Sunday, March 31, 2013

The Vicious Cycle of Vaginismus

Over the last few months I've been talking about dyspareunia, or pain with intercourse, and the conditions associated with it. Dyspareunia is what I call an umbrella term or diagnosis, in that it is very general and doesn't tell us why someone is having pain with intercourse.  Today I'm going to discuss a type of dyspareunia that explores why the pain is occurring.

Vaginismus is a condition where the pelvic floor muscles involuntarily contract in response to any type of penetration. This is not under a woman's control and is a reflexive response to something being inserted into the vagina, whether that be with intercourse, inserting a tampon, or speculum insertion with a gynecological exam. When attempting intercourse, penetration can be extremely painful or even impossible. Some women
or their partners report it is like "hitting a wall."

There are two different types of vaginismus, primary and secondary. Primary vaginismus is when a woman has never been able to have intercourse without pain. Many times this is diagnosed in young women when they first attempt to have sex or with their first gynecological exam. Unfortunately many young women that I have treated have experienced years of painful intercourse because they were not diagnosed with vaginismus until much later in life and they just thought that pain was a part of sex.

Secondary vaginismus occurs later in a woman's life and often occurs after many years of pleasurable sex, which makes it that much more frustrating. This type of vaginismus can occur due to hormonal changes due to menopause, child-birth, surgery or a traumatic event.

Many factors can contribute to vaginismus including physical and non-physical factors. Physical factors can include trauma or abuse, hormone changes, infection, child birth, infections, inadequate lubrication and medications. Non-physical factors include stress, anxiety, fear associated with sex, religious beliefs or teachings regarding sex, or emotional issues with a sexual partner.

Unfortunately one of the challenges with vaginismus is that a history of pain with intercourse leads the body to anticipate pain with penetration and cause the pelvic floor muscles to contract as a protective response. This leads to more pain with penetration, which reinforces this reflex. The diagram below shows what a vicious cycle this can be.
Cycle of Pain - courtesy of
Fortunately vaginismus is very treatable. If you are having pain with intercourse, talk to your doctor about pelvic floor physical therapy. A pelvic floor physical therapist can perform manual techniques to decrease pelvic floor muscle tension and teach you how to relax your pelvic floor muscles. Physical therapy, in combination with a dilator program which further gives you practice in relaxing your muscles with penetration, is the best way to tackle the issue of vaginismus.  It may also be appropriate to work with a mental health counselor to work through any emotional issues that could be contributing to your symptoms.

There is also a great book out there called Completely Overcome Vaginismus that is a fantastic tool for women dealing with this issue.

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