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Vaginismus is a sexual dysfunction categorized by the involuntary tensing of the vagina. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM – 5], vaginismus falls under the broad category of genito-pelvic pain/penetration disorder. Despite massive advancements in the medical field, this is a condition that’s still unexplored. However, little research shows that roughly 1-6% of women experience it worldwide. But, experts believe the estimates are low since there are several stigmas surrounding women’s sexual health and dysfunction, so there’s a high probability of underreporting the condition.
In this article, we sat down with Dr. Mozhgan Sayyad, a prolific gynecologist from Dubai. With over 25 years of invaluable experience, she shares everything you need to know about this sexual dysfunction.
What is Vaginismus?
Vaginismus is when the vagina involuntarily tenses or contracts upon penetration. The penetration could be a penis, finger, tampon, or medical instrument. Since each woman and their bodies are different, the pain varies, ranging from mildly uncomfortable to extremely painful. However, although it prevents penetration, vaginismus does not interfere with arousal.
Medical Conditions Similar to Vaginismus
The symptoms experienced with vaginismus may mimic other conditions like:
- Vaginal Atrophy: An illness that develops after menopause due to the lack of estrogen. In vaginal atrophy, the lining of the vagina is thin and dry.
- Vulvar Vestibulitis: A condition that causes immense pain upon penetration.
- Lichen Sclerosis: A skin disorder commonly found in women that results in thin, whitened, and wrinkled skin. It can cause itching, pain, and vaginal scars.
Types of Vaginismus
Vaginismus can be categorized into four parts. They are:
- Primary Vaginismus
With primary vaginismus, the condition is lifelong. It begins with the first time a woman has sexual intercourse or inserts an object like a tampon. Oftentimes, during sex, women believe that the penetration is similar to “hitting a wall” at the vaginal opening. The symptoms disappear when the penetration stops.
- Secondary Vaginismus
This condition develops at any time, even when a woman has experienced successful sexual intercourse. Unlike primary vaginismus, this condition isn’t always present and usually stems from infection, menopause, childbirth, surgery, or trauma.
- Global & Situational Vaginismus
Global and situational vaginismus can be both primary and secondary. Global vaginismus refers to cases where the symptoms are persistent despite the type of penetration. Whereas in situational, the symptoms vary according to the penetration. For instance, someone might respond negatively towards sex while having no trouble inserting a tampon.
Causes of Vaginismus
Experts haven’t narrowed the root causes of this sexual dysfunction. But there’re a variety of physical and emotional factors that can trigger the condition. Those factors are:
- Anxiety or fear
- Past relationship trauma
- Sexual trauma
- Childhood trauma
- Infection [urinary infection or yeast infection]
- Childbirth
- Menopause
- Pelvic surgery
- Inadequate stimulation
- Inadequate vaginal lubrication
- Health conditions [cancer]
Symptoms of Vaginismus
The symptoms include:
- Painful intercourse [dyspareunia]
- Pain when inserting tampon
- Pain during a gynecological examination
- Fear of sexual intercourse
- Generalized muscle tension during intercourse
Although penetrative sex is difficult, it doesn’t interfere with a woman’s ability to experience orgasm or enjoy non-penetrative sexual activities like clitoral stimulation. [image]
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Diagnosis
To diagnose vaginismus, the patient should experience one or more of the above symptoms for over six months. Usually, the doctor will take into account the medical history and conduct a pelvic examination to rule out any possibilities of other conditions like an infection.
As women with this condition are sensitive to penetration, the doctor will conduct the pelvic exam as gently as possible. The patient can inform what position they’re comfortable with and request to stop when it gets painful or uncomfortable. The doctors can even suggest the patient guides their hand or the medical instrument to make the penetration easier.
Treatment Options for Vaginismus
Vaginismus treatment primarily focuses on relaxing the vaginal muscles and treating anxieties that lead to tensing. Some of the effective treatments are:
- Psychotherapy
Psychotherapy mainly focuses on dealing with the psychological side of the sexual disorder—anxieties about relationships or intercourse or past traumas can hinder someone from experiencing penetrative sex. Moreover, educating about one’s body will help combat their fears.
- Vaginal Dilator
A vaginal dilator is a plastic, silicone, or cylinder cone with a rounded end designed to stretch the vaginal tissue. Also known as an insert, vaginal dilators help relax the muscle and strengthen the pelvic floor muscles. It comes in various sizes, but they’re usually four inches long and differ in width. In this treatment, the patient is gradually made comfortable with penetration. As their muscles relax, the dilators become wider.
- Botox
Throughout the years, Botox has proven to cure vaginismus. Unlike other treatments, Botox is used in combination with psychotherapy and vaginal dilators. During the procedure, the patient is administered general anesthesia. The doctor will inject Botox into the pelvic floor muscles and dilate the vagina with the patient’s widest dilator. After a week, the patient has to follow a dilator protocol to achieve a favorable outcome strictly. Typically, patients can engage in penetrative and painless intercourse after 3-4 months.
- Surgical Treatment for Female Genital Mutilation [FGM]
Female genital mutilation [FGM] is a procedure where female genitals are intentionally cut, injured, or changed. Medically, FGM brings no health benefits and can cause a string of painful symptoms, including urinary problems, vaginal issues, menstrual irregularities, sexual concerns, and others.
Four types of FGM are:
[a] Clitoridectomy: Removal of all or parts of the clitoris
[b] Excision: Removal of all or parts of the clitoris and the inner labia [lips surrounding the vagina], along with or without the removal of the labia majora [larger lips outside the vagina]
[c] Infibulation: Narrowing of the vaginal opening by a seal that’s created by cutting and repositioning the labia
[d] Other harmful practices on the genitals, including burning, scraping, cutting, piercing, or pricking
In terms of treatment, there is de-infibulation, which is a surgery that opens the vagina. De-infibulation can alleviate some of the symptoms caused by FGM, like painful sex and pain while peeing. The surgery is performed by creating a cut to open the scar over the entrance to the vagina.
Common Questions
Q1. Can vaginismus be cured completely?
Of course, through proper medication and assistance, it can be cured. However, the time will depend on the severity of the case.
Q2. Can vaginismus affect sexual desire or arousal?
Although it doesn’t directly hinder one’s sexual desire or arousal, it may be difficult to engage in intercourse due to the fear of pain or discomfort.
Q3. Can vaginismus affect fertility or pregnancy?
Similar to Q2, it doesn’t directly impact fertility or pregnancy. However, it may be difficult for them to conceive due to the fear or anxiety associated with intercourse.
Q4. Can a woman with vaginismus have a normal sexual relationship?
Of course! With the proper treatment, women with vaginismus can continue to have a normal sexual relationship.
Q5. Is it possible to have vaginismus and not know it?
Yes. Especially if they’ve never engaged in intercourse or attempted vaginal penetration.
Q6. Can vaginismus be caused by psychological factors alone?
Yes, in some cases, it can be caused solely by past trauma, anxiety, or fear of sex.
Q7. What exercises help with vaginismus?
Some of the exercises that help with this condition are:
[a] Pelvic Floor Breathing: Begin by placing one hand on your lower tummy while resting the other on your breastbone. Gently breathe through your nose and let the air fill your stomach so your lower hand rises.
[b] Pelvic Floor Exercises
[c] Piriformis Stretch: Begin by laying down on your back with your legs straight. Gently lift one leg by bending your knee. Then with your opposite hand, reach across your body and pull your knee towards your opposite shoulder gently. Hold this position for 15 to 30 seconds. Repeat with the other leg. You can try this exercise on each side up to 4 times.
[d] Child’s Pose
[e] Happy Baby
[f] Deep Squat
Q8. Can medication help relieve vaginismus?
In some cases, medications like muscle relaxants or anti-anxiety meds may be prescribed. However, in most cases, medications are always used in conjunction with other treatment methods.
Get Help with Dr. Mozhgan
As you can see, vaginismus can be easily treated with proper care and medication. If you’re searching for one of the best gynecologists in Dubai, then meet Dr. Mozhgan Sayyad. With over 25 years of invaluable knowledge and experience, she will be your best guide to treating vaginismus.
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