Vaginismus — I want to...but I can't

Despite all the information we have access to today and the fact that there is more tolerance when it comes to the discussion of intimate matters, sex remains a taboo subject for most people. Disinformation (or misinformation) regarding sexual matters is still rampant in the 21st century society.

As a result, many myths and stereotypes about sexuality remain and prevent us from living full, informed and satisfying sex lives. Indeed, these beliefs and prejudices are the perfect breeding ground for the development of a range of sexual disorders.

Without wanting to be too exhaustive, in this article we'll focus on one of the sexual disorders that is estimated to affect on average 10-12% of women of childbearing age: vaginismus.

What is vaginismus?

Vaginismus is the involuntary and unconscious contraction of the muscles around the vagina (pubococcygeus muscles). This impedes penetration (as well as gynaecological examinations or the insertion of tampons).

Despite being a common female sexual problem, it doesn't always end up being professionally treated. Of course, some women may manage to have a satisfying sex life without penetrative intercourse (perhaps we should learn from them!). But it's often a problem when a woman suffering with vaginitis wishes to conceive; this is when most will finally decide to seek professional help. 

What causes vaginismus?

There are many possible causes for vaginismus, but the majority are due to physical factors (surgeries, hormonal changes, medication, etc.) and psychological problems. The latter always involves a degree of anxiety, which could be due to certain fears or traumas (fear of pregnancy, a repressive upbringing, sexual abuse, etc.). The anxiety could also manifest itself as a result of painful past sexual experiences, which then leads to the involuntary contraction of the pubococcygeal musculature — making penetration impossible. What ensues is a vicious circle, where the body anticipates pain and reflexively contracts the pelvic floor muscles. This, in turn, generates more pain — as well as frustration and despondency. This can then lead to a lack of desire, further limiting a woman's ability to enjoy an active sex life.

Furthermore, we mustn't forget that anxiety itself hampers, or even impedes arousal. Vaginal lubrication will be conspicuous by its absence, making any attempt at penetration even more difficult and painful.

Can vaginismus be treated?

Although the outlook may seem gloomy, the truth is that vaginismus is one of the sexual problems that has the best outcomes when treated — especially when the partner is involved. When the partner is patient, understanding and supportive, the therapy is much more likely to succeed. An impatient partner, or one who sees it as just ''her problem'', can block progress.

How vaginismus is treated will depend on the circumstances in which it develops. It's therefore important to assess the underlying conditions and history of the problem beforehand, so that treatment can be adjusted accordingly.

The ideal approach may be a multidisciplinary one. This combines psychological tools (relaxation techniques, sensory focus, gradual desensitisation (including dilators), positive self-instructions, cognitive restructuring...) and pelvic floor physiotherapy. The patient will then be able to recognise how her pelvic muscles are contracting and relaxing and learn to manage any anxiety and fears that may arise before and during sexual intercourse. And as mentioned before, the involvement of the partner is usually crucial to achieve effective results in a shorter period of time.

If you feel pain during intercourse or find penetration difficult or uncomfortable, it's time to seek professional help. With the help of professional sex therapists, you'll be able to pinpoint the source of your sexual problems and find potential solutions.

And don't forget: you're entitled to an enjoyable sex life. Don't give up on having a fulfilling and unconstrained sex life in which you can realise your full potential.

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