V is for Vaginismus

There are times when our bodies rebel against our minds and desires, and choose to have minds of their own.

vagina monologue

There’s a party

Imagine this: you are 17. Your parents have left you alone for the first time EVER, and you have the house to yourself. You just had a birthday last week, so you came into a bit of money from aunts and grandparents who didn’t know what gifts you’d appreciate.
So you do what teenagers do: call your friends for a smol smol get together. Everything is ready – the drinks, the ice, the snacks, the music. You’ve showered, lathered on scented lotion and dressed up. You are ready.

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The doorbell rings, prompting you to jump up in excitement to let them in, to let the party begin. You unlock the door, one hand on the handle, the other on the door frame, and swing the door open. The second your first friend steps foot on the welcome mat, the door slams close, pushes your body against the wall and locks your fingers between itself and the door frame.

You screech from pain but keep it together so as to not scare your audience. You take a deep breath, pray the pain away and proceed to re-open the door – the party must begin. Again, without warning, it violently swings and shuts close, fingers stuck again. This happens over and over until you decide the party is not worth the trauma. Friends have to go away. It’s a party for one now.

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Now, imagine the party is coitus/sex. The host is a woman, the friends – a phallus (penis), the door is the woman’s pelvic floor and the bruised hand is her entire genitalia (I’m talking vagina, cervix, uterus, the muscles, everything there).

Enter vaginismus

This is when the muscles of the pelvis contract suddenly and outside the woman’s control when something invades the vagina. It could be a penis (during sex), a speculum (during a pap smear) or, if severe, even a tampon (during menstruation). This causes discomfort or pain during penetration (dyspareunia) or, at worst, makes penetration impossible. It can occur as early as when a woman has sex for the first time, or begin much later after years of normal sex.

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Fear

The main cause: fear of pain. It is tricky in that, you have fear that it will be painful, thus become anxious about it. The anxiety tenses you up and you therefore get the pain. This reinforces the idea that sex will be painful and further instils fear, thus creating a pitiful cycle.

Sometimes, physical causes can be found – infections, scar tissue after surgery, abnormality of the vaginal wall, etc. Oftentimes however, no physical cause is found. It may be psychological, due to previous trauma, sexual abuse or rape. These experiences may cause fear of intimacy and emotional distress, and that in turn leads to the vaginismus.

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How common/rare is it?

Worldwide, it is thought to affect about 5-17% of women but, as with all issues pertaining to sexual dysfunction, the numbers may underestimate the issue. Embarrassment, shame, or the belief that it is normal, may cause many to avoid reporting this as a problem.
A second issue, not unrelated to the first, is that it is underdiagnosed by doctors. This adds to the illusion about the frequency of vaginismus.

Treatment

In those who are diagnosed, treatment consists of exercises, dilators and behavioural therapy. Basically, this means taking time to unify the mind and body, to allow the body space to slowly and steadily act in accordance with the mind’s will, and to allow the mind to break free from the fear of pain. When the above fails, Botox can be considered. Yes, I said it – Botox. That expensive cosmetic injection used by middle-aged women to stay young and wrinkle-free (by preventing the muscles of the forehead from contracting) can be used to stop the vaginal muscles from contracting and causing pain. Isn’t science beautiful?

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Sex can be a lot of things. It can be euphoric, confusing, weird and beautiful. It can be awkward, fun, tiring and gut-rearranging. But one thing it should not be, is excruciatingly painful.