PAIN DURING SEX: VAGINISMUS

VAGINISMUS

SYNOPSIS

A woman may have pain during intercourse, or on insertion of a tampon or a clamp in the vagina. Such pain is often caused by a condition called Vaginismus. Pain can range from just discomfort to so severe that breathing may cease temporarily. A woman may not be able to have intercourse because of vaginismus and this can adversely affect her relationship with her partner.

The cause of vaginismus is not known. It can be physical or emotional or a combination of the two.

There is no definitive medical test to diagnose vaginismus. Diagnosis is based on medical history, gynecological examination and tests to rule out other causes of pain. The condition is rare. Physician may not therefore have adequate experience and misdiagnosis is possible.

Treatment is physical, doing Kegel exercises; or emotional by psychotherapist and sex counsellors; and, usually, both running concurrently.

Treatment success-rate is nearly one hundred percent. Results may take a few weeks to a few months to appear. Kegel exercises should be continued even after the treatment has succeeded.

Woman have satisfying sex life after a successful treatment.
So do not hesitate; do not delay; do not hold back. Speak to your partner; speak to your therapist. Speak now.

INTRODUCTION

A small number of women have pain during intercourse. Such pain is often because of vaginismus, also called vaginism. In this condition, insertion of a tampon, penis or speculum into the vagina causes the pelvic floor muscles to go into a spasm causing mild to severe pain that makes insertion difficult or impossible. The woman is thus unable to have intercourse, or undergo gynecological examination (Pap tests), and this can cause frustration and distress.
A recent study estimated vaginismus incidence at 5% to 47% in people complaining of sexual problems. The wide variation is because of cultural differences and society’s expectations of sexuality.

Different forms of vaginismus are:

• Primary vaginismus is a lifetime condition. But women discover it from the pain they have during their first vaginal penetration – using tampon, having sex, or Pap smear test.
• Secondary vaginismus happens at a later stage in life; before that, woman has no difficulty in having intercourse. It is caused by a specific life-event such as a yeast infection, childbirth, and other such events.
• Global vaginismus is always present, and any object will trigger it.
• Situational vaginismus occurs only in certain situations. It may happen during sex but not during gynecological exams or tampon insertion.

CAUSE 

Vaginismus is idiopathic – that is, its cause is unknown. It can be because of medical factors, or emotional factors, or a combination of the two. It is linked to anxiety and fear of having sex. It can be anticipatory: that is, happens because the person expects it to happen.

The medical/physical factors are:

• vulvar vestibulitis syndrome, a sub-clinical inflammation in which pain occurs only when penetration is attempted.
• urinary tract infections
• vaginal yeast infections
• health conditions, such as cancer or lichen sclerosis
• childbirth
• pelvic surgery
• medication side effects
• any physically invasive trauma (not necessarily involving or even near the genitals)
• vaginismus chronic pain conditions
• Peri-menopause and menopause which cause drying of the vulvar and vaginal tissues because of reduced estrogen. Intercourse may cause “micro-tears” that cause pain and may lead to vaginismus.
• inadequate foreplay
• insufficient vaginal lubrication
• sexual abuse, rape, other sexual assault, or attempted sexual abuse or assault
• development of a medical condition

Emotional factors are:

• generalized anxiety
• anxiety about performance or because of guilt
• Stress
• fear of pain associated with penetration and with the “breaking” of the hymen at the first intercourse, or fear of pregnancy
• harm-avoidance behaviour
• traumatic life events, including rape or a history of abuse, or of witnessing these without being personally abused.
• domestic violence or similar conflict in the early home environment
• negative emotional reaction towards sexual stimulation, e.g. disgust both at a deliberate level and also at a more implicit level
• strict conservative moral education, which can elicit negative emotions
• fear of vagina not being wide or deep enough, and/or fear of partner’s penis being too large
• undiscovered or denied sexuality
• relationship problems, for example, having an abusive partner or feelings of vulnerability
• psychological causes
• a combination of causes

SYMPTOMS

Pain or discomfort during intercourse, or on insertion of tampon or speculum into vagina, is the first sign of vaginismus.

The symptoms vary between individuals. The main symptoms are:
• discomfort that may diminish during intercourse
• minor pain
• burning or stinging pain and tightness that persist
• penetration being difficult or impossible, and extreme pain if entry is forced
• generalized muscle spasm or breathing cessation during attempted intercourse
• long-term sexual pain with or without a known cause
• pain during tampon insertion
• pain during a gynecological examination

Pain subsides on withdrawal, but not always.

Women with vaginismus can and do get sexually aroused. But they may become anxious about sexual intercourse, and therefore avoid sex or vaginal penetration.

DIAGNOSIS

There is no definitive medical test to diagnose vaginismus. The diagnosis is based on medical history, gynaecological check, and teste to rule out other medical conditions that may be causing the problem. It may therefore be necessary to consult several specialists before a reliable diagnosis is made. Misdiagnosis is possible. And often it may be left undiagnosed. This is especially true when the symptoms occur only during intercourse and not during other vaginal insertions.

Many women are hesitant or shy or embarrassed to discuss their sex disorder with physicians, especially male doctors. This is especially true in India. So it may be advisable to consult a female doctor.

TREATMENT

Vaginismus is a treatable condition. The success rate is nearly one hundred percent. Treatment does not require drugs, hypnosis, surgery or any other complex invasive technique.

The aim of treatment is to reduce the automatic tightening of the muscles; and to remove or reduce the fear of pain, or any other fear, related to that may be related to vaginismus.

Treatment is physical: to reduce the automatic tightening of the muscles; and emotional: to reduce the fears that may underlie the problem. Both treatments run concurrently.

Physical

Physical treatment is a combination of pelvic-floor control exercises, insertion or dilation training, pain elimination techniques, and transition steps. Treatment steps can often be completed – in cooperation with the therapist – in the privacy of home and at a pace that suits the patient.

Kegel exercises improve control of the pelvic floor muscles.
• To identify your pelvic floor muscles, stop urination in midstream. If you succeed, you’ve got the right muscles.
• If you have difficulty identifying the muscles, insert a vaginal cone in the vagina and use the floor-muscles to hold it in place. That will help you identify the muscles.
• Always empty the bladder before doing Kegel exercises.
• Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
• For best results, focus on tightening only your pelvic floor muscles. Do not flex the muscles in your abdomen, thighs or buttocks. Do not hold your breath during the exercise; breathe freely.
• Do at least three sets of 10 repetitions a day.
• You can do the exercises in any position, but it is easier to do them lying down at first.
• You can do Kegel exercises discreetly just about anytime,
• If you have trouble doing Kegel exercises, ask your therapist for help.
• Make Kegel exercises a permanent part of your daily routine.
• Results may take a few weeks to a few months to appear.

Insertion or dilation training begins by the woman touching an area as close as possible to the vagina without causing pain, and moving closer each day. Once she can do that, she should open the vaginal lips or labia. Next insert one finger, then two fingers, then three, and go progressively deeper without causing pain. Next she should learn to use the vaginal dilators (Hegar dilators), also called vaginal trainers, with the help of her therapist. She should insert a plastic dilator, or a cone shaped insert, and leave it in for about fifteen minutes. Next use a larger insert. Next her partner can put his penis next to vagina without entering. Once the woman is comfortable with it, the couple can try intercourse, building up progressively as in the case of insert. Use a lubricating jelly when practicing insertion.

Emotional

Emotional factors often underlie vaginitis. Education, counselling and psychotherapy therefore helps.

Psychological factors underlying vaginismus are fear of painful sex; the belief that sex is wrong or shameful (often the case with patients who had a strict religious upbringing); and traumatic early childhood experiences (not necessarily sexual in nature). Childhood sexual interference, and less positive attitudes about their sexuality, are other contributing factors. Lack of sexual knowledge or (non-sexual) physical abuse do not seem to be factors.

Education to make a woman understand her sexual anatomy and sexual response cycle – happenings during sexual arousal and intercourse and how parts of body work – helps her understand the pain and the processes her body goes through.

Emotional counselling by a counsellor specialized in sexual disorders helps the woman identify, express, and resolve any emotional factors that may be contributing to her vaginismus. Counsellor will teach relaxation techniques, and may use hypnosis, to help woman relax and feel more comfortable with intercourse. Joint counselling of the woman and her partner gives better results.

Pharmacologic

Experimental studies have shown that Botulinum toxin A (Botox) and lidocaine temporarily reduce the hypertonicity of the pelvic floor muscles. Anxiolytics and antidepressants have also been used along with psychotherapy modalities. But results from these types of pharmacologic therapies have not been consistent.

Treatment for primary and for secondary vaginismus is the same. But previous experience with successful penetration may result in a quicker resolution of secondary vaginismus.

Even after any underlying medical condition is corrected, pain may continue if the body has become conditioned to respond in this way.

Vaginismus may sometimes be mistaken for Dyspareunia in which painful intercourse is caused by a physical problem such as cysts, pelvic inflammatory disease, or vaginal atrophy. Vaginismus rarely requires surgery.

RELATIONSHIP

Sexual dysfunction like vaginismus adversely affects relationship and marriage. Therefore be proactive: discuss with your partner your feelings and fears about intercourse; and seek treatment at the earliest. Remember, treatment success rate is nearly one hundred percent; and most women recover and have a satisfying sexual life.
So do not hesitate; do not delay; do not hold back. Speak to your partner; speak to your therapist. Speak now.

REFERENCES:

1. Vaginismus: Cleveland Clinic
https://my.clevelandclinic.org/health/diseases/15723-vaginismus

2. Obstetrics and Gynecology at Baylor College of Medicine in Houston, Texas
https://www.bcm.edu › … › Care Centers › Obstetrics and Gynecology › Conditions

3. Vaginismus: NHS UK
https://www.nhs.uk/conditions/vaginismus/
4. Women’s Health: Sex & Intimacy – WebMD
https://www.webmd.com › Women’s Health › Guide

5. Medical News Today
https://www.medicalnewstoday.com/articles/175261.php

6. Vaginimus: Wikipedia
https://en.wikipedia.org/wiki/Vaginismus

7. What Is Vaginismus?
https://www.healthline.com/health/vaginismus

8. Vaginismus: Practo.com
https://www.practo.com/health-wiki/vaginismus-meaning-symptoms-and…/article

9. Health Direct
https://www.healthdirect.gov.au/vaginismus

10. Sexual Dysfunction in Women; MSD Manual
https://www.msdmanuals.com › … › Sexual Dysfunction in Women

11. Women’s Therapy Centre
https://www.womentc.com/conditions-and-treatments/penetration-pain…/vaginismus/

12. Vaginismus-diagnosis

13. Kegel-exercises: Healthline
https://www.healthline.com/health/kegel-exercises

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