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.