One of the “perks” of being a doctor is that your friends are more likely to come to you with their most intimate health related worries. So, sometime last year, I was approached by one of my friends with a rather distressing problem. After dating her partner for almost 8 years, during which they both agreed to abstain from sex, they had recently gotten married. Now that they finally had the blessing to go ahead, it was time to consummate things. On attempted sexual intercourse however, she experienced such severe pain that her partner was unable to successfully achieve penetration.
Having looked forward to this event for some time, she was quite disappointed and mildly distressed and this was further compounded by a feeling that she had somehow let her partner down. I started by reassuring her that she was not a disappointment and nothing was wrong with her. Then I suggested she do a google search for “vaginismus” and see if the symptoms sounded familiar to her. They did.
Vaginismus
is a condition that happens when the muscles at the opening of the vagina tense up. This usually happens in response to any attempt to insert anything into the vagina. This includes a penis, tampon, medical device and even a finger. Some women may experience this when they first start engaging in sexual activity, while some may suddenly start to experience this after years of having successful vaginal sex.
What causes this is not known, but there are a few factors that may lead to some women experiencing this condition. Some of them include:
Sociocultural factors:
Many women are socialized both religiously and culturally to think of sex as wrong/sinful and something to avoid. This can sometimes have a major psychological impact which may translate into difficulty with penetrative sexual activity.
Gynecologic issues:
Conditions such as endometriosis can cause pain during sexual intercourse. Other conditions such as scar tissue from previous pelvic surgery, infections, and in older women; menopause and pelvic floor support problems, can also cause pain on attempted penetration of the vagina.
History of Trauma:
Women who have experienced some forms of sexual trauma may develop anxiety about anything related to their vagina. Trauma in this respect can range from genital mutilation to rape and everything in between. Sometimes healthcare professionals may also cause trauma without meaning to while carrying out a medical examination and this can have the same effect on a woman.
Women who have vaginismus can still experience arousal and desire and even orgasm, as long as vaginal penetration is not attempted. However, many women desire to experience penetrative vaginal sex, especially those who would like to get pregnant and for this reason, it can feel quite distressing when pain is getting in the way.
Thankfully, there is help for women with this condition.
The first step is to see a doctor. The doctor would take a detailed history and possibly perform some examinations to make sure there is no medical problem causing the pain or muscle tightening. There is no specific test for vaginismus. Once any medical problems have been excluded, the doctor might refer you to a sex therapist.
Sex therapists are professionals with special expertise in helping individuals and couples address sexual problems by providing information, improving communication, and giving instruction in specific exercises to improve intimacy and mutual pleasure.
In women who a medical problem has been excluded, most of the work involves
Some women also benefit from Pelvic floor physical therapy (PT). This can significantly decrease discomfort associated with involuntary tightening of pelvic floor muscles. Physical therapists who perform this type of PT are specially trained in pelvic manipulation and rehabilitation.
For older women who start to experience vaginismus, vaginal estrogen can help. This treatment can help if you have dryness or thinning of the tissues near the vagina, which is usually associated with menopause. Vaginal estrogen comes in creams, tablets, or a flexible ring.
After my friend shared her dilemma with me, I ordered her a set of dilators. A dilator is a plastic or silicone rod or cylinder with a rounded end that is inserted into the vagina to help stretch the tissues. A dilator can come in many sizes, but they’re often about 4 inches long and vary in width. They often come in kits that include a range of dilators at different widths, from very narrow to thick.
Inserting it can also help train people to relax or strengthen their pelvic floor muscles.
These can help you get used to having something in the vagina. A well-lubricated dilator of the appropriate size is placed into the vagina several times for approximately five minutes daily.
The idea is to gradually increase the size of the dilator depending on your comfort level. It is advisable to use numbing lubricant to make things go smoothly.
I am pleased to report that after some counseling sessions and using the dilators, my friend managed to achieve penetrative sex a few months after we first spoke about her dilemma and is now expecting her first baby in the coming weeks.
If your vaginal muscles seem to be determined to keep you from fulfilling your desires, speak up and get help.