What happens with vaginismus
In response to the anticipation of pain, the pelvic floor muscles reflexively contract, the entrance to the vagina narrows, and an attempt at penetration causes sharp pain. Pain confirms fear, fear intensifies the spasm - this is how a vicious circle is formed, which does not break on its own. General tension is often added: the woman closes her legs, holds her breath, and moves away. There is a distinction between primary vaginismus, when penetration has never been possible, and secondary vaginismus, which occurs after childbirth, surgery, a painful examination or a traumatic experience.
- Involuntary spasm of the pelvic floor muscles
- A vicious circle of fear and pain
- Primary - penetration was never successful
- Secondary - appeared after a certain event
- May apply to both tampons and examination
- Often combined with general anxiety
Reasons and factors
Vaginismus rarely has a single cause. Psychological factors are important: anxiety, strong beliefs that intimacy is shameful or dangerous, fear of pain and injury, negative or violent experiences in the past, problems in relationships. No less important are the physical ones: previous inflammation, vulvodynia, endometriosis, scars after childbirth and operations, dryness due to a lack of estrogen. Even when the physical cause has been eliminated, the habitual muscle response may persist, so treatment almost always combines work with the body and emotions.
- Anxiety and fear of pain
- Negative or traumatic sexual experiences
- Strict attitudes and lack of knowledge about the body
- Past inflammation and painful examinations
- Scars after childbirth and operations
- Vaginal dryness and estrogen deficiency
- Tensions with your partner
How does it manifest itself?
The main symptom is the impossibility or severe pain of inserting anything into the vagina: penis, tampon, finger, speculum during examination. The woman describes the feeling of a wall or barrier. At the same time, tension in the whole body, holding your breath, trembling, and sometimes panic and tears occur. At the same time, attraction and the ability to receive pleasure are often preserved, which is important for both the woman and the partner to understand. Over time, avoidance of intimacy and examination develops, feelings of guilt grow, and relationships suffer.
- Inability to penetrate or severe pain
- Feeling of an insurmountable barrier
- Leg compression and general body tension
- Panic and tears when trying
- Avoidance of inspection and proximity
- Attraction usually persists
What examinations are needed
The doctor’s task is to exclude physical causes of pain and not increase fear. The examination is carried out as carefully as possible, starting with a conversation and explanation of each step, with the woman’s right to stop the procedure at any time; in case of severe spasm, the first visit can be done without an internal examination at all. They take a smear for flora and, if necessary, tests for infections. If indicated, a pelvic ultrasound is performed to rule out endometriosis and other diseases. The condition of the pelvic floor muscles and the presence of scars are assessed separately.
- Detailed conversation and explanation of each stage
- Careful external inspection
- Flora smear and infection tests
- Pelvic ultrasound according to indications
- Assessment of pelvic floor muscle tone
- Rule out vulvodynia and skin diseases
Treatment
The treatment is built step by step and almost always gives results. They start with information: the woman studies anatomy, learns to notice tension and relax the pelvic floor muscles, and masters breathing techniques. At the same time, they work with a psychologist or psychotherapist, and if anxiety is expressed, they use appropriate methods of assistance. The key tool is vaginal dilators of increasing diameter, which the woman uses herself, at her own pace, without pain. Concomitant conditions must be treated: infections, dryness, scars. It is important to support your partner and refuse to try to overcome the spasm by force.
- Teaching anatomy and relaxation skills
- Psychotherapy, including cognitive behavioral
- Training with vaginal dilators
- Working with a pelvic floor specialist
- Lubricants and local estrogens for dryness
- Treating infections and other causes of pain
- Joint consultations with a partner