Vaginismus: causes, symptoms and treatment

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Vaginismus is a sexual dysfunction caused by the involuntary contraction of the pelvic floor muscles before the imminent penetration, at the time it takes place or when it has already happened. Currently, the Diagnostic Manual of the American Psychiatric Association classifies it as a genitopelvic pain/penetration disorder along with dyspareunia.

The causes can be multiple, being psychological the most frequent. The main symptom is muscle tension or contraction, and it is necessary for the diagnosis to last for at least 6 months and cause discomfort in women. The most effective treatment consists of exposing the patient to stimuli that produce anxiety or fear.

Namely, attempts are made to deal with penetration progressively gradually reducing the involuntary contraction of the muscles. Likewise, it is also useful to educate and inform about sexual responses and phases and to work on the different emotions linked to them. It is essential that the couple also participate in the intervention so that they understand the disorder and can cooperate in the recovery.

In this article we will talk about vaginismus, we will explain what this disorder consists of, what are the main causes that produce it, what symptoms are characteristic and how to treat it.

  • We recommend you read: “The 10 most common sexual dysfunctions (and how to treat them)”

What is vaginismus?

Vaginismus is classified within sexual dysfunctions, specifically the fifth edition of the Diagnostic Manual of the American Psychiatric Association (DSM 5) classifies it within genito-pelvic pain/penetration disorders, together with dyspareunia. The alteration consists of the involuntary contraction and tension of the pelvic floor muscles, thus causing the vagina to narrow or even close.

It is considered a pathology since the contraction of the vagina does not allow the woman to have sexual intercourse in a satisfactory manner, thus it will be difficult to carry out medical or geneological check-ups or it may show problems for the use of the tampon.

Let’s remember that this tension appears involuntarily, the woman does not do it wanting nor can she control it, for this reason it is normal and habitual that it generates discomfort. Apart from the woman, in reference to sexual problems, the couple will also be affected, and their relationship may be compromised.

what-is-vaginismus

Causes of vaginismus

The causes that lead to this sexual affectation can be different, being both linked to the environment and associated with genetics and physiology. The environmental causes that may be a risk factor for the appearance of vaginismus are: having experienced physical pain during sexual intercourse, having been a victim of sexual or physical abuse, having previously suffered vaginal pain or concerns about the size of the vagina as well as the size of the vagina. for the pain that sexual relations can entail.

Likewise, having had a first painful sexual experience is also a risk factor. or present fear of becoming pregnant. For its part, the physiological causes may be due to vaginal infections and that the pain has persisted even though the infection is cured. The course of vaginismus cannot be known exactly, since most of the time affected women take time to seek help, making it difficult to classify whether the problem has always been present or is acquired.

Although there is no specific age of onset, it occurs more frequently in premenopausal women or in women who have recently given birth (postpartum). It can show comorbidity with other disorders and its presence is common in couple relationships when they are not having a good time and conflicts are frequent. Remember that the problem is due to muscle contraction, therefore anxiety causes body tension to increase.

causes-vaginismus

vaginismus symptoms

As we already pointed out vaginismus considered a genitopelvic pain/penetration disorder in DSM 5. This manual classifies vaginismus together with dyspareunia, pain before vaginal penetration, considering them both as the same pathology, since in most cases vaginal contraction ends up producing pain before the penetration attempt or before penetration.

Of course, in the case of dyspareunia, men can also be diagnosed, since they can show pain during penetration. Contrarily, vaginismus, obviously, can only be diagnosed in women.

The DSM 5 indicates 4 criteria necessary to make the diagnosis of genito-pelvic pain disorder. Criterion A consists of persistent difficulty with: severe vulvovaginal or pelvic pain during vaginal intercourse or attempted penetration; a marked fear or anxiety related to vulvovaginal or pelvic pain in anticipation, during or after penetration; or high tension of the pelvic floor muscles when trying to penetrate.

We see how in any case it refers to a sexual relationship consisting of vaginal penetration. Similarly, also it is necessary to verify that the affectation lasts at least 6 months, causing clinically significant discomfort in the subjects who suffer from it. Finally, we must make the differential diagnosis with other sexual dysfunctions and rule out other possible causes that nullify the diagnosis of pain disorder, such as currently being a victim of gender violence.

symptoms-vaginismus

How to treat vaginismus

Now that we know better what vaginismus consists of, it will be easier to understand what interventions we apply to improve it. We know that the causes can be multiple, classifying them as physical or psychological, this distinction will be important to know what is the best way to proceed.

Regarding treatment in cases where the involvement is physical, these being the least likely causes of vaginismus, surgical intervention can be performed in order to remove a small amount of vaginal tissue to facilitate penetration and prevent the woman from feeling pain.

On the other hand, if the cause is psychological, this type of affectation being the most frequent, there are different techniques that we can use to reduce the patient’s discomfort. The treatment considered effective in reducing vaginismus is exposure. As with any other fear, the best way to reduce it is to face it to verify that the consequences obtained are not as serious as we imagine and that the phobia or anxiety is not really linked to a real risk.

In the case of vaginismus, when the reasons are psychological, the fear of penetration, the pain that it can cause, is what involuntarily generates the contractionFor this reason, systematic exposure or desensitization consists of exposing women to precisely these situations, with the help of vaginal dilators and training in the pubococcygeus muscle.

Exposure is usually done gradually, through systematic desensitization. With the purpose of getting the subject to adapt little by little to the situation. Thus, in the case of the dilators, we will start first with the smaller ones to gradually increase them. In addition to the dilators, the pubococcygeus muscles are also trained and worked so that the woman gets used to contracting and relaxing them at will. Given the intimacy that these techniques entail, the woman will perform them in her home.

treatment-vaginismus

As we have already mentioned, the process will be progressive, so we will not try to have sexual relations with penetration until the woman, after having overcome the previous exercises, feels ready. The goal is to achieve satisfactory penetrationwithout pain, but the first approaches of the couple do not have to culminate the act, we will approach little by little to see how the woman reacts.

Sex is a fairly taboo subject and even more so if it is related to some kind of problem. For this reason, it is advisable to inform the patient of appropriate sexual practices, the anatomy of the sexual organs and the different phases of sexual activity. This knowledge can be useful for you to achieve a satisfactory sexual practice and better understand your disorder.

In addition, it can also be favorable to work on emotions, as we saw some of the causes of this dysfunction are related to bad sexual experiences, we can thus treat the emotions linked to them so that they can express and face them, thus reducing them.

Despite being the woman the subject that shows the pathology, both members of the couple must be involved in the treatment since both participate in the sexual relationship and must know what the appropriate procedure to apply is. Likewise, we know that the relationship can be affected, problems arise due to not understanding what is happening, not understanding the problem, appearing feelings of guilt, reproaches, mistrust…

It will be essential to inform and educate the couple about the disorder and indicate the need to move forward progressively, without forcing or trying to go faster, since we can lose everything we have achieved. The two well-known sexologists William Masters and Virginia Johnson point out that in order to achieve intercourse beforehand, it is necessary to get the woman to reduce the involuntary response of muscular contraction.

Similarly, prior to genital stimulation or targeting, sensory targeting is recommended, that is, stimulating other parts of the body other than the genitals but which also arouse the subjects.

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