Treatment for Vaginismus (PART II)

PART TWO of Sassy Chat Blog on Vaginismus

Treatment for Vaginismus can have many factors and the good news is that Vaginismus is usually 100% treatable. First, the psychological issues that accompany it must be treated. If a woman has been sexually assaulted, traumatized or abused she must work through her feelings about that experience in therapy. Having sex used as a weapon to harm you can have devastating affects and it takes time through therapy to work through all the issues and feelings associated with that and be able to return to thinking about sex as something pleasurable instead of harmful.

If a woman has been taught that sex is dirty, bad, sinful, and shameful and that her body or genitals are ugly, dirty, smelly, not to be touched etc. then it is easy to internalize negative feelings about sexuality. This is also something that needs to be discussed with a therapist so she can understand that sex is natural, pleasurable, and a wonderful expression of love and intimacy and that her body is beautiful and nothing to be ashamed of.

What else will happen in therapy?

The therapist, along with helping the woman to deal with the psychological issues she is facing, will also use other techniques to help with woman be able to relax and be able to have vaginal penetration. Women get “homework” and are assigned exercises to do at home between therapy appointments.

The techniques for treating Vaginismus include:

•       Relaxation exercises. Learning to practice deep breathing from the belly, meditate and relax the entire body will help learn how to relax the body and mind during sexual activity.
•        Pelvic floor exercises. Exercises such as Kegel exercises which not only strengthen the pelvic floor muscles but also control them. The best way to understand how to do Kegel exercises is to start urinating. In the middle of your flow of urine, squeeze your pelvic muscles until the stream of urine stops. Hold this for a few seconds and then release the muscles and start urinating again. Whilst this is the correct muscle to exercise it is not recommended that you repeat this pattern each time you go to the bathroom. If you are able to put lubricant on your 1st and 2nd fingers and slide them about an inch into your vagina and squeeze and draw up on your fingers, you are doing well, as that is the correct action. You may need to start with one finger. As you build up your pelvic floor muscles, the amount of time you can squeeze and hold them will increase. After a few weeks, you should see a difference. Learning how to identify your pelvic floor muscles as well as control them, also retrains them and helps reduce pain and tolerate penetration.
•       It is also helpful to use restraining devices when doing pelvic floor exercise, such as a Vaginal Barbell, or the Fun Factory Teneo Smartballs.  There are double and singles balls which are weighted, that helps the brain remember to squeeze.  It is recommended that you insert and do exercises for at least 15 minutes each day.
•       Sensate Focus. Invented by Master’s and Johnson, Sensate Focus exercises are designed for couples to learn about touch without sexual intercourse. Through a series of controlled touch exercises where the body, apart from the genitals are touched, stroked and caressed, couples can increase intimacy and trust, take the pressure off of expecting sex, and build an understanding of what the woman needs to progress through treatment and get to the point where she is comfortable attempting intercourse.
•        Masturbation.  While it is true many women who suffer from Vaginismus have issues with their genitals, especially touching them, masturbation is a key component of overcoming the problem.  Masturbation is a normal, healthy sexual activity and it can help someone learn about their body, from basic anatomy to what is pleasurable. Women who experience Vaginismus will be asked to masturbate to help them become comfortable with being touched in the genital area, which will also help overcome feelings of guilt and shame about their bodies and sexuality and prepare for the next phase of treatment. Vibration gives increased sensory input to muscles. There are many women who have discovered the benefits of using a vibrator when masturbating.  A variety of clitoral stimulators are available without having to use penetration.    

Vaginal Dilators

An important aspect of treating Vaginismus is the use of vaginal dilators. These are used at home, alone at first and then with the woman’s partner. There is a series of dilators that range in size with the smallest one being about the size of a pinky and the largest one being about the size of an average penis. The woman starts with the smallest one and works her way up over several weeks to the largest one. The woman attempts to insert the dilator into her vagina slowly until it is all the way in. Usually lubricant is used to help make it easier and the woman does the deep breathing and relaxation exercises to try to relax the pelvic muscles and reduce anxiety. She does this every night for a week and the next week starts with the next dilator in size. This pattern is continued until the woman can successfully insert the largest dilator all the way into her vagina. Vaginal Dilators trigger pelvic floor muscle reactions and women can learn how to control these reactions and redirect them so they respond correctly to penetration. At each stage, if the vagina starts to clench or anxiety increases, the woman should stop, try to relax and start again. It may take several attempts or several sessions of trying before it works but if the woman does not give up, success can be attained in overcoming Vaginismus.

Bringing in the Partner

Once a woman is able to successfully insert the largest dilator with no problems, her partner enters the exercise. Each night they spend some time with the dilators. First the woman will insert the dilator in front of her partner. This not only shows him how to do it and allows her to control the speed and depth of penetration, but also helps reduce anxiety, embarrassment, guilt and shame the woman may be experiencing. When this hurdle is cleared and penetration with the dilator is successful, the next step is letting the woman’s partner insert the dilator.  Her partner should take care to go slow, pay attention to any anxiety she may be feeling and stop immediately if she tells him to stop. As with the solo exercises, it may take several tries before penetration can be achieved but this is the time for patience and understanding.

Progressing to Intercourse

The next natural step in the process is attempting intercourse. It is important that the woman feels she is ready to try having sex, both physically and emotionally. She should be sure to use lubricant, go slowly and have plenty of foreplay. Relaxation exercises should be done and this is something couples can do together. The first time intercourse is attempted the woman should be on top so she can control the depth of penetration and proceed to deeper penetration at her own pace. Couples may have to start and stop more than once in the middle of sex to deal with anxiety and tightening of vaginal muscles.

Sometimes couples get discouraged if they are not successful on their first try but again, patience and understanding are necessary as is good communication. As the woman becomes more comfortable with each sexual encounter, couples can try different sexual positions to see which works best for them.

A word about Communication

By far, the most important aspect of overcoming Vaginismus is good communication between partners. A woman must be able to express her feelings about what is happening to her physically and emotionally. Her partner must be able to do the same. Couples with good communication have better tools in their relationship to deal with whatever problems they face. Good communication facilitates healthy relationships, trust, comfort and intimacy.

Other treatments

Some women report successful treatment of Vaginismus with Acupuncture. The use of Botox injections in the vagina to relax muscles is a relatively new treatment and is still controversial in acting as a cure for Vaginismus.

Good overall health, regular exercise especially those that focus on strengthening the pelvic floor and trying to reduce overall stress can also help with Vaginismus.

The most important thing is to understand that there is help available. Women do not need to hide in guilt and shame. Instead they need to take control of their sexuality and seek out treatment. Women have a right to be sexual, experience sexual pleasure free from pain and love their bodies.  There is no reason with the right treatment Vaginsmus cannot be cured and instead of suffering in silence, women can experience happy, healthy and pleasurable sex lives.

Copyright © 2011 Marie-Elise Allen

Permission is granted to copy and redistribute this article on the condition that the content remains complete and intact, and that full credit is given to the author(s), that a link is provided to the author(s) website, www.sassyvibes.com.au and that the information is distributed freely.