A little-known condition could be causing unnecessary pain during intercourse.
“Whatever the cause, the physical and emotional effects can be significant,” said Lisa Krikorian, a nurse practitioner, who specializes in gynecology at Lahey Hospital & Medical Center in Burlington, Massachusetts. “It’s very consuming, because these women think about their vagina all the time, which is not normal. They’re nervous or embarrassed about having any conversations surrounding the discomfort with their friends or their care providers. They often have relationship issues because of this, even when their partners are supportive. But they feel anxious and sad about not being able to engage in those types of relations. They don’t feel very womanly. They might have the sexual desires but are unable to perform as they would like to.”
“Vaginismus is a recurrent, persistent type of involuntary spasm of the muscles around the vagina,” Krikorian said. “When penetration is attempted, these muscles contract and can prevent intercourse or make it painful. It also causes discomfort when inserting a tampon or having a pelvic exam or Pap test.”
What causes this condition, and how can vaginismus treatment help?
What Causes Vaginismus?
There are two types of vaginismus:
Primary vaginismus is a lifelong condition that’s discovered during a woman’s first attempt at sexual intercourse or inserting a tampon.
Secondary vaginismus develops after a woman has already experienced normal sexual function.
Secondary vaginismus can occur at any stage of life and has many potential causes, including:
Sexual trauma, such as rape or molestation
Inflammation from certain types of infections, including yeast and urinary tract infections
Menopausal dryness and vaginal atrophy
Trauma from pelvic surgery or complications during childbirth
Anxiety and depression
The good news, Krikorian says, is that there are many successful avenues for vaginismus treatment.
Because vaginismus has many possible causes, it’s important to understand why a woman experiences this pain during sex.
“Whenever we’re diagnosing this condition, we have to take a good sexual and medical history and try to uncover any contributing factors or events,” Krikorian said. “Simple diagnostic tests let us rule out infections. We do a pelvic exam to check for dryness or any abnormal lesions or ulcerations. We also ask about surgeries or complications during childbirth and then discuss any relationship issues or history of sexual trauma.”
Some of these issues can be addressed with medication and/or counseling, but Krikorian says vaginismus treatment often revolves around helping desensitize the condition and helping patients relax.
“We often involve a multidisciplinary team — a gynecologist, a physical therapist and maybe a counselor,” Krikorian said. “The goal of treatment is to try to reduce the tightening of the pelvic muscles. We have an excellent pelvic floor physical therapy team at Lahey that teaches women how to use contract-and-release exercises, such as kegel exercises and reverse kegels, to learn how to better control and relax those muscles. Then we often recommend counseling on emotional aspects related to the condition. Some patients need a behavioral medicine consult or a social worker, or some might be interested in sex therapy with their partners.”
Dilators can also be useful in helping women train their vaginal muscles to relax during penetration.
“The big key factor is to use a lidocaine jelly with the dilator, applied 15 minutes prior to insertion,” Krikorian said. “This helps to numb the area and ensures the patient doesn’t have a painful response. The minute they feel pain, they’re going to become anxious and start clenching their muscles, and then they’re back to where they started. If they can get used to the dilator and know their vagina will be amenable to this and not experience pain, they can start to get used to the sensation of penetration.”
A Sensitive Subject
With the right team of doctors, vaginismus treatment can be very effective in relieving pain during sex. But receiving help requires asking for it.
“The most important step in treatment is for patients to feel comfortable and safe bringing up their concerns,” Krikorian said. “If patients aren’t comfortable talking to their provider about these things, they need to find a different provider. That might sound harsh, but you need to have a provider-patient relationship where you feel that you are able to talk about all your health care needs, no matter how sensitive the subject.”