Vaginal spasms undiscussed problem
One out of every 10 women suffers from vaginismus, an involuntary spasm of the vaginal opening. Some of these women have never had sex, while others have experienced traumas in the past. The good news is that the problem can be treated, and you shouldn't be afraid to ask
Nobody talks about this problem, but it is surprisingly common. Estimates are that 10-15 percent of women suffer from vaginismus. The condition was first described in scientific literature in 1834, when it was described as a serious problem during sexual intercourse that led to “lack of satisfaction.”
The solution was to remove the hymen, on the assumption that cutting it would eliminate the barrier and solve the problem of sexual intercourse. Today we know that the reasons for vaginismus are mostly psychological, not physical.
What exactly is vagnismus?
Vaginismus is involuntary spasms of the lower vaginal muscles.
“These spasms make it impossible to put anything in the vagina,” according to to Gila Bruner, director of the Center for Sexual Medicine at the Sheba Medical Center, “including a tampon, a gynecologist’s finger, a partner’s finger, and of course, a penis.”
Sometimes the spasm includes not only the vaginal opening, but also the rest of the body: the legs close, and the body does not allow anything to come near the genitalia.
Vaginismus is classified as primary or secondary. Primary means that nothing has ever entered the vagina. Secondary occurs after a particular event: an operation, a serious illness, damage to the sexual organs, or rape.
Bruner says that in less severe cases of vaginismus, the women are able to have sexual relations that don’t involve penetration.
“They reach orgasm as long as they sleep with a partner they have a lot of trust in, who does not take take advantage of the opportunity and does not attempt to enter the vagina," she says. "They generally choose a wonderful, considerate, cooperative partner. In such cases they do not rush to the sex therapist since they are having sex and it’s fairly pleasurable for both members of the couple, so they put off going for treatment. This sort of woman generally comes for treatment when she wants to have a child.”
In more serious cases, the woman does not allow her partner to get near her. Many times such women remain alone, and go for treatment only when they are older, after they realize that the obstacle of vaginismus will leave them alone in the future, as well.
Why does it happen?
It is generally believed that the main reason for vaginismus is a deep-seated fear, sometimes caused by something concrete, and at other times by real experiences.
“I had a patient who suffered from vaginismus,” Bruner says. “She had been married for six years, and she and her husband had a four-year old child who was created by chance from the one time that her husband attempted to enter the vagina, and succeeded. This happened just the once, and she got pregnant.
“When I looked for what was causing the vaginismus, I found out that when she was a child, she heard her mother having pain during sex, and this was seared in her memory. In another case, a patient read detailed descriptions of a rape, and these caused her vaginismus.”
But sometimes the fear that causes the vaginismus is a result of some traumatic experience, such as a rape.
The main diagnosis is done on the basis of the patient’s story. Since usually the woman suffering from vaginismus has a fear of anyone approaching her vagina, the general practice is not to put her on a gynecologist’s examination table at the beginning of treatment.
“This is part of the fear,” Bruner says, “and we do the initial exam based on her description, and it is sufficient and very clear.”
How is it treated?
Because the problem is so complex, the treatment combines several different approaches: first the woman learns to make friends with her vagina. The goal is to become as familiar with her vagina as she is with her face.
The patient learns about the vaginal muscles, including how to control them, how to contract them, and how to relax them at will. At a later stage, the woman is placed on a gynecologist’s examination table with a large mirror next to her that allows her to see her vagina. Sometimes this is the first time she has seen the structure of her genitalia.
Familiarization process
This familiarization process includes touching: the feel of the labia majora, the labia minora, the clitoris, the pubic hair, the vaginal opening, and the inside of the vagina. At a later stage the sex therapists teach the woman to use the vaginal muscles to do Kegel exercises. This is similar to the Paula method for the ring muscles, which involves learning to contract and release in order to strengthen the muscles.
Another method involves relaxing the vaginal floor muscles through regular relaxation breathing. These are the relaxation exercises that involve inhaling slowly through the nose, and afterwards exhaling slowly.
Physical therapy is also used: All Israeli HMO's and hospitals offer biofeedback practice, which makes it possible to see changes in the pelvic area muscles, which the woman learns to control.
At a later stage, after the patient has learned to contract and release the vaginal floor muscles, she has a series of practice sessions using vaginal dilators, dildos that come in a variety of diameters. The patient learns how to place the dilator in her vagina for the first time in her life, starting with the narrowest one, and moving up to a dilator with the same diameter as her partner’s penis. This allows the woman to feel secure that her vagina is “capable” of allowing something inside it.
Several things can be used to assist in these exercises: lubricants, for one, as well as water- or oil-based moisturizers that can be purchased at any drugstore. Sometimes a local anesthetic is used for the exercises, when the woman is afraid of pain.
And what about women who are embarrassed?
Women who suffer from pain during sex or fear of vaginal penetration are advised not to continue with penetration. Bruner is quite definitive on this:
“You do not go in if it hurts," she says. "This is rule no. 1, since sex with vaginismus will only exacerbate the ever-worsening spasm until it is difficult to relax it.”
In the meatime, she recommends, try to get to know your vagina, and try the vaginal dilator exercises step by step, using moisturizer. If all else fails, see a sex therapist.
“We won’t touch you,” Bruner says, “Don’t be afraid. The longer you wait, the longer the treatment will take, and the lower will be the chances for success. The sooner you visit the sex therapist, even if the treatment is only talk therapy, the greater the chances for success.”
