Vaginismus Treatment - Funda Yazıcı Erol MD

What Is Vaginismus?

Vaginismus is the inability to have vaginal intercourse as a result of involuntary contraction of the vaginal muscles. The main reason for not being able to have intercourse is vaginal contractions.

In advanced vaginismus disease, contractions are not only limited to the vagina but also affect the whole body. Different approaches can be applied to treat vaginismus in these patients.

In vaginismus, the problem is not only experienced during intercourse. Suppository usage, tampon application, gynecological examination and touching to her genital area can initiate vaginal contractions.

Vaginismus Symptoms

The prevalence of vaginismus in the general population is higher than expected. In our country, vaginismus is seen in one of every 10 married couples. Some of the women live as unaware of this disease. Vaginismus is usually noticed on the first day of marriage. A woman cannot tell her family and friends that she cannot have intercourse because of feelings such as shame, sin and fear.

Symptoms of vaginismus disease include;

Inability to have vaginal intercourse on the coitarche or partial penis entry,
Excessive fear, excitement, anxiety, tremors, palpitations and sometimes fainting during intercourse,
Experiencing a panic attack-like situation during intercourse,
Intense aches and pains during intercourse,
The inability of the partner to provide vaginal penetration,
Pushing partner with hands, closing legs,
Inability to touch the genital area, a feeling of disgust
Nausea, vomiting during intercourse,
Inability to insert fingers into the vagina, inability to insert suppositories or tampons,
Not being able to have an gynecological examination,
Inability to perform transvaginal ultrasound,
Inability to take a smear test.

Causes of Vaginismus

%90 of vaginismus causes are psychological ones. 10% of the reasons are organic problems. Vaginismus usually occurs as a mutual result of many different causes.

The causes of vaginismus are;

Lack of sexual knowledge and education,
Familial life style, parental attitude,
Environment, society and cultural factors in which the person lives,
Incorrect information about the coitarche,
Incorrect information about the hymen,
Personality characteristics,
Sexual trauma,
Painful gynecological examinations and treatments,
Genital area problems.

Overbearing, domineering and overprotective childrearing can cause vaginismus. Growing up in a family environment that has insufficient knowledge about sexuality and consideration that sexuality is bad, shameful and sinful creates a negative perception against sexuality in women.

Girls want to protect themselves against sexuality as a result of these motives. This thoughts settle in subconscious day by day. Then the body reacts to this distortion and misperception via contraction of vaginal muscles in case of sexual intercourse.

Misinformation about the hymen, thoughts that there will be too much pain and a lot of bleeding initiate vaginal contractions. Women with vaginismus generally have high levels of anxiety. They may have similar fears and anxieties in the other areas except sexuality field . Other problems in the genital area can also contribute to vaginismus.

Septa in the hymen, congenital narrowing of the vagina, intravaginal septa, bartholin cyst, chronic infections, congenital genital anomalies, vaginal myomas and lesions of the external genitalia are organic causes for vaginismus disease. In these people, causal treatment is firstly performed.

Very rarely, vaginismus disease can be seen without any underlying cause. To determine the cause, gynecological examination must be performed. Because causal treatment in this disease is the most accurate approach.

How is Vaginismus Treated?

Vaginismus treatment is done with treatment methods based on suggestions, genital exercises and psychotherapy in which couples participate separately and together. According to the vaginismus stage of the woman, treatment is supported by various exercises and homework given by the doctor.

Vaginismus is a clinical spectrum. In the clinic, vaginismus is evaluated in 5 stages. At the root of vaginismus is a lack of sexual information. These couples definitely should give professional assistance.

One of the important points in the treatment of vaginismus is to start treatment as early as possible. Women with vaginismus often postpone treatment using some excuses. For this reason, vaginismus is known as 'procrastination disease'.

Diagnosis of Vaginismus

The most important symptom in diagnosing vaginismus is the inability to have vaginal intercourse. Gynecological examination, evaluation of the couple and taking a detailed history are sufficient for the diagnosis of vaginismus. The woman says that she experiences intense fear, anxiety and contraction during intercourse.

Female closes her legs, pushes her partner with her hands and feet. This symptoms finishs when sexual activity ends. This clinical course is not identical in every couple. While some of the couples have mild findings, others experience more severe findings.

Where is the pain in vaginismus?

The most important reason why a couple cannot have intercourse is the misconceptions that include of pain and hurt. If female experience painfully and negative vaginal intercourse before, it is saved to subconscious mind. In the next attemp, it may show itself in the form of vaginal contractions. Pain and pain-induced vaginal contractions actually create a vicious circle. Pain and soreness initiate vaginal contractions. Vaginal contractions launch pain and soreness as well. This cycle makes coitus impossible.

Mental Problems in Vaginismus Disease

If vaginismus is not treated, it becomes a disease accompanied by mental problems. The couple's inability to have vaginal intercourse in the long term creates a perception that the situation is unsolvable. On the one hand, the baby expectations of family and friends increases the stress that they are experiencing. Women with vaginismus may become depressed because of the negativity they experience during this long process.

Depression lead to participate less social activities and have a bad mood. Of course, vaginismus treatment shouldn't just be considered in terms of sexual function. Many problems experienced by the couple should be evaluated and solved together. Ignoring a depression makes the treatment process very difficult.

Is Vaginismus Treated with Hypnosis?

In the treatment of vaginismus, hypnosis may be performed in addition to therapies aimed for reducing fears and anxieties. As hypnosis is succesful, it is very important to believe and trust the this treatment approach. Hypnosis in the treatment of vaginismus is usually performed on stage 4-5 vaginismus patients.

Vaginismus Exercises

In the treatment of vaginismus, progressive exercises are performed in various ways to prevent vaginal contractions. Vaginismus exercises should be done under the supervision of a doctor. Wrong exercises cause the unpleasant consequences rather than benefit. One of the most important benefits of vaginismus exercises is that the woman can see and recognize her own genital area. This is very useful for relieving of fears and anxieties that emerge in coitus experience.

Vaginismus exercises include exercises that the woman performs herself or with her partner. Vaginismus exercises are done differently for each couple according to the stage of the disease. In other words, early stage vaginismus exercises and advanced vaginismus exercises are different from each other.

In the treatment of vaginismus, it is very essantial that a woman recognize her own genital area and touch to it. The certain anatomical information is given to patient and then want the patient to explore her genital area with a mirror. In the later stages, by touching the genital area, their fears and anxieties about sexuality are reduced.

Vaginismus exercises are based on finger and dilator exercises. Vaginismus finger exercises are vaginal penetrations performed with the finger in a relaxed, peaceful and calm atmosphere at home. These exercises are applied first by the patient herself and secondly by his husband in the process.

When performing vaginismus finger exercises, firstly a single finger entry can be applied and then double finger entry can be applied in the process. The aim is to provide vaginal entry with gradual exercises.

Vaginal penetrations are made with different sized finger-like instruments called dilators. The thickness of these instruments is varied according to the stage of vaginismus. As vaginismus treatment progresses, the transition is made from thin to thick dilators. As women and couples do the vaginismus exercises, their self-confidence improves. The fears and anxieties they feel during the vaginal intercours will decrease and disappear.

Kegel exercises are contraction and relaxation movements performed to strengthen the pelvic floor muscles in women. It is applied in the form of holding and releasing urine. In the treatment of vaginismus, these exercises are done to take under control the vaginal muscles.

Common characteristics of Women with Vaginismus

There are some mutual features seen in most of women with vaginismus. However, not all of these properties may be seen. These;

They are usually people who obey the rules, who think the worst outcome.
They are known as the favorite daughter of the family.
They have a childish personality.
Their emotional and spiritual development may be incomplete.
They show a dependent personality trait.
They may not have the self-expression skills
They may not be pleased with their bodies.
They perceive sexuality as dirty and bad.
They don't like their genitals and may even be disgusted.
Their sense of confidence may have been damaged.
They may perceive males as aggressive.
They may have been exposed to a negative sexual act, image, or remark.
Women with vaginismus don't want to talk about sex.
They do not become the initiator of sex.
Families of vaginismus patients are often overprotective, oppressive, and don't talk about sexuality.
They may have maritial problems.

Types of Vaginismus

Vaginismus is classified to three types as primary, secondary and situational vaginismus.

Primary vaginismus
Secondary vaginismus
Situational vaginismus

1. Primary vaginismus

Primary vaginismus appears at the first sexual intercourse. Pain is felt in the vaginal entrance as a result of involuntary contractions. Thus, the woman abstains from sexual intercourse. In primary vaginismus, the person don’t experience a successful vaginal intercourse before. Vaginal examinations cannot be performed on these people. The continuation of these manifestations leads to the diagnosis of vaginismus. The most important underlying cause of primary vaginismus is fear.

2. Secondary vaginismus

In secondary vaginismus, there has been sexual intercourse before. Vaginismus subsequently appears. The most important causes of secondary vaginismus are previous trauma, harassment, surgeries, miscarriage, abortion, difficult birth, a severe infection, and hard gynecological examinations. Even if these reasons disappear, the woman cannot have sexual intercourse because of fear of having painful sexual intercourse.

3. Situational vaginismus

Some maritial problems can lead to vaginismus disease strengthening these taubles much more. The woman contracts herself during sexual intercourse, because they assume to have pain, hurt, bleeding, vaginal burning. She does not allow sexual intercourse. Nevertheless she can use tampons and accept a gynecological examination done by a doctor.

Stages of Vaginismus

Vaginismus is evaluated in 5 level according to its clinical degree. Level 1 is the stage where the mildest signs and symptoms are seen. Level 5 vaginismus has a obvious, exaggerated clinic. The vaginismus level is determined according to the clinical history given by the couple and gynecological examination findings.

Level 1 vaginismus;

These women can comfortably undergo a gynecological examination.
Women can touch their own genital areas.
She can move her finger to the entrance to the vagina and into the vagina.
She allows her partner to touch her genital area.
Although there is limited penis penetration to vagina, she experiences contraction afterwards.
She closes her legs and pushes her partner.
When sexual intimacy ends, the contractions pass.
There is usually no sexual trauma experienced in the past.

Level 2 vaginismus;

These women can have a gynecological examination.
During the gynecological examination, the person is not comfortable, has the vaginal muscles contractions.
The person can touch her own genital area but not inside of her vagina.
She allows her partner to touch to her genital area.
Although there is limited penis penetration to vagina, she experiences contraction afterwards.
She closes her legs and pushes her partner.
Contractions pass when sexual intimacy ends.
There is no sexual trauma experienced in the past.

Level 3 vaginismus;

During the gynecological examination, contractions begin even when touched.
A normal gynecological examination can not be performed.
The woman does not like to touch and look at her own genital area.
Even when touched to entrance to the vagina, there are contractions.
She allows her partner to touch his genital area, but it is quite uncomfortable.
She does not even allow limited penis penetration to vagina.
These women experience contractions as soon as the penis touches during sexual intercourse.
She pushes her partner and ends the vaginal intercourse.

Level 4 vaginismus;

During the intercourse attempt, the pelvic muscles as well as the back and legs are contracted.
In addition to contraction there is anxiety, fear, the act of closing the legs, withdrawal for self-preservation.
Even if the vaginal penetration attempt ends, the contractions don't go away immediately.
It is quite difficult to examine her gynologically.
Even when touched her genital area, she feels pain, withdraws herself.
There is no penis penetration.
As soon as the penis touches to outside of vagina during sexual intercourse, she experiences contractions and pushes her partner.

Level 5 Vaginismus;

During the intercourse attempt, there is an intense contraction in the whole body as well as the pelvic muscles.
In addition to contractions in the whole body, there is a state of anxiety, fear, disgust and panic. The woman wants to avoid intercourse by closing her legs and pushing her partner.
There may be physical symptoms such as nausea, dizziness and blackout.
These patients can not undergo gynecological examination.
They refuse that their partner touch to their genitals.

Vaginismus Risk Factors

Why some women have vaginismus while others do not?. The answer is not very obvious. But there are some risk factors that can cause to vaginismus.

The most common cause of vaginismus is incorrect or incomplete sexual information. Today, our children are still not given adequate sexual education and sexual information. The fact that everything related to sexuality is considered a shame or a sin induces misinformation about sexuality to emerge.

Sexual myths play an important role in the appearance of vaginismus. Fears about sexuality are important in the formation of vaginismus. The most prominent predisposing factors caused vajinismus are the image of penis penetration overestimated and far-fetched ideas about bleeding and pain. Fear of conception, fear of passing on sexually transmitted diseases such as AIDS, sfilis, fears of rejection, and loss of innocence play a reasonable role in the basis of vaginismus.

When women who have vaginismus are investigated, It is seen women who have sexual fears, timid, fragile, childdish features and don’t have sexual experience. Women having vaginismus are rule-abiding, introverted, well-behaved, intelligent. Their families are often oppressive, conservative, and authoritarian. If we look at the husbands of women having vaginismus, they are usually understanding, kind, polite and relaxed gentlemen. They are afraid that their partner will get hurt.