This entry is a guest post by pelvic health physiotherapist Angelique Montano-Bresolin, on a comprehensive approach to treating vaginismus–a condition that can cause pain during intercourse, gynecological exams and tampon use.
Vaginismus has been defined as ‘recurrent or persistent involuntary muscle spasms of the outer third of the vagina which interfere with sexual intercourse’ (Binik, 2010) or the ‘inability to experience desired vaginal penetration during intercourse’ (Basson, 2004). The pain associated with penetration can often send a woman into a cycle of humiliation and anxiety that leads to her avoidance of sexual intercourse or any type of gynecological exam. This can have negative consequences to her personal relationship as well result in poor gynecological follow up care. Any further anticipation or thought of penetration will then set off her fear, and again lead to a vaginismic response of muscle spasm (Butcher, 1999). The cycle will then continue to repeat itself.
We can see that this cycle involves physical, emotional and psychological components. This is why when it comes to treating this condition, a multi-disciplinary approach is recommended.
Physically, women may benefit from working with a pelvic health physiotherapist that can assist with desensitization exercises with the use of dilators, optimize co-ordination of pelvic floor muscle function and educate on appropriate breathing mechanics. Exposure based treatment with dilators and mirror work can also help someone with vaginismus establish a sense of control which can help overcome the fear of penetration (Ter Kuile, 2009).
Scientific evidence also points to the use of cognitive based therapy to help address erroneous cognitive beliefs that are associated with a conditioned vaginal spasm (Van Lankveld, 2007). By working with a sex therapist, psychotherapist or psychologist, the woman can change her automatic thoughts, beliefs and responses to vaginal penetration. A sex therapist may also help with the strain that personal relationships may take on when tackling this condition.
Incorporating pain education, physiological relaxation, meditation and other modalities to help calm a sensitized nervous system may be effective. By targeting vaginismus from several angles, a woman can achieve better treatment outcomes and improve her overall quality of life.