Vaginismus occurs when the muscle at the entrance to the vagina spasms and closes the entrance so that insertion of any item is made impossible. This reflex is unconscious and involuntary. Vaginismus is classified as a genito-pelvic pain – penetration disorder in the DSM5.
Research is unclear on the exact cause of vaginismus. Women report many possible causes but there is no one specific identified reason for it occurring.
In our training, it was discussed that it was possibly a primitive response to prevent sexual assault. Women have identified that possible causes include:
- Fear of causing pain when inserting a tampon or engaging in intercourse for the first time.
- Medical examinations of the vagina that were painful or rushed.
- In rare cases sexual assault (ie rape).
- Childbirth trauma or surgery.
It can be a condition that also disappears as quickly as it appears, and whether the condition was occurring before or as a result of the events listed above, it can be difficult to know.
What else can it be the problem?
There are organic or physical causes of painful intercourse such as endometriosis, pelvic inflammatory disease, medications, medical treatments, viruses or bacteria, lack of naturally occurring lubrication and physical injury.
How bad can it get?
For some women it means not being able to have sex as penetration cannot occur.
This can prevent sufferers from wanting to commence a relationship if they know that one day they will need to disclose the condition and have intercourse.
If vaginismus starts after an event like childbirth, the inability to have intercourse can lead to the end of the relationship if not resolved.
Therefore, the consequences are profound to the small number of women affected. Many women hold off talking to a doctor, as they are unsure what’s wrong. The fear associated with the condition also prevents women seeking help.
Help for Vaginismus Sufferers
That’s why visiting a psychologist, trained in this field, can help you to explore the reasons for vaginismus, without fearing a physical examination.
Usually after the first appointment I will recommend women visit their doctor; often I can provide cognitive strategies to help women to find the courage to visit their doctor.
Sometimes it is helpful for women to book a female doctor or one that specialises in women’s health to make the appointment less fearful. It is very important that women feel safe when visiting for medical assessment.
Fortunately for most women, visiting a psychologist for vaginismus will provide effective treatment. The article below mentions 6 treatments. Biofeedback and electromyography require electronic equipment so this is available through a physiotherapist. The other 4 treatments are all psychological in nature and include:
- Progressive muscle relaxation – please try this yourself and if it fixes the problem you won’t need an appointment!
- Hypnotherapy – Some therapists offer hynotherapy as part of treatment.
- Densensitisation – involves behavioural therapy using a vaginal trainer. This is effective for 72-99% of women so this is my preferred method.
- Sensate focus – involves sex homework for couples. Often a partner will attend this session and learn techniques to increase relaxation and reduce stress. Making sex fun, relaxing and not a performance event is the key in this approach.
My therapy process to treat vaginismus includes a combination of relaxation and the use of a vaginal trainer.
In addition to this it is very important to note that the article cited does not offer suggestions around treatment for possible traumatic events that may be emotionally linked to the vaginismus. This is my area of expertise. The first session involves assessing all possible causes, visiting the GP to exclude physical causes, and then returning for the second session to start on the above strategies.
If there is likely trauma we can try the behavioural strategies first. If the trauma symptoms are worse than the vaginismus, then I prefer to treat the trauma first, and the vaginismus second.
On a positive note both the trauma counselling and the behavioural strategies for the vaginismus are very effective. Most women would attend as part of a mental health plan that permits 10 sessions and most find this is enough to effectively treat the trauma and vaginismus.
Author: Vivian Jarrett, B Psych (Hons), MAPS, MAICD.
Vivian Jarrett is a Psychologist experienced in providing sex therapy for individuals and couples, including helping those needing help for vaginismus.
To make an appointment try Online Booking. Alternatively, you can call Vision Psychology Brisbane on (07) 3088 5422 or M1 Psychology (Loganholme) on (07) 3067 9129.
Crowley T, Goldmeier D, Hiller J. 2009. Diagnosing and managing vaginismus. BMJ;338:b2284