When sex hurts: What is vaginismus and how can it be cured
Problems in the sexual sphere can be justified as physical diseases, and features of the psyche, as well as the consequences of various injuries and shocks. The situation is complicated by the fact that people are often embarrassed to talk about such concerns, and more often they simply do not know which specialist to turn to. One of these conditions is vaginismus, that is, a contraction of the vaginal muscles that blocks penetration. We talked about vaginism with experts - the head of the gynecological department of the ATE clinic Oksana Bogdashevskaya and the sexologist and psychotherapist of the Mental Health Center clinic Amina Nazaralieva.
Fear of penetration
Vaginismus is a state of tension in which penetration into the vagina becomes impossible. It is important to understand that we are talking about a reflex reaction, which is difficult to track and even more so to control. Vaginismus can be accompanied by a feeling of fear, tension in the muscles of the pelvic floor, painful sensations in the area of the vulva when trying to penetrate. At the same time, often the manifestation of vaginism does not at all mean unwillingness to have sex or lack of arousal - it is precisely penetration that causes fear. There are different degrees of severity of such a syndrome: if in the most difficult cases no penetration is possible - a woman cannot even insert her own finger into the vagina, then in other situations she can only react painfully to one type of penetration.
Women cured of vaginism and told about it in Cosmopolitan and Jezebel, admitted that they wanted sex, but could not control the reactions of their own body. The heroine of one of the publications faced with vaginism after a long struggle with the psychological consequences of rape. "I was raped when I was a student, and now my body does not allow me to have sex," she said. “Honestly, I could never even insert a tampon - I think I don’t know where the entrance is, and I don’t think that anything can penetrate there; pain scares me,” the post’s heroine on the Israeli website says sexologist Tilly Rosenbaum.
"I remember that one time in high school, when I tried to use a tampon. I took one of my mom's boxes, sat down on the toilet and tried to put it inside. Nothing happened. I remember how unpleasant it was, and it seemed that everything was very strong I didn’t understand what was the matter, and I felt pretty stupid - which girl of me, if I don’t even know how to insert a tampon? Since then I have only used pads, ”writes the author Feministing.
Vicious circle
According to Amina Nazaralieva, who helps couples suffering from vaginism, in some cases, painful sensations can appear from the very thought of penetration. She notes that women describe it as a sharp pain or burning sensation in the area of the entrance to the vagina or inside it. These sensations cause a kind of “block” that prevents penetration, and it seems to them that they are abnormal from the anatomical point of view, that the vagina is too small and narrow, that the penis “does not fit”. These thoughts make them feel ashamed and feel inferior, disgust at the genitals.
As Oksana Bogdashevskaya notes, gynecologists most often encounter manifestations of vaginism when trying to examine a patient in a gynecological chair. In severe cases, inspection becomes almost impossible, and attempts to get at least some information to solve the patient's problem can significantly aggravate the manifestations of vaginismus and transform the problem from difficult to unresolved.
The manifestation of vaginismus does not mean unwillingness to have sex or lack of arousal - it is the penetration that causes fear
Among researchers, there is still no consensus about what exactly causes vaginismus. Traditionally, it was explained by psychological reasons, such as conservative religious upbringing, lack of premarital sexual experience, negative attitudes associated with sex, ignorance, and lack of sexual education. Other hypotheses explain vaginismus by dysfunctional relationships within a couple, sexual and physical abuse, or trauma. Unfortunately, vaginismus is poorly researched, and there is not enough evidence in favor of one or another reason, according to Amina Nazaralieva.
The problem is often aggravated by the vicious circle of its mechanisms: the girl anxiously awaits penetration, which she fears terribly, associating with terrible pain. During the first attempt at penetration in life, we most often talk about the insertion of a tampon, the pelvic floor muscles involuntarily contract and, if these attempts continue, real pain occurs against the background of muscular tension. Of course, this increases the alarm of waiting for the next penetration. As a result, avoiding or guarding behavior, catastrophisation in thoughts and muscle tension are formed; anxiety and anticipation of pain intensify, and a vicious circle arises.
Who can help
In patriarchal countries, vaginismus is a more frequent complaint than in sexually liberated societies. However, the true scale of this problem is difficult to assess: according to various estimates, from 0.49 to 10% of women suffer from vaginism. It is difficult to accurately determine the prevalence of vaginism, not least because it is a taboo problem, and many patients are embarrassed to discuss it with a doctor.
True psychogenic vaginism differs from the fear and avoidance of penetration resulting from gynecological diseases - for example, postpartum injuries or infections that make penetration painful. Vaginism related to psychological problems requires an interdisciplinary approach, and gynecologists deal with its treatment in conjunction with psychotherapists. “In our clinic, there are up to ten such patients a year,” says Oksana Bogdashevskaya, “while we don’t treat true vaginism, we help only those with penetration pain associated with other gynecological pathologies. We send patients with real vaginism to other professionals. "
At the initial stage of therapy, it is important for a specialist to understand what thoughts a woman attends before, during and after the penetration attempt: what she thinks about herself, about her illness, about the attitude of men towards her, about her partner. This is important in the work of the psychotherapist, since evaluations and thoughts affect emotions and body reactions, leading to appropriate behavior. For example, catastrophic thoughts are accompanied by fear, which can both lead to avoiding dangerous situations and also cause reflexive contraction of muscles. But the more a person avoids what makes him fear, the more he fears, because the brain is not able to make sure that in fact it is not so dangerous.
How to treat vaginismus
Currently, there are several methods for treating vaginism: for example, since the 1970s, vaginism has been treated with the help of a paired behavioral-oriented sex therapy. Most often, in such a treatment, dilators are used - a set of plastic nozzles of various sizes, resembling dildos, which should gradually wean the woman to fear penetration into the vagina.
As Nazaralieva notes, the most effective method is considered to be a gradual exposure (exposure) - an approach traditionally used in behavioral therapy of various kinds of phobias. As part of this method, the patient is asked to build a hierarchy of fears associated with penetration. This is a scale from 0 to 100, where 0 is not at all scary, and 100 is the worst thing that can be. For example, the introduction of your little finger can be scary for 20 points, a tampon for 30, the introduction of a husband's finger - 40, the introduction of two fingers - 60, the movement of two fingers introduced - 70, the introduction of a dildo - 90 points.
The more a person avoids that which causes him fear, the more he fears. The brain is not able to make sure that in fact it is not so dangerous
Partners are asked to measure the diameter of its erect member in order to be guided by this figure when selecting expanders. Then spend 1-3 sessions in the office, equipped with a gynecological chair, with a duration of 150 minutes. During these classes, the woman consistently passes the scale from 0 to the maximum possible (ideally 100). Then she gets homework - to train the same at home with a partner. Special extenders, from very small to very large, can be purchased at the clinic or online to practice at home on your own.
There are other methods of treatment, including the introduction of Botox into the muscles surrounding the vagina, pelvic floor physiotherapy. All these methods are aimed at achieving one goal: to give women the opportunity to engage in penetrating sex. This is not about getting an orgasm or pleasure - these goals are achieved in other ways. According to the sexologist, some of her patients have a positive attitude towards sex from the very beginning and derive pleasure from it both before and after the treatment of vaginism. For others, sex is not associated with pleasure, and is only important for the preservation of the family and procreation. Still, attitudes towards sex are not directly related to vaginismus and will not necessarily change with a cure for this ailment.
Photo: irisoff - stock.adobe.com, antonel - stock.adobe.com
