Stop being such a pain in my Vag!

Do you avoid Tampons? Your OB/GYN? That cute boy next door? Or worse…Your vibrator?!?
If you have this impending doom feeling upon the prospects of something coming close to your vagina, you might have Vaginismus. 
Vajin-uzmus- pain upon insertion/penetration, leading to emotional distress. 
It is different from Dyspareunia in that it isn’t (just) with deep penetration or thrust. It hurts to even have something as small as a Q-TIP pressed at the 6 o’clock position of the vaginal opening. Resulting in significant anxiety over and avoidance of any stimulation of that area. So much so, that vaginismus is actually considered to be an emotional pain disorder and is listed in the Diagnostic & Statistical Manual of Mental disorders ( DSM 5). 
No, that doesn’t mean its just in our heads. If you  have ever had your neck or back give out after having a really stressful day at work or wicked anxiety, you probably know what I am talking about. 
Now, imagine that, but in your vagina. 

The anatomy of the vagina is a coalescence of three main muscles ( Deep and Superficial transverse perineal muscles,  and the bulbospongiosis). These three merge into something called the central tendon or the “perineal body”- the site that is often compromised during vaginal birth. The true cause of vaginismus is chronic tension in these muscles, either in anticipation of or during penetration.  So much tension, that it results in pain, avoidance, underuse, and subsequently sets up for a worsening pain-fear of pain-worse pain cycle. 
Who is at risk of having it? 

Any woman can develop this at any age. It is typically correlated with having a negative perception or experience of vaginal penetration. Sometimes this correlation is made due to cultural beliefs ( stimulation is bad), sexual abuse ( stimulation is a reminder of a bad experience), physical trauma (stimulation will feel like when you had a tear during child birth). Anticipation of such a negative experience results in tense, less receptive pelvic muscles. Which only further exacerbates the condition by causing avoidance and underuse. Thus creating self perpetuating cycle. 

How is vaginismus treated? 
It is a learned and reinforced negative response to stimulation in the vaginal area. The longer the learned behavior is in effect, the tougher it can be to undo the instinctive response ( pain, aversion). Drawing a womans attention to her sexual health, what is normal discomfort ( partner specific, infection related, positional) versus not so normal ( originated in fear) can be an important starting point in the diagnosis and treatment of vaginismus. 

Breaking the fear-avoidance-pain cycle is critical. I usually recommend that women first get comfortable with exploring themselves.  Literally, take a mirror, look, touch, feel, push, poke, prod. Get to know your anatomy down there. Take the fear of the unknown away and chart the territory yourself so you might be more relaxed about having tourists. 

I reassure my patients that if it hurts, guess what? They can stop, and nothing bad will happen. They are in complete and total control. I also encourage relaxation techniques before, during and after such as deep breathing, music therapy, heck even some wine. The point is to have fun with it. Change the negative of the unknown into a comfortable, doable, known (pun?). 

If these basic measures are not effective, or if it is a very advanced case, pelvic floor physical therapy is my mainstay of treatment. It works. Hands down. This is like having a personal trainer teach you proper form at the gym as oppose to you doing it on your own. The results are definitely more palpable. A pelvic floor physical therapist can assist with muscle relaxation ( myofacial release) either with direct interaction or using dilators. Dilators are not for the purposes of enlarging the vagina ( because that isn’t the issue). They are just to gradually increase your comfort with, well, discomfort. Over time, it becomes easier to not cringe at the prospects of something going up there. And hopefully, one day, there is even a positive anticipation. Thats the sweet spot. 

For more information or if you have any questions, please don’t hesitate to ask. 

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