What is Dyspareunia or Vaginismus? How is it treated? Everything about dyspareunia and its causes, symptoms, and treatments.
What is vaginismus?
In some women, when trying to insert anything into the
vagina, such as a tampon or speculum (a tool used to expand the walls of the
vagina for better examination), the vaginal muscles involuntarily and
persistently contract, a condition known as vaginismus. Even touching the area
around the vagina can trigger this disorder. Consequently, these contractions
can hinder sexual intercourse or make it exceedingly painful. While vaginismus
doesn't impede sexual arousal, it can impact sexual relationships and a woman's
overall quality of life.
The primary muscles affected by this disorder are the pelvic
floor muscles, comprising two muscles referred to as the PC muscles. These
muscles govern bladder control, intercourse, orgasms, bowel movements, and
childbirth. It's noteworthy that no physical abnormalities typically contribute
to the development of vaginismus; instead, it's often triggered by emotional or
medical factors, or a combination of both. Vaginismus manifests in various
forms, and symptoms can vary among individuals. The pain intensity can range
from mild to severe, eliciting various sensations. It's important to note that
without treatment, vaginismus can lead to frustration, psychological distress,
and may worsen over time. Fortunately, treatment, which typically involves
physical and emotional exercises, is usually effective.
What are the symptoms of vaginismus?
Symptoms of vaginismus vary among individuals. Involuntary
contraction or spasm of the vaginal muscles is a primary symptom, with the
severity varying among women. Regardless, vaginal contraction makes insertion
of anything challenging or impossible. If you have vaginismus, you're unable to
control or stop the contraction of your vaginal muscles, resulting in painful
spasms (dyspareunia) accompanied by a burning sensation. These symptoms are
also experienced during activities such as inserting a tampon or undergoing a
gynecological examination. In severe cases, breathing difficulties may occur
due to intense pain. Pain severity can range from mild discomfort to intense
burning.
Anxiety stemming from unsuccessful attempts at sexual
intercourse due to fear of penile penetration into the vagina often prompts
women to engage in alternative practices such as oral or anal sex,
unfortunately increasing the risk of contracting related diseases, including
HIV/AIDS. Therefore, timely treatment for vaginismus is crucial.
Who is typically affected by this problem?
Vaginismus can be triggered by physical or emotional
stressors, or a combination of both. It often occurs predictably, as the
individual expects the disorder based on past experiences. Emotional triggers
may include:
Fear, such as fear of childbirth pain or the loss of
virginity
Anxiety due to poor sexual performance or guilt associated
with sex
Problems in sexual relationships, such as having an
unsatisfactory or abusive partner
Traumatic memories of rape or sexual abuse
Childhood experiences, such as exposure to sexual imagery or
observing sexual acts
Physical triggers may include:
Infections such as urinary tract infections (UTIs) or yeast
infections
Medical conditions such as cancer or multiple sclerosis
Childbirth
Trauma
Pelvic surgery
Lack of arousal before sex
Side effects of certain medications
It's important to note that men also face their own specific
sexual issues such as erectile dysfunction or premature ejaculation, all of
which are treatable similar to vaginal disorders. For diagnosis, your doctor
will typically conduct a physical examination followed by inquiries about your
medical and sexual history. Addressing these issues (vaginismus risks) can help
pinpoint the underlying causes of the contractions and work towards resolving
them.
Types of vaginismus disorders.
Vaginismus presents in various types and can affect women of
different ages, including:
Primary vaginismus
Primary vaginismus is a lifelong condition characterized by
pain and burning sensations, especially during sexual intercourse, tampon
insertion, or undergoing a gynecological exam. Most women experience it during
their first attempt at intercourse, and their sexual partners may be unable to
penetrate the vagina. Men often describe the sensation as "hitting a
wall" inside the vagina. In some cases, in addition to pain and spasms in
the pelvic muscles, women may experience general muscle spasms and temporary
cessation of breathing. These symptoms typically dissipate when sexual
intercourse is halted.
Secondary vaginismus
In secondary vaginismus, a woman who previously enjoyed
pleasurable sex experiences involuntary spasms of the pelvic muscles following
gynecological surgery, childbirth, trauma, injury, infection, menopause, sexual
problems, or other triggers. It can occur at any stage of life. Even after
addressing the underlying cause of this type of vaginismus, mild pain during
sexual intercourse may persist.
Global vaginismus
With global vaginismus, the disorder is ever-present and
occurs with any attempt at vaginal penetration.
Situational vaginismus
Situational vaginismus only occurs in specific situations,
such as during intercourse, achieving orgasm, or inserting a tampon. Unlike
other types, it doesn't manifest consistently.
Some women experience vaginismus after ovulation, as
decreased levels of estrogen in the body lead to vaginal dryness and reduced
lubrication.
Treatment options for Vaginismus.
Vaginismus is a treatable disorder, and depending on the
cause, the treatment process may involve various specialists. Before addressing
the emotional causes of vaginismus, it's essential to treat any underlying
physical causes such as infections.
The overarching goal
of treating this disorder is to reduce involuntary muscle contractions and
alleviate the fear of pain, as well as address any associated fears. Therefore,
treatment programs typically incorporate education, counseling, and practical
exercises, or a combination thereof. These may include:
Sex therapy and sexual counseling
This therapy typically educates individuals about sexual
anatomy, the sexual response cycle, and stimuli to help them understand their
body's processes and responses during sex. Participants also gain insights into
the pelvic muscles involved in vaginismus. Working with a specialized sexual
disorders counselor can be highly beneficial in this area. During sex therapy,
individuals are usually encouraged to gently touch their genital area daily,
gradually progressing to penetration of the vaginal opening or labia, and
eventually attempting insertion of a finger. This process helps prepare them
mentally for sexual intercourse.
Psychological and emotional counseling
This form of therapy assists individuals in identifying,
expressing, and addressing emotional factors such as anxiety, depression, and
post-traumatic stress disorder (PTSD) that may contribute to involuntary
vaginal muscle contractions. Learning relaxation and mindfulness techniques can
help calm the mind and foster a greater sense of comfort during intimacy.
Use of vaginal dilators
Once individuals can insert a finger into the vagina
comfortably after initial training, they may progress to using graduated
plastic dilators to achieve deeper penetration in subsequent stages. Dilators
are typically inserted into the vagina for 10 to 15 minutes to allow the
muscles to acclimate to the pressure. Larger dilators or the assistance of a
partner may be introduced in subsequent stages. With consistent practice,
individuals can eventually progress to successful penetration with a partner.
Muscle control exercises
These exercises involve activities such as pelvic floor
muscle contractions and relaxation exercises, including Kegel exercises, to
improve muscle control. If individuals are unable to use vaginal dilators, a
physiotherapist specializing in pelvic floor rehabilitation can provide
guidance on performing these exercises effectively.
Use of topical treatments or oral medications
Topical treatments containing lidocaine or oral medications
may help alleviate pain associated with vaginismus. The duration of treatment
required for successful resolution of vaginismus varies from person to person.
In rare cases, surgery may be necessary to address vaginismus. For further
information, articles on vaginismus from reputable sources such as the Mayo
Clinic and Wikipedia are valuable resources.
Treatment of Vaginismus with Herbal Medicines.
Experience has shown that certain natural vaginal lubricants
are as effective as chemical counterparts in alleviating vaginismus symptoms.
Among these herbal and natural ingredients are jojoba oil, olive oil, peanut
oil, and aloe vera gel, which, like vitamin E, promote increased vaginal
lubrication. Incorporating probiotics into the diet can help alleviate symptoms
of vaginal atrophy, a contributing factor to vaginismus. During sexual
intercourse, a water and glycerin solution can be used as a lubricant.
Consuming estrogen-rich foods such as soybeans in the daily diet can also be
highly effective. It's important to note that certain herbs may interact with
prescribed creams or gels or elicit unwanted side effects. Therefore,
consulting with a physician or traditional medicine practitioner is advisable
in this regard. Notably, essential oils such as peanut oil should be properly
diluted before use, as some individuals may experience sensitivity to them.
Conduct a patch test on a small area of skin on the hands before applying to
the sensitive vaginal area.
Traditional Medicine Approach to Treating Vaginismus.
According to traditional medicine, the primary cause of
vaginismus is a woman's emotional state. Thus, efforts should focus on
alleviating anxiety during sexual activity. Aromatherapy using scents such as
jasmine, ginger, strawberry extract, and vetiver before and during intercourse
can help restore a woman's lost energy and induce calm, thereby preventing
involuntary vaginal contractions. Additionally, the use of herbal creams
containing muscle-relaxing properties can effectively alleviate vaginal constriction.
When should I seek medical attention?
Sexual disorders can strain marital relationships; thus, timely treatment can greatly benefit a marriage or partnership. Remember, there's no need to feel ashamed, and discussing your feelings and concerns about sex with your partner can help ease anxiety. Your doctor or therapist can offer strategies to overcome vaginismus. Fortunately, many patients experience successful treatment and go on to enjoy a fulfilling sex life. If you experience symptoms such as painful intercourse accompanied by burning or stinging sensations, vaginal redness post-intercourse or after using a tampon, it's essential to schedule consultation sessions with a gynecologist or obstetrician.