Sex Questions from the Twittersphere: Treatments for Vaginismus
Dr. Carol Queen replies to this question from our social networks:
Whats the best path of treatment for vaginismus? Are there any good online resources for self-help? (asking on behalf of my gf)
I’m not sure about the vast range that the online world offers re: this, but there is a substantive-looking site called vaginismus.com which is certainly worth exploring. And there has been one good book written about Vaginismus, which is a condition which involves the vagina not relaxing enough to allow for comfortable penetration — sometimes the tightness is so extreme that even a finger can’t be inserted without pain. Its functional definition refers to the inability to have intercourse. The book is called “When a Woman’s Body Says No to Sex,” the authors are Linda Valins and Susie Orbach, and of course it’s way out of print, as so many good sex books are.
However, just the title is worth considering, as is the definition of vaginismus itself, since of course, “sex” isn’t *penetration* by definition — even though so many people seem to think it is. And there appear to be two main reasons a woman’s body (or, for that matter, a man’s or a transgendered person’s body) has this response — well, actually I think I’ll say two and a half reasons. The first is that some trauma has occurred to cause a fear response (this could be an experience like rape or abuse, but could also be something like fear inculcated by a person’s erotophobic background); the fear response causes a clenching of muscles that results in the tightness and pain of vaginismus.
The second is that pelvic pain of any sort might result in such a response, even if the condition that originally caused the pain has been resolved. That’s the one-half reason: the fact that a pain response seems to be, at least for some people, learned, and the body must *un*learn it to be able to overcome vaginismus.
This may involve emotional/psychological healing from any past trauma (a wonderful set of references for this are Staci Haines’ books, “The Survivor’s Guide to Sex” and “Healing Sex: A Mind-Body Approach to Healing Sexual Trauma”; there is a video as well). This healing may well involve the help of a qualified therapist; having a supportive partner is also very valuable (so thank you for reaching out on her behalf, but guard against being so eager for her to heal and get comfortable with sex that it feels to her like pressure). Haines, by the way, maintains a private practice in San Francisco and founded a nonprofit, Generation 5, which is dedicated to ending child sexual abuse within five generations, and depending on your partner’s situation, it might be a useful resource.
Overcoming vaginismus may, instead (or in addition), require work to heal any physical source of pelvic pain — I mean physical *malady*, not painful experience. My sexologist colleague Heather Howard, Ph.D., specializes in this; though there are other pelvic pain specialists out there, few if any are also trained sexologists. Pain, especially the kind that lingers as a sort of learned response, can be a tough nut to crack. If some disease or injury is present, it will be important to get a diagnosis — not always easy, when a woman can’t stand to have a pelvic exam — and choosing a physician with some knowledge of vaginismus would be important.
Home healing involves relaxation, graduated-in-size dildo-like items called “dilators” used with ample lubricant, and sometimes a lot of demystification and learning about sexuality, especially for the woman whose vaginismus is related to growing up in such an erotophobic environment that she’s developed the belief that sex hurts. (This is sometimes necessary in a trauma survivor’s case too — understanding, for instance, that a rape experience is not the same as a desired experience of intercourse may not be easy.)
As Dr. Jack Morin said of anal penetration, if the person to be penetrated really desires the experience, it can make all the difference: for a woman to really desire penetration under these circumstances, it matters enormously that she feels fully supported and that her boundaries are her own. (She may also be battling shame around being different from other women, and that, too, needs support to be healed.) Best of luck to the two of you, and please reach out to explore these resources when your partner is ready. –CQ