Did you know that vaginismus can also be referred to as genito-pelvic pain, penetration disorder or sexual pain disorder, too? In the UK, 50% of female sexual problems in psychosexual clinics are accounted to these. As we know, our sexual wellbeing plays a big role on our mental and emotional wellbeing, and vice versa. So, when we talk about the term psychosexual, we are relating to the mental and emotional aspects and attitudes towards sexual activity and our sexuality.
The fact that 1 in 2 vulva owners who are referred to psychosexual clinics suffer from vaginismus or the alike, highlights just how common it is. It can occur at any stage in our lives, and be triggered by just about anything; genital infection, vulval skin problems, child birth, genital or reproductive operations, menopause, sexual trauma etc. Such things can be painful physically, and though the medical conditions are treated and cause of initial pain removed, the emotional pain and trauma can remain. This can cause a physical reaction in which the pelvic floor spasms and vaginal muscles tighten up. The previous association between pain and the genital area means women can still experience discomfort and pain, diagnosed as vaginismus.
We spoke to Violeta Jawdokimova, a sexual psychotherapist, to understand the psychological factors and break down possible therapeutic treatments...
Vaginismus is one of the female sexual dysfunction problems alongside dyspareunia, lack of sexual desire, and anorgasmia. Vaginismus means that women either experience vaginal pain during penal or other kind of penetration or are unable to have vaginal penetrative sex or vaginal penetration with a tampon, finger, dildo, vibrator etc. Although the symptoms are physical, underlying issues are psychological, or should I say emotional. Ideally our thoughts, emotions and body will work together during penetration but sometimes this is not possible or are disturbed by the reasons we shall discuss further. Psychosexual treatment for vaginismus can help vulva owners establish this trio working together.
Prevalence of vaginismus is high and although pain is something that many women endure during penetration, few of us seek help when it persists. The reasons for this are based on our association with pain and the vagina as the norm, like with periods and childbirth.
Myth also plays a part, such as our ‘first penetrative experience is supposed to be painful’. Then there’s the social construct that women should not complain about their pain ‘lay back and think of England’ sadly coming to mind. On top of all of this, the physiological fact that vulva and vagina are not visually accessible add to the various myths about our anatomy; that our vaginas are fragile and can break, the virginity phenomenon of the breaking of the hymen, the lack of encouragement to touch and explore... Instead of ‘Diamonds are girl’s best friends’, we should consider ‘mirrors are a girl’s best friend’; using one as a tool to get to know our bodies and become familiar with our genitals. 63% of women in the UK do not know what the vulva is, and this kind of knowledge can be integral to having a better relationship with our genitals. The vulva is the external genitalia, and the vagina part of the internal genitalia.
Messages about sex and female anatomy are very often saturated with negativity or fear when it comes to education. Pleasure is very rarely mentioned or celebrated in programs, as if promoting pleasure is something to shy away from. Without a sex positive perspective, it is not surprising that so many, especially younger people, have misconstrued ideas about sex and sexual behaviour. We should be creating frank yet compassionate and kind discussions about sex, and changing the approach to the ‘sexiness’ of things to conversations about sexuality instead.
For a vulva owner, the source of vaginismus can arise during puberty, when a girl starts menstruation and tries to insert a tampon. Tampons, which are very dry, are not very conducive to a non-lubricated vagina so penetration can be difficult and very often scary. The lack of open-conversation can leave a young vulva owner feeling that something is wrong, and worrisome. From here things can go downhill, where that first experience could colour every subsequent penetration or lead to avoidance of any genital exploration, which is crucial for development of a healthy relationship with a body. Very often we choose to overlook the pain and not deal with it, so when we start sexual activity we might struggle with penetrative sex, which impacts our sex lives and consequently partner relationships. Withholding from exploring the cause of pain when we are younger can lead to vaginismus.
At this point we can say that the causes for vaginismus are multiple and complex and it could be either one or more factors involved in it. Here are some possible causes:
Vaginismus is considered to be a psychological problem. Despite the physical symptom of pain, the vaginas of the women with vaginismus are completely healthy and developed. However, very rarely are young women referred to a psychosexual therapist straight away if they have any issues with penetration. The physical examination is the usual first step, but this can just increase anxiety. I would advocate that vulva owners are referred for psychosexual therapy first, even if just for advice and a bit of sexual education and once that treatment/education is completed doctors can carry necessary physical examination. The examination can wait until a woman is confident and secure about her own body and can even examine it herself.
Some healthcare professionals, in order to “reassure” women that there is nothing wrong with their vaginas may say “it is all in your head”, this can be detrimental as for a woman who is not able to have penetrative sex the reality is very physical in that she physically feels that nothing can get inside her. These comments also make women feel inadequate as they may already feel and shame that they are not “normal”. Implying that not only are their vaginas “not working” but also that their heads too “are not working”. Sensitive and understanding therapists will acknowledge this and patiently and compassionately work with a woman. Upon establishing a secure relationship with clients, which can take just a few sessions or a considerable amount of sessions lasting years, a therapist will work with either set of vaginal trainers or encourage vaginal and genital exploration which involves penetration with her own fingers. Some women come to see us because they are unable to have a smear test too, so we adapt and give them speculum to practice with.
With vaginismus treatment we often come across the term ‘vaginal dilators’, however this name is not conducive to the work we, as psychotherapists, try to do. I call them vaginal trainers as they help women to train their vaginas to experience penetration in a different and, most importantly, non-painful way. The work involves gradual insertion of different sized trainers and the goal is to insert them without any discomfort. Women will work on their own and once they are able to insert the biggest one that is generally bigger than the average penis they can start practicing with their partners. The same applies to same sex relationships, they will choose the sizes that want to insert for penetrative pleasure.
This can be an empowering process where women start taking ownership of their own examination and her own exploration. This is gradual work and at a later stage it will involve partners. Partners are involved once the woman achieves a good level of security in herself and her body, as well as confidence to communicate her sexual needs. Vaginismus can be emotionally painful for women and their relationships, too; but we do not involve partners straight away because that could create additional pressure. We want women to be as relaxed as possible, and own their self-discovery.
Psychosexual therapy or, simply, sex therapy is a very successful talking therapy and as long as we commit ourselves to it success is a very realistic possibility!
Violeta Jawdokimova, MA Counselling and Psychotherapy, PG Dip. Psychosexual Therapy, Dipl. Humanistic Integrative Counselling. Violeta also completed a qualitative research into lifelong Vaginismus in 2017 as part of her Master’s thesis
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