Vaginismus is a condition that causes pain at the time of sexual intercourse. It is a problem that affects 3% to 5% of the female population .
Often caused by fear and excessive stress, vaginismus is a condition in which involuntary muscle spasm prevents vaginal penetration. This usually results in pain and discomfort for women at the time of intercourse.
It often begins when sexual intercourse is attempted for the first time, with an underlying (unreal) fear that penetration may hurt. It can make it painful, difficult or practically impossible to have sex, have a gynecological exam and insert a tampon.
When a woman tries to insert an object, such as a tampon or even the penis into the vagina, an involuntary contraction of the pelvic floor muscles occurs. This leads to generalized muscle spasms, pain and even temporary interruption of breathing.
The muscle group most commonly affected is the pubiococcygeus, a muscle found in both sexes, which extends from the pubic bone to the coccyx and which forms the floor of the pelvic cavity, supporting the pelvic organs. These muscles are responsible for urination, sexual intercourse, orgasm , bowel movements and childbirth .
Without treatment, it can lead to frustration and distress , and it can get worse. However, treatment is possible.
Risk factors
Risk factors include a history of sexual assault, endometriosis, vaginitis or previous episiotomy. The diagnosis is based on symptoms and clinical examination. It requires that there be no anatomical or physical problems and a desire for penetration on the part of the woman.
Quick facts about vaginismus
- There are different forms of vaginismus and the symptoms vary between individuals;
- The pain can vary from mild to severe and can cause different sensations;
- Vaginismus can result from emotional factors, medical factors or both;
- Surgery is generally not indicated;
- Botulinum toxin is being studied;
- About 0.5% of women worldwide are affected. The results are generally good with treatment;
- The treatment, which involves physical and psychological exercises , is usually effective.
Treatment may include cognitive behavioral therapy , such as gradual exposure therapy and gradual vaginal dilation.
Types of vaginismus
There are different types of vaginismus that can affect women at different ages.
Primary vaginismus
Vaginismus occurs when vaginal penetration cannot be experienced without pain. It is commonly found among teenagers and women in their twenties, as it is at this point that many girls and young women first try to use tampons, have penetrative sex or have a Pap test for the first time. Awareness of vaginismus may not happen until vaginal penetration is attempted. The reasons for the condition may be unknown.
Some of the main factors that can contribute to primary vaginismus include:
- a condition called vulvar vestibulitis syndrome or vulvodynia , more or less synonymous with focal vaginitis, a so-called subclinical inflammation, in which no pain is perceived until some form of penetration is attempted;
- urinary tract infections or vaginal yeast infections;
- sexual abuse, rape, other sexual assault or attempted sexual abuse or assault;
- having witnessed or become aware of the sexual or physical abuse of others, without being personally abused;
- domestic violence or similar conflict in the initial family environment;
- fear of pain associated with penetration, particularly the popular myth of hymen rupture on the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs;
- chronic pain conditions and pain avoidance behavior;
- any physically invasive trauma (not necessarily involving or even close to the genitals);
- generalized anxiety ;
- stress ;
- negative emotional reactions to sexual stimulation, for example, feeling deliberate or more implicit disgust with intercourse;
- very conservative education, where sex is seen as taboo, can also provoke negative emotions.
Secondary vaginismus
Secondary vaginismus occurs when a person who has previously achieved penetration develops vaginismus. This may be due to physical causes, such as a yeast infection or trauma during childbirth , while in some cases it may be due to psychological causes, or a combination of causes.
The treatment for secondary vaginismus is the same as for primary vaginismus, although in such cases, previous experience with successful penetration may assist in faster resolution of the condition. Vaginismus in menopause and pre-menopause, usually due to dryness of the vulvar and vaginal tissues, as a result of reduced estrogen, can occur as a result of “micro-ruptures” causing sexual pain first and leading to vaginismus.
Other factors that can contribute to secondary or primary vaginismus include:
- Fear of losing control;
- Do not trust your partner;
- Self-awareness about body image;
- History of sexual abuse, rape, sexual assault or attempted abuse or sexual assault;
- Misconceptions about sex or unattainable patterns for sex from exaggerated sexual materials, such as pornography or abstinence;
- Fear that the vagina is not wide or deep enough;
- Fear of the partner’s penis being too big;
- Undiscovered or denied sexuality.
Symptoms of Vaginismus
Symptoms vary between individuals. They may include:
- Dyspareunia (painful sexual intercourse), with a feeling of tightness and pain that may be burning or stinging;
- Difficulty penetrating during sex;
- Long-term sexual pain with or without a known cause;
- Pain when inserting a tampon;
- Pain during a gynecological examination;
- Generalized muscle spasm or interruption of breathing during attempted intercourse.
The pain can vary from mild to severe in nature and from discomfort to a burning sensation.
Vaginismus does not prevent people from becoming sexually aroused, but they may be anxious about sexual intercourse, so they try to avoid sex or vaginal penetration.
During a gynecological examination, for example, a woman with a more severe degree of vaginismus may experience a visceral reaction, such as sweating, hyperventilation, palpitations, tremors, tremors, nausea, vomiting, loss of consciousness, the desire to jump off the table or attack the doctor .
Causes
Vaginismus is a condition that can be caused by physical stressors, emotional stressors, or both. It can become anticipatory, so that the signs appear because the person expects it to happen.
Emotional triggers
These include:
- fear, for example, of pain or pregnancy ;
- anxiety , about performance or 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 representation of sex while growing up or exposure to sexual images.
Physical triggers
These include:
- infection, such as urinary tract infection or yeast infection
- health conditions like cancer or lichenoid sclerosis
- delivery
- menopause
- pelvic surgery
- inadequate or insufficient preliminary
- insufficient vaginal lubrication
- medication side effects
Sexual problems can affect men and women. They are nobody’s fault, and they are nothing to be ashamed of. In most cases, treatment can help and it is recommended to seek help and guidance from a sexologist.
Treatment
To diagnose vaginismus, the doctor will have a medical history and do a pelvic exam. Treatment may involve different specialists, such as a urologist, psychologist or sexologist depending on the cause.
Any possible underlying cause, such as an infection, may need to be ruled out or treated first, before focusing on vaginismus.
The goal of treatment will be to reduce automatic tightening of muscles and fear of pain, and to deal with any other type of fear that may be related to the problem.
Treatment usually includes a combination of the following:
Pelvic floor control exercises: include muscle contraction and relaxation activities, or Kegel exercises, to improve control of the pelvic floor muscles.
Education and counseling: Providing information about sexual anatomy and the sexual response cycle can help an individual understand his pain and the processes his body is going through.
Psychotherapy: This can help the person to identify, express and resolve any emotional factors that may be contributing to their vaginismus. Currently it is also possible to chat with a sexologist online , where you can talk about your issues in a safe and private way, from a place where it is most comfortable for you. Sites like Vittude can help you make that choice with a lot of assertiveness.
Exercises to reduce sensitivity to penetration
The woman will be encouraged to touch the area as close as possible to the vaginal opening every day, without causing pain, approaching each day. When she is able to touch the area around the vagina, she will be encouraged to touch and open her vaginal lips or lips. The next step is to insert a finger.
Insertion or dilation training: Since a woman can do this without pain, she will learn to use a silicone dilator or a cone-shaped insert. If she can insert it without pain, the next step is to leave it for 10 to 15 minutes, to allow the muscles to get used to the pressure. Then she can use a larger insert and then she can teach her partner how to apply the insert.
When the woman is comfortable with this, she can allow her partner to place the penis close to the vagina, but not inside it. When she is completely comfortable with it, the couple will be able to try intercourse again. They may want to build gradually for this, as with insertion.
The time it takes for vaginismus to be successfully treated will depend on the individual.
It is very rare that vaginismus needs surgery.
Anyone who is concerned about symptoms related to vaginismus should speak to their doctor for evaluation.
