• Sex Hurts!!! Part 5- Vaginismus

    by Dr Angie Stoehr, MD FACOG
    on Nov 27th, 2017

"Sex is impossible- my vagina just won't cooperate!"

It's not an uncommon problem, sadly, to have an uncooperative vagina. Remember my "dreaded speculum exam" post?  This is it...the most common cause of a painful speculum exam. Now, as you've seen in other posts, it's not the only reason. But it can cause some serious issues in your relationship, and obviously may make sex painful or impossible. 

What is Vaginismus?

Vaginismus is when your vaginal muscles tighen up spontaneously, without your intentional help. This makes penetration with sex, or even placing a tampon, painful or almost impossible. It can also push things out of the vagina after they've been placed there. 

For some people this happens with the very first time of trying to have sex. It can lead to what we call unconsummated marriages and is pretty common in some cultures. It can also start after having had no issues in the past. 

Primary Vaginismus

This is when you've never successfully had sex. Nothing, or at least a penis, has ever been in there. The partner may say it feels like there's some type of barrier whe he tries to penetrate, or that "the hole is too small." Sometimes other muscles get in on the action and tighten up. Women often hold their breath. Primary vaginismus is often caused by societal ideas, family expectations, personal thoughts about sex, or cultural practices. But it can also be related to unusual anatomy or sometimes a history of abuse.

Secondary Vaginismus

This is when you've been able to perform before without problems, but now you're getting painful vaginal tightening. Something almost always triggers this. It could be something as awful as rape, or as simple as a urinary tract infection. It's really common with marital issues, especially cheating. Once the trigger problem is treated and fixed, like antibiotics for the infection, the vagina may continue to tighten. This is a "knee jerk" type reaction that has been programmed. It's like Pavlov's dogs that salivated when a bell was rang because they associated the bell with food. If your brain associates pain with sex, it may tighten the vagina up without your conscious permission.


 What does it feel like?

For you ladies, it can feel anywhere from mild discomfort, burning with tightening, to severe tightness, or a complete inability to allow anything in there. If something is forced inside it will cause severe pain. For your partner, it feels like a barrier, a wall, or a really tight vaginal opening. I've seen cases so bad that I couldn't get a single finger in for an exam. 


What can be done for this?

If this seems like an awful diagnosis, I can assure you it's treatable. But, it requires some work on your part. There's some psychology that's in play with this diagnosis, so counseling is usually involved. It can be on the fun side, like a sex therapist, or more intellectual like counseling. The most important first step is education. Other therapies include dilators, medications, and injections. 

Techniques for treatment include:

1. Education about your body, the vagina, and the muscles in the pelvic floor. 

2. Physical therapy to teach you how to relax the muscles

3. Vaginal dilators. These you can purchase online and use at home. You start with a really small dilator and place it inside for 10-15 minutes every day. Once you can insert it without pain, you go up a size. It can take months to get up to the size you'll need to be able to have pain-free sex, but the work is worth it!  You'll need to conitnue dilating for a while, usually 6-12 months to get full effect. 

4. Injections of botox. This is obviously done by a trained expert.

 

5. Therapy- either sex therapy, or counseling, or both.

 

As always, if you have questions, or think you might have vaginismus, please make an appointment to see me at Boardwalk Ob/Gyn.

 

https://www.ncbi.nlm.nih.gov/pubmed/24894201 

https://www.ncbi.nlm.nih.gov/pubmed/28363809 

Author Dr Angie Stoehr, MD FACOG Dr. Angie Stoehr, MD is a Pelvic and Intimate Pain specialist who provides care to women experiencing any type of pain from the belly button to the mid-thigh, front and back. She obtained her medical degree at Creighton University in Omaha, NE, and residency degree at St Francis Hospital and Medical Center in Hartford, CT.

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