus. For example, if a medical condition is causing you physical pain during sex, and this is contributing to vaginismus, it may be possible to treat the underlying cause of the pain.

Endometriosis

Endometriosis is a possible reason for surgery. This condition causes small pieces of the womb lining to grow outside the womb. Surgery can remove or destroy these areas of tissue.

Enlarging The Vagina

Surgery can be carried out to enlarge your vagina. This may be necessary if, for example, previous surgery to this area has meant that scar tissue has formed and is either blocking or restricting your vagina. This can occur if it was necessary for doctors to make a cut in your perineum during childbirth (Episiotomy).

A small operation called the Fenton's procedure can be done to remove the scar tissue. The operation involves neatly cutting out the scar tissue and sewing together the clean-cut edges with small stitches. The stitches should dissolve on their own after a few weeks. The operation will be carried out under either local or general anaesthesia. You may experience some pain after the operation, which you can treat with painkillers such as paracetamol. You may also have some bleeding. Use sanitary towels rather than tampons.


Let's start meaningful discussions at the WORLD'S BEST Mental Health, Sexual Health and Addiction/De-addiction forum: https://www.thehappytreehospital.com/forum