Vaginismus
Vaginismus is an involuntary contraction, or reflex muscle
tightening, of the pelvic floor muscles that generally occurs
when an attempt is made to insert an object (tampon, penis,
speculum used for a Pap test) into the vagina. This muscle
tightening causes pain, which can range from mild discomfort
to severe burning and aching. Vaginismus may be primary
(i.e. lifelong), or secondary (occurring after a period
of normal sexual function). It may also be global (occurs
in all situations and with any object) or situational (may
only occur in certain situations, such as with one partner
but not others, or with sexual intercourse but not with
tampons or pelvic exams or vice versa).
Women with vaginismus often think that they’re “too
small” and that their vagina needs to be stretched.
Just imagining this is painful! The truth is that women
with vaginismus don’t need to “stretch”
anything; they need to learn to control the muscles around
the vagina. This can be done with exercises.
How do I know if the pain I have with intercourse is vaginismus?
Your doctor should be able to answer that after he or she
has asked you a few questions and examined you. The pain
with vaginismus occurs only with penetration. It starts
as soon as the partner attempts to insert his penis and
usually, but not always, goes away after he withdraws. The
pain is often burning or tearing. Women may describe it
as “It feels like he’s hitting a wall”,
“It feels like he’s too big for me” or
“I feel like I’m being torn”. The pain
may or may not improve as sexual intercourse progresses,
and there may be times when the pain is not as bad. Women
with vaginismus often, but not always, also have discomfort
when inserting tampons or having an internal exam.
Is the pain all in my head?
Vaginismus is a learned reflex. A useful way to look at it
is to compare it to getting a finger in our eye. We’ve
all been poked in the eye at some time in our life and if
we see a finger or other object approaching our eyes, we shut
them automatically. In the same way, a woman with vaginismus
has had an experience of painful intercourse (or other object
in the vagina). Later on when she or someone else tries to
insert an object in the vagina, the vagina “shuts”
to protect itself from pain without the woman even being conscious
of it. The muscle spasm is what causes the pain and that is
definitely real.
How common is vaginismus?
Vaginismus is a much more common problem than you may realize.
Women with vaginismus tend to be very embarrassed about
it and not mention it to anyone. That is too bad because
it is a lot easier to treat vaginismus if it has only been
going on for a few months than it is if it has been going
on for several years. Many women have mild degrees of it
at some point in their lives. Vaginismus can vary from mild
discomfort with intercourse to the man being unable to enter
because of pain and spasm. There are many couples who have
been together for years but have never had intercourse because
of vaginismus. They may even have had children by means
of a “splash pregnancy” (the man ejaculates
near the vaginal opening and sperm make their way up the
vagina). Many women with vaginismus have very active sex
lives; they just don’t have intercourse. Sometimes
a couple is happy with the way things are and would rather
not try to change things; if you and your partner both agree
- that is perfectly fine.
What can I do if I have vaginismus?
The good news is that there is a cure for vaginismus; it simply
involves learning how to control and relax the muscles that
are tightening involuntarily. The bad news is that this does
not happen overnight and requires you to do “exercises”
for several weeks to several months. How long it takes for
the exercises to work depends on how faithful you are in doing
them and also on how long the vaginismus has been a problem.
During the time period that you are doing the exercises, you
should avoid intercourse. It may be hard to explain to your
partner that you won’t be having intercourse for several
weeks and possibly several months. However, every time you
have painful intercourse, you are reinforcing the reflex and
it will take that much longer to get rid of it. You can still
do all the other things that give you and your partner pleasure
including touching each other, oral sex, etc., just not intercourse.
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How exactly do I do these exercises?
Start by doing Kegel exercises. If you have had a baby, you
probably learned to do Kegels in prenatal class. These involve
tightening the muscles of the pelvic floor - the same muscles
you would contract if you were on the toilet urinating and wanted
to stop the flow of urine. You should contract your muscles,
hold for a couple of seconds, then relax. Initially, you can
do the exercises on the toilet to make sure that you are contracting
your pelvic floor muscles and not your abdominal muscles instead;
however, as soon as you are certain that you are doing them
correctly, you should no longer do them on the toilet but whenever
you think about it during the day. Each time you do them, do
about 20 contractions. You can do these while talking on the
phone, watching television, etc. Don’t forget to relax
the muscles for a few seconds after each contraction.
After a few days you should try doing the exercises with fingers
in your vagina, starting with one finger and working your way
up to three. It is a good idea to cut your fingernails and to
use a lubricant such as Astroglide. The fingers must be inserted
to a depth of at least 5 to 6 cm or to the level of the first
joint after your knuckle. We ask you to do this for several
reasons: you can feel your pelvic floor muscles contract and
relax around your fingers so that you can be sure you are contracting
and relaxing the right muscle. It also helps you get used to
having something in your vagina. Why fingers? They are the easiest
object to remove if it starts to hurt and they don’t cost
anything. Women will sometimes wonder if they can use their
partner’s fingers instead; this is generally not a good
idea since you have less control if you use your partner’s
fingers than if you use your own.
You also want to avoid associating your partner with pain. Many
women like to do the exercises in the bathtub where water acts
as a natural lubricant. You should do the exercises daily if
possible. Don’t get discouraged if some days you can’t
insert as many fingers as others; this is normal. If you find
that you can’t get your fingers in far enough, try doing
the Kegels; as you relax the muscles you should be able to get
the fingers in a little bit further.
How long do I have to do the exercises before I can try to have
sexual intercourse again?
The time it takes to get to three fingers varies from weeks
to months, depending on the duration of the problem and on how
faithfully you do the exercises. When you can insert three fingers
without pain a few times, then it is time to try intercourse.
The first few times you try intercourse you should be on top
so that you have total control and lubricants should be used.
You can try pushing out as if you were having a bowel movement
as you insert your partner’s penis. This is because you
can’t push out and contract your muscles at the same time.
If it hurts, you should stop, contract your pelvic floor muscles,
then relax. It is not a bad idea to just lie still with your
partner’s penis in your vagina the first few times, with
no movement. When that is successful, the next couple of times
you only should move, so that you have total control over the
situation. (It’s a good idea to discuss this with your
partner beforehand). If that doesn’t hurt, then the next
time you can do whatever you wish. If you find you just can’t
have intercourse the first time you try, don’t panic.
Just go back to the fingers for a few days, then try again.
What are the chances that these exercises will work for me?
These exercises, though they may seem very simple, are successful
more than 90% of the time, as long as there is no history of
sexual trauma. Obviously, if you are suffering from flashbacks
or nightmares as a result of sexual assault or abuse, these
issues also have to be dealt with. The exercises also won’t
work if you have physical problems causing pain such as an infection
or inflammation of the vulvar glands. Usually, though, when
the exercises “don’t work” the problem is
that the woman hasn’t done them for some reason or other.
If you just can’t seem to make yourself do these exercises,
you should discuss it with your doctor. He or she may have some
suggestions or may be able to refer you to someone who can help.
Suggested Reading:
One very good book on sexuality in general is Woman’s
Experience of Sex by Sheila Kitzinger. Ms. Kitzinger is a nurse/midwife
and the mother of five daughters. This is a great book overall
and it has a good section on vaginismus. Another good book is
A Woman’s Guide to Overcoming Sexual Fear and Pain by
Goodwin and Agronin. New Harbinger Publications, Inc. (1997) |
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