Vaginismus - How to treat it?

When a woman's vaginal muscles squeeze tightly, or slams shut making it impossible or extremely painful when penetration with the penis or any other object is attempted, we describe that situation as 'vaginismus'. It's an involuntary contraction of muscles surrounding the vaginal opening. It is different from voluntarily squeezing the vaginal muscles out of fear. Vaginismus happens out of the person's control. In other words, the opening shuts automatically, when intercourse or insertion of a medical instrument is attempted. Penetration would not happen; the attempt would end up in pain for the woman. In the case of intercourse, she might describe the experience as a feeling that the man is 'hitting a wall'. Usually, women having vaginismus would fear genital examination and disallow it, especially inserting any object -even a finger, leave alone the speculum. There are cases where women kicked the staff, jumped off the examination table and ran out. Ridiculous as it might appear, it's a genuine morbid fear for the woman. 

Why does it happen?

No physical cause is identified with vaginismus. It's considered mostly psychogenic. In some women, it can be traced to a previous painful intercourse, or a rough and injurious attempt at intercourse, and severe anxiety. Some are severely apprehensive and anticipate pain and injury during first intercourse. I have known a woman who was terrified watching her sister deliver a baby, and decided to never conceive. The subconscious association of intercourse with pregnancy used to trigger anxiety in her whenever intercourse is attempted and resulted in vaginismus. 

How can it be resolved?

It can be resolved, though it's a little time-consuming therapeutic process. It is not cured with medicines. And, there is no need for surgery. A sex therapist skilled in treating vaginismus, can help the couple resolve their problem through therapeutic suggestions and counseling, without touching the client (I mention this because several clients keep asking us anxiously "do you have to examine me?", and feeling so much relieved on hearing a "no!"). 

How does the therapist go about it?

1. Educating the couple: The couple – especially the woman needs awareness about her basic anatomy and function of the sex organs. what each is meant for, how one should touch, explore and handle them. 
2. Exercises: During sex therapy, she will be given various homework exercises that include: 
   • exploring genitals to increase her level of comfort with the genital area. 
   • using graded vaginal trainers to be inserted into the vagina gently and gradually in a non-threatening way at her own pace, and
   • controlling and relaxing vaginal muscles, and stretching the vagina. 
3. Relaxation: Getting yourself to relax progressively is a matter of exploration and touching, which can help you understand the kind of touch and the exact areas that make you tense. During sex therapy, you may be taught a technique known as progressive relaxation. The purpose is to get gradually comfortable with insertion. 
4. Sensate focus: This is a part of sex therapy and involves your partner. In this method, you will be asked to abstain from sex and touch each other without going to the genitals and other private parts. This will help in better arousal and sexual stimulation, especially for those women who, for fear of intercourse, also experience arousal problems. 

Surgery: Surgery is rarely indicated in vaginismus, unless a physical problem is contributing to it or when there is a need to enlarge the vagina. This may be necessary if a previous surgery has left scar tissue making vaginal entry painful, such as an episiotomy during childbirth. If you wish to discuss any specific problem, you can consult a sexologist.