Vaginismus

Vaginismus is the term used to describe recurrent or persistent involuntary tightening of muscles around the vagina whenever penetration is attempted.
It can disrupt or completely stop your sex life, and can lead to distress, a loss of confidence and relationship problems. It may even prevent you starting a family.
The condition can also make gynaecological and pelvic examinations difficult or impossible.
The symptoms can vary from one woman to the next. Some women are unable to insert anything into their vagina because it closes up completely, while others can insert a tampon but are unable to have penetrative sex, and other women are able to have sex but find it very painful.

Many factors can play a part in the development of vaginismus, although it’s not fully understood why the condition happens.
Factors can include:
• thinking the vagina is too small
• negative sexual thoughts (thinking sex will be painful and cause damage)
• previous sexual abuse
• damage to the vagina (for example, during childbirth or an episotomy)
• painful conditions of the vagina and surrounding area, known as vulvodynia
• painful first intercourse
• relationship problems
• fear of pregnancy

Vaginismus can be treated. How it’s treated will depend on the cause.

If there’s an obvious physical cause, such as an infection, it can be treated with appropriate medication.
If the cause is psychological, sex therapy may be recommended in the form of counselling or cognitive behavioural therapy (CBT). These therapies can help to address any underlying psychological issues, such as fear or anxiety and can tackle any irrational or incorrect beliefs that you have about sex and, if necessary, be used to educate you about sex.
Sex therapy is available privately. In many parts of the UK, it’s no longer available through the NHS.

Vaginal trainers can be used to help you relax the muscles in your vagina by gradually getting you used to having something inserted into it. These are a set of four smooth, plastic penis-shaped objects in different sizes, which can be used in the privacy of your own home.

The smallest trainer is inserted first, using a lubricant if needed. Once you feel comfortable inserting the smallest one, you can move on to the second size and so on. It’s important to go at your own pace, and it doesn’t matter how long it takes – whether it’s days, weeks, or months.

When you are able to tolerate the larger trainer without any pain or feelings of anxiety, you and your partner may want to try having sex.

Vaginal trainers are not used to “stretch” a vagina that is “too narrow”. Women with vaginismus have normal-sized vaginas. The trainers are simply a method of teaching the vagina to accept penetration without automatically closing.
If you prefer, you can try using your fingers instead of vaginal trainers.

You may also find that relaxation and exploration exercises help. Having a bath, massage and breathing exercises are good ways to relax while you get to know your body.
Your therapist may also teach you a technique called progressive relaxation. This involves tensing and relaxing different muscles in your body in a particular order. You can then practice tensing and relaxing your pelvic floor muscles before trying to insert your finger or a cone.

If you reach the stage where you can put your finger inside your vagina, you can try to insert a tampon, using lubricant if needed.

It’s important to take things slowly and gently and, when you are ready for intercourse, make sure you are fully aroused before attempting penetration.

A physiotherapist may be able to teach you pelvic floor exercises, such as squeezing and releasing your pelvic floor muscles, that can help you gain control over the muscles causing the vagina to close involuntarily.
These exercises are usually recommended while using vaginal trainers.

More recently botox injections have been used to help with symptoms. Botox (Botulinum Toxin A) is derived from a strain of bacteria called Clostridium Botulinum. When Botox is injected into a muscle, it blocks the signals sent from the brain which tell the muscle to contract. Botox targets the muscles involved by effectively disarming them and ensuring that they do not send panic signals throughout the body. The body believes that there is no pain being experienced. Botox can help to keep the muscle relaxed for anywhere from three to six months, after which it is hoped that the muscle will be able to contract normally without pain or spasms. This is available privately from the London Pain Clinic.

Vaginal laser rejuvenation, for example NU-V, has also been shown to be very effective in treating the symptoms of vaginismus. Like botox, this is not currently available on the NHS but has had very good results for many women and is available at The Women’s Health Clinic.

One of our patients Sara Carson has written a blog on her symptoms, described as atrophy.

You can read it here: https://medium.com/@saracarson/my-name-is-sara-im-50-and-after-complications-from-cancer-and-the-menopause-i-d-like-to-share-my-5e22434cbcfd