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Vaginismus the common condition leading to painful sex

Posted by Jodie West on

Vaginismus can be a cause of pain with intercourse and can sometimes prevent any kind of penetrative sex or any kind of penetration including the use of tampons or gynaecological examinations. It can cause discomfort, burning, pain, penetration problems,

Vaginismus is also known as genito-pelvic pain disorder or genito-pelvic penetration disorder (GPPD), pelvic floor over-activity/hypertonicity, pelvic floor myalgia, and is sometimes confused with vulvodynia.

What is Vaginismus?

Vaginismus is the involuntary reflexive contraction of the pelvic floor muscles (in particular those around the vaginal opening) in response to attempted penetration, e.g., tampons, speculum in a gynaecological examination or penis during sex. The level of pain varies widely between individuals. The amount of muscular contraction in response to penetration can vary from a slight contraction which still allows penetration usually with some discomfort and or pain. To a muscular contraction that completely closes the vagina so as to not allow any penetration at all. This level of reflex can feel like a partner is hitting a brick wall.

Vaginismus can be classified as primary vaginismus or secondary vaginismus. Primary Vaginismus is when vaginal penetration has never been achieved. While secondary vaginismus is when vaginal penetration was once achieved, but is no longer possible, potentially due to factors such as gynaecological surgery, trauma, or radiation. Vaginismus may or may not be experienced in combination with Vestibulodynia and can even be a learned reflex due to the pain that it causes.

The exact number of women with vaginismus is difficult to know, but in clinical settings, the rates are reported to be between 5-17% (Lahaie et al, 2010; Melnik et al, 2012). If you have experienced vaginismus, you are certainly not alone. 

What causes Vaginismus?

There is not always an obvious cause of vaginismus. Commonly it is it is a learned response due to a painful experience with penetration or after childbirth, an infection, pelvic pain, other medical conditions or even some medical treatments. It can also be associated with anxiety and stress about having sex, difficult relationships, some religious beliefs and past sexual abuse, however this is not always the case. I once heard it explained as if every time you were given chocolate you were poked in the eye eventually your eyes would close if anyone offered you a chocolate and you probably wouldn’t want chocolate anymore because you associate it with pain.

With vaginismus, when there is anticipation or fear of pain, or actual pain (eg. during intercourse or when trying to insert a tampon), the vaginal muscles tighten which makes penetration/insertion even more difficult, and further tensing can cause a cycle of pain.

Pain cycle in vaginismus

How is vaginismus diagnosed?

A thorough history and physical examination is required by an experienced gynaecologist or pelvic health physiotherapist. There are no specific tests such as blood tests or swabs that would lead to a diagnosis as it is purely a reaction of the pelvic floor muscles.

How do you treat vaginismus?

A multidisciplinary approach is recommended combined with a willingness to do a home program. First stop would be a Pelvic floor assessment with a Pelvic Health Physiotherapist or Gynaecologist. A Pelvic Floor Physiotherapist can help to teach you how to actively contract and relax your muscles. Sometimes gentle muscle release and stretching is required, as well as a graduated home program. Often home programs involve using 'accommodators' (dilators) to desensitize the vaginal tissues and experience self-controlled penetration, with the goal of returning to full intercourse. Working with a counsellor or therapist can help overcome any fear of pain during intercourse, they can also help you work out the best way to communicate with your partner, incorporate your self care into your intimacy and in some cases help you expand your definition of sex and redefine pleasure. Some women find they are still able to enjoy pleasurable sexual activities that do not involve penetration and are still able to orgasm. Pain with sex can definitely put a strain on any relationship. Being open with your partner and still finding ways to be close and intimate is key while working to resolve the pain. Finally you can include slim line pleasure products and quality lubricants into your sex life.

Vaginismus is not something you have to put up with. There is help available.

References

Lahaie, MA, Boyer, SC, Amsel, R, Khalifé, S & Binik, YM (2010) Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment. Women’s Health, vol 6, no. 5, pp. 705–719
Melnik, T, Hawton, K, McGuire, H (2012) Interventions for vaginismus. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD001760. DOI: 10.1002/14651858.CD001760.pub2.

 

Disclaimer: The information contained in this document should be read as general in nature and is only to provide and overview of the subject matter. Please read product packaging carefully and follow all instructions. Seek advice specific to your situation from your medical professional or mental health professional. Safe - Sane - Consensual 

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