As a Psychosexual Psychotherapist I work with the condition of vaginismus a lot and I have to say that it is one of my favourite themes of work.
Vaginismus is a condition involving an involuntary muscle spasm in the pelvic floor muscles, which results in penetration of the vagina being painful, difficult or even impossible. This can make not only penetrative sex a problem, but also the use of tampons and medical examinations, such as smear tests.
Vaginismus is caused by a wide range of biological, psychological and social factors.
On the biology side, if a person with a vagina has vulvodynia, vulal eczema or psoriasis, repeated bouts of BV or thrush, overactive bladder or chronic urinary tract infections, or any other condition affecting the reproductive system, they are likely to experience pain during sexual activity which could, quite understandably, trigger vaginismus. It’s the pelvic floor’s way of saying ‘no thank you’ to pain.
Connected to this, on the psychological level, a person who experiences sexual pain once, naturally expects pain to happen when they are sexual again. This can mean that they feel less relaxed in a sexual situation, are insufficiently aroused, brace themselves at the point of penetration and… lo and behold .. experience pain. This is referred to as the cycle of pain.
Other psychological aspects of vaginismus can include disgust and revulsion at the thought of penetration, or sex of any kind. In these cases Psychosexual Therapists need to be careful to explore whether the aversion is due to asexuality or a generalised squeamishness.
Vaginismus can also be triggered by fears and phobias connected to the idea of penetration, or the consequence of penetrative sex, such as pregnancy or STI’s. It can also be connected to poor sex education and inadequate technique, which leads to reduced arousal, insufficient lubrication and, consequently, painful sex. I am constantly surprised at the lack of knowledge people have about their sexual anatomy and the routes to arousal and can say that a lot of time in psychosexual therapy is devoted to basic sex education.
Finally, but by no means typically, vaginismus can be triggered by sexual abuse and sexual assault. Again, the pelvic floor can communicate perhaps what the person can’t – a clear No! to sex.
The social contributing factors to the development of vaginismus include strong cultural and religious messages of penetrative sex being preserved for marriage. If a person with a vagina is raised in a culture that prizes virginity before marriage, their body can act in line with these messages and unconsciously refuse vaginal penetration, even when the prohibition has been lifted and they are married.
So why do I love working with this theme? Well I love working as a Psychosexual Psychotherapist primarily, but the great thing about working with vaginismus is the potential for recovery. In my experience, if time and care is taken in accurately determining the contributing factors to vaginismus, and treatment is tailored to each individual client, the chances of recovery in the safety of a strong therapeutic alliance are high.
The problem is that myths still abound about the condition of vaginismus which are not helpful.
People with vaginismus don’t like sex
This is not at all true. Most of the people I have worked with who have a diagnosis of vaginismus are sexual and are enjoying all aspects of non-penetrative sex. In cases where the cause of the vaginismus is sexual disgust, fear or phobia, if the client does not identify as asexual, sexual arousal can often mitigate and overcome disgust responses.
Vaginismus is caused by sexual abuse
Of course, some people with vaginismus can trace the cause back to sexual abuse or assault. But not every case of vaginismus has a traumatic cause and assuming such can be confusing and frustrating to people presenting with this condition.
There is something wrong with the vagina
Vaginismus is an involuntary spasm of the pelvic floor. The vagina is a potential space in that area that is closed due to the pelvic floor spasm. Vaginismus is not the vagina’s fault!
Penetration is important
In our culture, particularly for heterosexually identified people, penetrative sex is seen as the aim of all sexual activity, the pinnacle, the be all an end all. Well, news flash …. it isn’t! Penetrative sex is just one form of sex and, spoiler alert, not everyone likes it (even people with penises!). Many of my clients with vaginismus have come into therapy after years of satisfactory sex to resolve vaginismus in order to conceive. That is a perfectly understandable reason for accessing therapy for sure, but knowing that a very small self-insemination kit could do the job can take some of the pressure off achieving penis in vagina penetration – fondly referred to as PIV by sex therapists.
Vaginismus is only experienced by heterosexuals
Vaginismus is not just about penis in vagina sex and penetrative sex is not only desired by heterosexual people with vaginas. People with vaginas of all gender and sexual identities may desire penetrative sex and may have vaginismus.
If you are struggling with penetrative sex and would like professional support to resolve it, please ensure you go to your GP first for an accurate diagnosis. You can access a specialist trained psychosexual therapist through Sex Therapy Herts or on the COSRT register. undefined