"Vaginismus" A Psychological Condition That Affects Womens Sexuality. Are You Aware of it?

A woman's virginity has long been a cultural fixation. From abstinence pledges and purity balls – wherein teenage girls promise their Evangelical fathers they'll remain virgins until marriage – to the abject quackery that suggests virginity causes cancer, many people are quick to take sides in the imaginary moral war.

But I am quick to dismiss any discussion of morality, as I often find myself counselling some of the unwitting casualties.

While saving oneself for marriage is a personal choice, there is an unexpected condition that can affect some women who are waiting for Mr Right – vaginismus.

Vaginismus is not due to a physical abnormality. Some women wonder if their vagina is too small or they have no vaginal opening at all and that is the reason why sex is so difficult. But in most cases the vagina is perfectly normal and would be capable of intercourse without pain, if the pelvic floor muscles could be relaxed.

Described as an involuntary contraction of the muscles surrounding the entrance to the vagina, it can make penetration either painful or impossible and cause much distress to the individual.

Women who suffer from vaginismus find that attempts at sexual intercourse are very painful or unsuccessful. This involuntary contraction of the muscles surrounding the entrance to the vagina, makes the muscles around the vagina shut down and prevents her partner from penetrating, it feels like he has hit a brick wall.

Thought to affect at least 2 to 4 per cent of  women generally, it's more common among women who are saving themselves for marriage. It is also commonly seen in women, who due to religious or cultural reasons, have developed an overriding fear of penetrative sex.

To suggest that if you wanted to remain a virgin you are going to end up with vaginismus wouldn't be right. 

It's mainly the fear of sexual intercourse.

It can and does effect women brought up in restrictive religious environments who can develop unhealthy attitudes toward sex.

Any sex before marriage is considered dirty, filthy, mortal sin, etcetera. But in marriage it is beautiful, it's God's gift.

And women believe this stuff, they believe that sex is grubby on the morning of their wedding day, but by evening the earth will move and fireworks will go off.

Which rarely happens!

More serious than a lacklustre sexual experience, women who suffer from vaginismus often feel confused and inadequate, which only compounds the disorder's psychological underpinning.

This is the most extreme sexual problem because they're not having no orgasm with sex or whatever, they're not having sex. 

It's a devastating problem. 

And many of these women will say, 'What did I save myself for?'" 

As this often will be experienced on, or after, the wedding night one can imagine how distressing this is for a couple who just can't understand what is happening to them. They waited so long and now sex is impossible and they are not able to consummate their marriage. Also the women often believe it is their fault and blame themselves or their partner who will then feel frustrated, rejected or inadequate.

It is also such a taboo topic that they often are too embarrassed to discuss the issue with their family or friends and suffer in silence. Some couples take years before they finally look for help.

While a religious upbringing is a common thread found in many cases, it's not the only link. Women subjected to sexual abuse can develop similar problems, as can individuals who have developed a fear of childbirth.

Some women have a fear of childbirth, primarily due to the pain. I've seen women come to see me whose mothers have died giving birth to them. Think about that algorithm: sex, pregnancy, childbirth, death. You've got the devil's job in psychotherapy to get them away from this notion of sex and death.

Though the issue is common, many women are reluctant to seek treatment and those that do are often steered in the wrong direction by doctors who aren't educated on the subject.

I know of some women who have been misdiagnosed by unskilled or unscrupulous physicians who suggest they undergo a hymenectomy - or Fenton's procedure – to widen the entrance to the vagina. 

I also suggests that some specialists are even partially responsible for it in the first place, citing how a heavy-handed bedside manner can lead to long-lasting insecurities.

If someone says during a vaginal examination, "Oh, gee, you're small down here. You're going to have trouble down here when you want to have babies," some women store that away and talk themselves into it." 

Not the best way to assure a woman who already has difficulties with her self esteem and mental well-being!

The condition is treatable. 

The first step towards treating the problem, is to help an individual become more knowledgeable and comfortable about her own body. 

While many of my more religious clients are intelligent and educated they're not always so well informed when it comes to their own bodies.

Vaginismus is reasonably easy to overcome the more they understand.

I suggest that they get a mirror and look at their vagina because many of these women have never seen it before ... I treat by counselling, education, anxiety reduction, pelvic floor exercises and retraining of pelvic floor muscles. It may take some months of physiotherapy sessions and practice at home but the success rate of therapy is very high when individuals and couples commit to treatment.

One of my previous counselling clients,  a 21-year-old girl who comes from a strict religious back ground. Had previously visited her GP after she found out that it was impossible to have penetrative sex with her boyfriend. This GP, who obviously did not recognise the nature of her problem, referred the young woman to a gynaecologist. 

My client was devastated, the thought of having an operation on "that part" of her body made her petrified. 

We had a counselling session where I made her aware of the condition called  “vaginismus” and how it affects women and that the condition was fully treatable without the need of any surgery.

As it is a “psychological” condition and fully treatable

Needless to say she was greatly relieved and undertook a four month treatment program with me and was eventually able to enjoy full sexual intercourse with her boy friend. 

Please note here, I suggested that her boyfriend be involved in this process to which she agreed. 

Not only did he become educated about the condition she was suffering from, he was fully supportive of her and helped with my guidance, to overcome her fears of anxiety around penetrative sexual intercourse.

With the boyfriend being involved and him being supportive it helped build trust and deepen the intimacy in their relationship and the bond between them stronger and more loving.

Both sexually experienced and inexperienced women can develop vaginismus. 

Primary vaginismus occurs when a woman has never, at any time, been able to have pain-free intercourse. 

They often are unable to insert anything: the doctor's finger or speculum, when they need a Pap smear or vaginal examination; their own or partner's finger; or even a tampon.

Secondary vaginismus occurs when a woman who previously has enjoyed intercourse without pain, develops the condition later. 

It can be triggered by a traumatic experience like a difficult child birth, sexual assault or painful experiences with intercourse due to underlying conditions such endometriosis, pelvic or vaginal infections, low sexual arousal with lack of lubrication, menopausal dryness or other vulva conditions.

Vaginismus is treated by counselling, education, anxiety reduction, pelvic floor exercises and retraining of the pelvic floor muscles. 

Psycho sexual education is important as it is essential that the woman gains knowledge of her sexual anatomy. Women who suffer from vaginismus are often raised in moral or religious homes, schools or institutions and, after a childhood of anti-sexual messages, it can be very difficult to face sexual interaction and accept sexual pleasure, even within a loving relationship.

Through counselling by an experienced sex therapist, the sufferer is able to free herself of the negative moral understandings that contribute to her condition. Post counselling I refer my clients to an experienced pelvic floor physiotherapist who specialises in this area. The treatment of vaginismus involves unlearning the fear-contraction reflex and learning to keep the pelvic floor muscles relaxed during intercourse.

Successful treatment does not require drugs, surgery or any complex invasive techniques. 

Some plastic surgeons have been injecting Botox, a procedure that none of my clients ever contemplated and, in my opinion, should be regarded as a last resort.

What can men do to help their wives/partners through vaginismus?

Men can help their partners in many ways through the process of successfully overcoming vaginismus.

When the trial of vaginismus hits, men often feel helpless, thinking “What can I do about it? 

Vaginismus, however, is not just a woman’s problem – it is a couple’s problem.

The truth is there are a number of things men can do to help. 

By becoming educated about the dynamics of vaginismus and being emotionally supportive of their partners, men can help their spouses to be more positive and proceed through treatment more quickly. 

The trial may be hard to endure, but it is not hopeless. Once the condition is diagnosed and treatment begins, success is the likely outcome.

Some of the ways men can help their partners include:

1. Being supportive – A supportive, loving relationship based on encouragement and mutual respect provides an excellent backdrop for a woman to work through the program. It can be physically and emotionally draining for women to walk through some of the steps alone. When men encourage and support their partners, it allows them to focus on the program instead of on immediate relationship concerns. Supportcan be paramount to a woman’s success. Men should consider simply asking their spouses how they would like them to be involved. By participating in and helping with the treatment, spouses have the opportunity to be part of something that draws them closer as a couple. It can be an incredible opportunity and feeling to be part of another’s healing process, especially when the other person is someone deeply cared for.

2. Walking the steps together – Men can help their spouses by walking together with them through each step of the treatment. Working through the steps together helps men fully understand the mechanics of treatment and aids them in understanding where their partners are both emotionally and physically. Helping their partners work through areas of fear and confusion heightens bonds of trust as couples get to know each other in more intimate ways going beyond intercourse. When men become educated about vaginismus themselves, they are able to talk to their partners knowledgeably and rationally. Men can help their partners stay motivated, focused and moving forward through emotional hurdles, stress and feelings of failure. Participating willingly and knowledgeably in those exercises that involve them directly also helps smooth the transition from painful intercourse or penetration problems.

3. Celebrating success – What may seem like a small step to men may actually be a huge victory to women going through treatment for vaginismus. Small gifts such as going out to dinner, buying a small present, writing a congratulation note, or giving a massage, etc. may help encourage women through the process. Celebrating and making each victory feel special will help spouses to view the process as being worth the challenge. When men are showing interest and positive excitement about progress it helps women stay motivated to continue moving forward.

4. Staying positive and patient – As men often await anxiously for their spouses to progress through steps, there is a tendency to project pressure and negativity which can play on their spouse’s feelings of stress and failure. Men should try to stay positive and patient in their attitude, maintaining a hopeful, balanced outlook. Being strong and steady, during periods where spouses feel weak or vulnerable, creates an assured environment that helps women to feel more confident and hopeful.

5. Continuing to be intimate – We urge couples to continue to share an intimate lifestyle even if intercourse is not possible yet (note that during early steps of the program intercourse should not attempted). Complete avoidance of sexual contact generally amplifies relational troubles and makes the problems worse. Without physical contact, feelings of fear, shame, guilt, or rejection tend to accumulate. 

6. Men can attempt to foster a continuous, viable sex life, temporarily without intercourse, by seeking alternative ways to give and accept pleasure with their spouses. One of the positive aspects of vaginismus for couples is learning to please each other in ways not previously considered. Sensual body touch and manual stimulation can reduce tension and form trust. While going through the early treatment steps, it is best to remove the pressure to perform penetrative intercourse from the sexual equation, however it is important to form intimate bonds through other sexual intimacy options.

7. Not becoming overly passive – There is a tendency for men with spouses facing vaginismus to become overly passive and to ‘bury’ their sexual nature and desires for intimacy. When attempts to consummate or develop sexual intimacy fail and cause their spouses ongoing anxiety or sadness, there is a natural tendency to bury these desires to avoid further anguish. If men become overly passive, they may not advocate for their own needs and if continued may allow their spouses to procrastinate on treatment and amplify relational problems. 

I recommend that men try to calmly, but firmly, encourage their spouses to move forward with treatment. Men need to advocate for themselves too, and insist for resolution of the sexual component for the relationship to function properly on a long-term basis. 

As vaginismus treatment is highly successful, it is unnecessary for men to take a position of life-long suffering and sacrifice. 

Sexless marriages generally weigh heavily on both partners and usually result in failed relationships and/or emotional damage if nothing is done to restore the sexual component and bring healing. For these reasons, we encourage men to take responsibility and continue gently advocating for restoration.

A Positive Future

Fortunately, vaginismus is a condition that has positive treatment solutions (as opposed to other debilitating conditions with few treatment options). Couples are elated at reaching treatment completion and pain and penetration problems are no longer an issue. For previously unconsummated couples, going from impossible intercourse to having full, pain free intercourse is a realistic, normal outcome.

Going through the trials of vaginismus can definitely test a relationship, but successfully going through treatment together can also strengthen it. Encouragement, love, patience, and communication can go a long way in helping to sustain relationships. By overcoming together, couples will be able to begin afresh in creating new and pleasurable sexual experiences and enjoy a strengthened relationship in the process.

I would like to make the public and the media aware of this condition as I realise that very few people know about it.

I also would like to hear from women who have had bad experiences.

Next time when you have an appointment with your GP or gynaecologist, ask them if they know what vaginismus is?

Unhappy Marriage? Try Sex Therapy

Sex provides a couple with pleasure, vulnerability and a deep, close connection that is very important to experience in an intimate partnership. 

It's also an important time-out and stress reliever from the mundane tasks and pressures of daily life. An unfulfilled sex life can become a big issue that can erode even the healthy parts of your marriage. 

If you or your partner is having sexual issues, it is best to deal with them directly, honestly -- and with the help of a professional.

Sex therapy is a specific type of therapy for couples and individuals that focuses on the sexual functioning of either the couple or an individual. 

When some couples deal with conflict and communication issues within their relationship, their sexual lives become more active and connected because of the increase in positive, loving feelings for their partner. 

Other couples, however, find that the real problem is not communication or conflict, but simply sexual dysfunction. These couples need a very direct approach, with concrete homework and an increased understanding of human sexuality.

Sex therapists have a much higher degree of knowledge than most about the physiological processes that are a part of human sexuality. 

In a very small number of cases, a separate "sexual surrogate" therapist may be needed, but most often, sex therapy is talk therapy with a cognitive-behavioral leaning, which can include homework assignments for one or both members of the couple.

So: How can sex therapy help you. 

Here's a short list:

People with sexual-identity issues.

Couples who want to increase sexual intimacy.

People who want to deal with sexual inhibitions.

People who are dissatisfied with their sexual functioning (i.e., they have erectile dysfunction or low libido, vaginismus).

Couples wanting to increase their communication about sexuality.

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