When a woman experiences a closure of her vaginal opening that is stiff and located about 1 1/2 inches inside the vagina (not at the very outside), this may be a condition called “vaginismus”. Vaginismus is an unconscious spasming of the pelvic floor muscles that surround the opening of the vagina. It happens even when you are engaging in what you would consider to be consensual, pleasurable penetration of the vagina, and feels like a strong ring or wall at the opening.
Vaginismus happens for a variety of reasons. Many women that we talk with develop vaginismus because they are taught that sex is bad or wrong and that they should never let a “boy” go inside their vagina. They do such a good job of protecting themselves that their bodies take over and make sure that they cannot be penetrated. In this situation, the problem occurs when they find a partner with whom they want to enjoy consensual pleasure. Even when they decide they are ready, their body may not be able to decide along with them.
Other women develop vaginismus after experiencing painful vaginal penetration, either during consensual sex, assault, or painful pelvic examinations. This can happen to younger women who experience painful penetration in their early experiences, and it can happen to older women who begin to experience painful penetration because of changes in their vaginal lubrication, skin thickness and skin flexibility. In response to the pain the body decides that penetration is not a good idea, and closes that pelvic floor muscle so that the woman can’t subject herself to that pain any longer.
Typically, regardless of the trigger of the pelvic floor spasm, it feels like it is not able to be consciously controlled by the woman who has it. It can be very frustrating, and when a woman asks her doctor about it, she can hear everything from “I don’t know what to do” to “you just need to have a nice glass of wine before sex and relax”. Neither of these statements is very helpful.
So what do you do?
Treatment of vaginismus includes several different aspects:
-Discovering the underlying trigger(s) that began the process.
-Healing any physical reasons for painful penetration other than the pelvic floor muscle spasm.
-Healing any psychological reasons for the vaginismus; negative attitudes about sex, sexual trauma, fear of getting pregnant, and other mind-based issues that result in a fear of sexual penetration and/or intimacy.
-Progressive relaxation exercises using a set of graduated-in-size dilators coated with a good intimate lubricant, to help the woman become accustomed to comfortable vaginal penetration. The woman should be in control of the speed at which she progresses, and should not ever experience pain or discomfort during this process.
-Pelvic floor biofeedback therapy with a physical or occupational therapist who specializes in pelvic floor dysfunction. This should be done in conjunction with psychotherapy to address any underlying psychological issues for the vaginismus, or it may not be as successful.
The woman and her partner should engage in non-penetrative intimate sex play to maintain their connection and enjoy sexual pleasure. This can include oral sex, external manual stimulation, tribadism (rubbing against a leg or other body part of a partner) and external vibrator play. Whenever she or her partner touches her vulva she should make sure to use a good intimate lubricant to prevent any skin tearing or pain.
When the woman feels ready, she can involve her partner in gentle vaginal penetration as a part of their sex play. She should remain in charge of speed and depth of penetration, and only have intercourse after a long period of “foreplay” and arousal.
What things should a woman NOT do?
A woman should never use numbing creams or gels to try to have intercourse despite the pain. She could tear her skin or her muscles and have much longer-lasting damage. And this does not address any fears or trauma that still exist, so it will not make the vaginismus go away.
She should not “grin and bear it”. That can also result in skin damage and torn muscles, not to mention it defeats the purpose of sexual intimacy.
She should not “stretch” her vagina with dilators. The goal of dilator therapy is to have her learn how to deeply and consciously relax her pelvic floor so that she can insert a dilator comfortably, without pain or the feeling of stretching. She is not stretching the vagina, she is teaching herself how to relax the pelvic floor muscles so they stop blocking penetration.
Don’t give up!
There are a lot of women who have vaginismus, and many good resources for them. There are some very good pelvic floor therapists, pelvic pain pain specialists and many good sex therapists who can help women get over vaginismus and enjoy comfortable and pleasurable penetration and comfortable pelvic exams. Many women who have vaginismus because of painful penetration due to post-menopausal and post-cancer changes find that they can treat their vaginismus on their own, using dilators and lubricant that we carry. I do recommend that women who believe that their vaginismus results from trauma get professional counseling help to heal from the trauma. Women who feel their vaginismus stems from strongly negative attitudes toward sex may be able to overcome those attitudes with help from partners and friends, and doing the progressive relaxation and desensitization on their own. But don’t hesitate to get help; it will make the healing process go more quickly and help you feel like you don’t have to do this all on your own.