The Painful Vaginal Disorder No One Talks About

by Rachel Sanoff

Vaginismus is a disorder that two out of every 1,000 women will experience in their lifetime — probably more, but shame and embarrassment prevents a lot of women from reporting their symptoms. So, in this culture that stigmatizes sexual health and encourages body shame in women, it is important that we ask ourselves, what is vaginismus and how do we treat it should it ever happen to us? Many women have never heard of the vaginal disorder, so they are confused and nervous when they begin experiencing its symptoms. As I write this article, my word processing software won't even recognize "vaginismus" as an actual word.

Vaginismus is a condition characterized by extreme “vaginal tightness causing discomfort, burning, pain, penetration problems, or complete inability to have intercourse," says The disorder results in involuntary muscle contractions and tightening of pelvic floor muscles. The roots of vaginismus can be purely physical, but emotional and mental health, as well as sexual trauma, definitely plays a big part. Not only is vaginal intercourse nearly impossible, if not actually impossible, but gynecological exams and tampon insertions also prove to be extremely difficult. But fear not! Treatment takes time and motivation, but it has almost a 100 percent success rate. But it's pretty difficult to get treatment about something you are embarrassed to say out loud.

I spoke with Dr. Jennifer Caudle, Family Physician and Assistant Professor at Rowan University School of Osteopathic Medicine, about the pain experienced by women with vaginismus. Dr. Caudle tells Bustle, "Treatment for vaginismus helps a woman gain control of her vagina — not only through physical health but through mental health." While it is typically during sexual intercourse when vaginismus becomes a problem, penetration of any kind can be impossible. "Some patients are unable to get pap smears because doctors cannot get the speculum into their vaginas. I've personally had three or four patients so traumatized that pap smears are impossible," she says.

Once a woman finds the courage to speak to a doctor about her sexual pain, she may experience misdiagnosis after misdiagnosis because female patient pain is frequently not taken seriously and there is a lack of awareness about vaginismus in the medical community. In order to diagnose vaginismus, a gynecologist will perform a pelvic exam to identify where the pain is coming from. The gyno has to eliminate any other problem such as endometriosis, pelvic floor disorders, etc. before they can land on a vaginismus diagnosis. Unfortunately, uncaring doctors confused by the disorder can continue with pelvic exams too aggressively; that only causes a woman to associate more pain with her vagina, possibly worsening the condition.

The diagnosis would not have to be so confusing and potentially traumatic if vaginismus was better understood. What should you know about vaginismus?

1. What Causes It?

So what causes these involuntary spasms and pain to occur? Numerous factors, both physical and mental, can be responsible for the disorder, and all of these complex issues must be taken into account in order to provide the best treatment plan. "Yes, it's a physical problem, but often there are psychological issues behind it, too," Dr. Caudle says. "A few patients have had past sexual trauma or experienced abuse. That can manifest itself as vaginismus."

Many doctors compare the involuntary tightening of the vagina to the involuntary shutting of your eyelids when your eye is about to be poked. If a woman has been traumatized after surviving sexual assault or some form of abuse, then her body may defend itself by preventing any kind of penetration. If a woman was not abused, but has only experienced painful sex or penetration, then her vagina may contract as a reaction to pain anticipation. Being raised with negative and shaming attitudes toward sex can also contribute to this physical reaction.

That being said, you do not have to be surviving trauma or dealing with a difficult past in order to have vaginismus. "Sometimes, it is not psychological,"Dr. Caudle says. "There is some gynecological issue physically causing the woman pain so that her muscles clamp down." This can include endometriosis, recovery after childbirth, pelvic inflammatory disease, etc.

Sometimes, doctors can't pinpoint any specific cause. Vaginismus can often occur at various different times in a woman's life, and the disorder is broken down into two types: primary vaginismus and secondary vaginismus. Those who have primary vagnismus have never been able to successfully penetrate their vaginas, whether it is with a penis, tampon, speculum, finger, etc. Those who have secondary vaginismus may have had healthy sex and easy insertion for their whole lives, but later in life their body begins to exhibit symptoms of the disorder. But most importantly, no matter what kind of vaginismus is present, it is treatable.

2. It Impacts Sex Lives

Women often discover this unique vaginal pain the first time they attempt penetration. That could happen during a gynecological exam or during attempts at using a tampon, but women typically discover it when they find that they cannot engage in vaginal sex. The spasms either result in excruciating, burning pain, and/or impossible penetration because the vagina essentially closes up; some women describe it as a wall blocking their vaginal opening. Nothing can get inside. This can understandably wreak havoc on a woman's self-esteem and her relationships.

However, as Meg Zulch writes in an essay for Bustle, amazing sex can still be had while you are building up to penetration. Our heteronormative understanding of sex as soley penis-in-vagina means that you may ignore all of the other ways that you and your partner can be intimate with each other. While it is absolutely very frustrating to not engage in penetrative sex if that is what you and your partner desire, it is important to recognize that you should not feel desexualized or inadequate during the interim.

3. There Are Various Types Of Successful Treatments

The excellent news is that vaginismus treatment has almost a 100 percent success rate. The bad news is that many women don't seek treatment because they are too embarrassed to bring up the issue with their doctors. Or, if they do seek treatment, they are met with unempathetic and cold doctors who tell them to just relax. This is especially frustrating because the sooner vaginismus is treated in a woman's life, the faster the disorder will be cured. The longer a woman has vaginismus, the harder it is to retrain her body (but it can still happen! It just takes longer!)

The most effective way to treat vaginismus is through a comprehensive treatment plan with various doctors, experts, and counselors in order to combat the intersecting physical and psychological causes of the pain and spasming. "I think it's pretty standard that there should be a health care team made up of a gynecologist and therapist," Dr. Caudle says. " A sex counselor is also super important here. For a lot of women, behind their vaginismus is psychological or sexual trauma manifesting itself physically. That needs to be addressed. We definitely want someone with that expertise on the team."

Treatment can typically be done in the comfort and privacy of one's own home, and consists of numerous steps to help a woman build up to pain-free intercourse. The steps differ depending on the underlying cause, as Dr. Caudle explains that the treatment can be shorter or longer if your vaginal pain solely stems from a physical issue or if it stems from a more complex emotional issue. "It is OK for every woman's treatment to be different," says Dr. Caudle. "I hope that's encouragement — no one size fits all."

So what are some of the recommended treatments? The point of all of the program steps is to help a woman gain control of her vagina. Surgery is not required or even a good idea. The treatments combine pelvic floor exercises, like kegels, transition movements to use during intercourse, therapeutic exercises to help identify negative attitudes towards sex and body image, and dilation therapy. Dilation therapy is often misunderstood as a method to stretch the vagina, making it bigger. A woman suffering from vaginismus does not need a larger vagina; she needs to learn how to control her pelvic floor muscles. That is the real point of dilation therapy.

"The dilators should be used in a comprehensive treatment plan," Dr. Caudle says. "Sex counselors are very important... the dilators should be used under the guidance of a sex therapist, counselor, or doctor. Dilation can do a number of things; it helps the woman gain better control of her body. There is also a very practical aspect of the therapy, which is getting used to the concept of penetration. Comfort with penetration is something that has to be relearned, or learned period. Dilation then helps the woman to be penetrated with less pain or sensitivity. It can be a great option."

4. Women Feel Stigmatized, Though They Shouldn't

Vaginismus is so common and can be treated so successfully, so why do women keep this disorder a secret? Dr. Caudle explains that the stigmatization of vaginal pain most likely relates to the fact a woman can't have sex with her partner. She may feel broken, as though something is irreparably wrong with her and she can never satisfy a partner. This stigma is so unfair and heartbreaking because lots of people experience vaginismus and find relief; the disorder shouldn't be stigmatized or feared.

5. Stay Positive And Hopeful!

As aforementioned, the length of treatment required is different for every person, and women should avoid comparing their journey to another person's. As explains, a common reason that treatments are unsuccessful is because patients give up in the midst of the program; frustration and challenges faced during the treatment process overwhelm them. Developing a support system and recognizing that vaginismus is not shameful is crucial for women going through treatment.

"Patients are often embarrassed, ashamed, and don't know what's normal or not," Dr. Caudle says. "And they are already reluctant to talk with their doctor in the first place. So when you finally do get a patient to talk about it, there will be ups and downs. Motivation is so important. Whether you are dealing with the mind, body, or spirit, things take time. It will be a process. You will take five steps forward and two steps back a lot, but that's very common. Surround yourself with encouraging people. That's why having a counselor or sex therapist that you can talk to is so important. It's all about resisting the urge to give up. Hang in there."

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Images: Andrew Zaeh/Bustle; Giphy (5)