Treatment for Vaginismus is usually multi factorial and the good news is that Vaginismus treatment usually has a 100% success rate. The course of treatment is decided based on the cause or causes of the Vaginismus. If there are medical issues that are contributing, the must be addressed. That is usually the easier part of treatment.
The real work comes from addressing the psychological causes and effects of Vaginismus. This is done through psychotherapy, often with a qualified sex therapist.
If a woman has been sexually assaulted, abused or traumatized in any way, she must work through her feelings and issues about this in therapy. Trying to go from having sex used against her as a weapon to having sex be an intimate, pleasurable experience is not easy and it takes courage to do the work needed in therapy to face these issues and seek to have sex become pleasurable again. It is not easy. Sexual trauma in any form is a violation of the most personal type and can have long lasting and devastating effects on the victim. Sexual trust in another can be severely damaged and it can be difficult for her to regain the ability to trust another person with her body. She must go at her own pace when dealing with these issues and with the help of a therapist she can reclaim that part of her life again and think of sex as something wonderful instead of something harmful.
Feelings of guilt and shame about sexuality, body image, genitals, touching and more must also be addressed in therapy. The internalization that takes place with these negative views about sexuality and related issues that make women feel their genitals are dirty, smelly or ugly and that sex is wrong or sinful must be worked through to allow the woman to have positive feelings about her body, including her vagina and that sexual expression is nothing to be ashamed of.
During the first therapy appointment the therapist will take a complete history, medical, psychological and sexual. They will discuss with you the reason for your seeking help and your goals for therapy. They will discuss treatment options with you and with your participation, make a concrete treatment plan. Of course dealing with the psychological issues the woman is facing is an important aspect of treatment. However, part of the treatment plan will be incorporating relaxation exercises and other techniques through “homework” for the woman to do between appointments. The goal for these exercises is to help the woman learn how to control her pelvic floor muscles, be able to consciously relax and reduce stress.
Some of these techniques include:
• Practicing deep breathing from the belly, meditation and relaxation of the entire body to help learn how to relax the body and mind during sexual activity.
• Kegel exercises and other pelvic floor exercises to not only strengthen the pelvic floor muscles but also control them. To understand how Kegel exercises are done, start urinating. In the middle of the flow of urine, squeeze pelvic muscles until the stream of urine stops. Hold this for 10 seconds and then release the muscles and start urinating again. Repeat this pattern each time you urinate and increase the amount of time you squeeze and hold your muscles. As pelvic floor muscles build up, the amount of time you can squeeze and hold them will increase. After a few weeks, a difference should be noticeable. Learning how to identify your pelvic floor muscles as well as control them, also retrains them and helps reduce pain and increases toleration of penetration.
• Sensate Focus. Master’s and Johnson, were the first to utilize Sensate Focus exercises. They 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. It also reinforces the idea that not all touch needs to be sexual or lead to sexual intercourse which can help lower anxiety.
• 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. For this to work, it must be accepted that masturbation is a normal, healthy sexual activity. It can help someone learn about their body, from basic anatomy to what is pleasurable and it can validate the fact that genitals are not dirty or ugly and self pleasuring can be very empowering. Women who experience Vaginismus will be asked to masturbate to help them be comfortable with being touched in the genital area, overcome feelings of guilt and shame about their bodies and sexuality and prepare for the next phase of treatment.
An important part of treating Vaginismus is the use of vaginal dilators. When the therapist feels the woman is ready to start using vaginal dilators, and the woman agrees, she is given a set 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. They can be made of wood, plastic, glass or silicone. These are used at home, alone at first and then with the woman’s partner. The woman starts with the smallest one and over the course of several weeks, works her way up to the largest one. Each day or night, depending on her schedule and comfort level, 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 with the same size dilator 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 without pain, discomfort or muscle spasms. 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. Sometimes it takes several attempts or several sessions of trying, even with the smallest dilator, before it works but she should not be discouraged. With determination and the desire to overcome the problem, she can learn to use the dilators.
When the woman is able to successfully insert the largest dilator with no problems, and she is ready, if she has a sexual partner, it is time to bring he or she into the exercises. Again, starting with the smallest dilator, each night they attempt to insert it into her vagina. First the woman will insert the dilator in front of her partner. This puts her in control of the speed and depth of penetration, and helps reduce anxiety, embarrassment, guilt and shame the woman may be experiencing. It also demonstrates to her partner proper use of the dilator. When the woman is ready, the next step is for the woman’s partner to insert the dilator. They should set ground rules they are both comfortable with before her partner tries vaginal penetration with the dilator. Ground rules to be considered include taking care to go slow, paying attention to any anxiety she may be feeling and agreeing to stop immediately if she tells him to. As with the exercises she did alone, it may take several tries before penetration can be achieved but this is the time for patience and understanding.
It should be apparent that the next natural step in the progression of therapy is attempting intercourse. The most important part of this is that the woman feels emotionally and physically ready to try having penetrative sex. Couples should be sure to use lubricant as liberally as needed, go at a pace they are both comfortable with and have plenty of foreplay. Relaxation exercises should be done prior to sexual activity. This is something couples can do together to enhance the intimacy and shared bond created by dealing with Vaginismus together.
The woman should be on top when intercourse is attempted the first time to allow her to control the depth of penetration and proceed to deeper penetration at her own pace and comfort level. This can also be very empowering to a woman if she has a prior history of sexual assault or trauma.
Couples may have to start and stop more than once in the middle of sex to deal with anxiety and tightening of vaginal muscles. That is ok. They may not be successful with their first attempt and that is ok too. It is not about the penetration but rather over coming the issues that prevent it. Not giving up and having patience and understanding with each other can help increase intimacy as it shows commitment to the relationship. Knowing someone is not going to cut and run because of a sexual problem can be the encouragement needed to want to solve the problem because it shows there is more to the relationship than just sex.
Over time, the woman will become more comfortable with each sexual encounter, and couples can try different sexual positions to see which works best for them.
It is important to point out that at all stages of this treatment, the exercises, dilators and progression to intercourse, the woman is still undergoing therapy sessions. Handing a woman a box of dilators and telling her to go to it is not how therapy works and is not all that is needed to overcome Vaginismus. Continued discussion of issues that the woman brought into therapy as well as feelings she has about the steps of her treatment must be part of an ongoing process between the woman and her therapist.
Often it is a good idea to have her partner join her for a therapy session so they can learn communication tools that help to discuss these issues. Communication in the relationship is crucial for the relationship to survive, not only in times of stress but in every day lives. When it comes to Vaginismus, both partners must be free to express their feelings and fears about what is happening to her physically and to both emotionally. It can be especially difficult on a relationship if they couple previously had pleasurable sex and for some reason are now experiencing Vaginismus.
Currently, the use of Botox for treatment of Vaginismus is getting a lot of attention. There has been a great deal of success with Botox treatment which consists of Botox injections in the vagina to help muscles relax and make intercourse possible. While Botox may make the vagina physically able to relax enough to take in a penis without problems, it is not enough to use it on its own. Again, therapy is needed in conjunction with Botox or any alternative treatment to address the underlying issues. In other words, you can give a woman 100 Botox injections, but if she has been sexually assaulted, no injection is going to help her deal with that trauma emotionally and that is critical for healing and emotional well being. The flip side of that is Botox injections may be just the confidence builder a woman needs to show her penetration is possible. This can help break the cycle of apprehension and anxiety that leads up to an unsuccessful attempt at intercourse.
Some women have reported Acupuncture has helped them tremendously with Vaginismus. Acupuncture is known for helping people relax so this may indeed prove to be beneficial.
By far the most important thing a woman can do about Vaginismus is to understand that there is help available. There is no reason for women to hide in guilt, shame, embarrassment or most importantly ignorance. Suffering in silence is not an option. Instead women should take control of their sexuality, seek out treatment and not let themselves be robbed of an important part of themselves. Women have a right to be sexual, experience sexual pleasure free from pain and love their bodies.
Taking that first step into the unknown with no fear, that leap of faith that we must all find the courage for at some point in life can empower women to seek the right treatment. Therefore, there is no reason Vaginsmus cannot be cured and instead of suffering in silence, women can experience happy, healthy and pleasurable sex lives.
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