I HAVE VAGINISMUS

Vaginismus involves both nerves and muscles. It can be a little complicated to understand why and how the muscles in the pelvic floor react, so this is how we at When Love Hurts have come to understand vaginismus:

VAGINISMUS, NERVES & MUSCLES 

THE NERVES

Just like when a doctor tests your knee’s response and your leg automatically kicks, vaginismus is an automatic reflex. When you get anxious or expect pain, the body will automatically respond to protect you. It happens involuntarily. Your will has got nothing to do with it.

Think of a hand approaching a hot stove. Most times you will be surprised at how quickly you reacted. Your body will remember the pain, attempting painful penetration more than once. That way, the next time penetration is about to happen, the body will react against it, tightening your pelvic muscles so hard it cannot happen. Your body is trying to protect you from the threat of pain (penetration), but in doing so, it inflicts more pain. The nerve responses of these muscles become reflexive and harder to control consciously. The pelvic muscles lose flexibility and blood flow, adding to the pain in the long run. Vaginismus can be a vicious pain circle, and that is why patience is essential when it comes to treating it.

THE MUSCLES

The unconscious tightening of the pelvic muscles happens around the urethra, vagina, and anus. Muscles eventually relax when the “threat” of penetration has gone.

The muscles involved are called the Levator Ani and the Perineal Membrane. They sit a little inside the vagina. The levator ani is split into sections, with the pubococcygeus (PC) muscle being the one most involved with vaginismus. The muscle wraps around either side of the urethra, vagina, and anus. A piece of the PC connects with the perineum, between the vagina and anus. When this muscle contracts, it squeezes the urethra, vagina, and anus closed.  The contraction also moves the perineum a bit up and forward. This creates the closed-off, tightened feeling in the vagina. The perineal membrane lies beneath the levator ani muscle, closer to the skin. When it contracts, the membrane squeezes the openings shut. This makes the tightness feeling even more intense. The Levator Ani group is much like the quad muscle in the thigh. It isn’t just one, but a group of muscles. You contract them together, they work as a team. This doesn’t mean that one section can’t be tighter than another section, though. 

LIVING WITH VAGINISMUS

Some women, not all, feel a lot of anxiety in relation to vaginismus. Just the mere thought of something getting near their vulva makes them want to flee. If you feel those overwhelming alarm signals, you probably have to address it cognitively. You need to reframe the action of something coming near you. On your way to overcoming vaginismus, you have to find something to put instead of fright. Look into how people overcome phobias Do I have Vaginismus.

If you can identify specific things or instances that bring on your tightness and pain, it may make it easier to avoid those triggers and to work them through. Any progress is an important step.

DOWNSCALE DAILY PAIN?

• If clothing triggers your pain, try not to wear something restrictive or tight, especially underwear and pants. Comfort is key to relaxing mentally and teaching your nerves and muscles to do the same. Take a break from wearing the things that aggravate your symptoms. Find a long skirt, girdles and choose to go commando (no underwear) 

RESTRICT CERTAIN ACTIVITES

• For example, riding your bike, especially for long periods, can worsen your symptoms. Any action that is stressing nerves and muscles should be avoided when possible.

DEDICATE TIME

• Finding time dedicated to treatment is very important. Set aside time to take care of yourself and try to improve your symptoms. Vaginismus doesn’t disappear by itself.

FEEL SAFE

• Make sure that you feel safe with yourself. Make a list of things you like to do or find relaxing and do some of them when you get upset or stressed. You need to charm your body – convince it that you can take care of it and protect it from unnecessary pain. If you can convince it that you will not let pain be a part of intimacy for whatever reason tricked it, it might lay down its defences and let you decide. Read treatment section Do I have Vaginismus. to learn more.

Work

• Talking to your boss may not be necessary, but if vaginismus makes you clench your teeth because you have difficulty sitting still for long periods of time, there are ways to approach the subject.

• Explain matters as they are and that it is important for you to move around periodically during the day. If you are uncomfortable talking about vaginismus specifically, you can simply refer to your symptoms as a “pelvic or a lower back problem” that makes it painful to sit for long periods of time. Ask your boss if it is okay for you to get up and walk around a few times a day in order to prevent pain. Sitting on a special pillow can relieve the pressure – or make use of a height adjustable desk.  Your lunch break is a good time to stretch or go for a walk. Read Care of Muscles

SINGLE WITH VAGINISMUS

• Enjoy yourself – take time to focus on your sexual needs

• Be in contact with your own sexuality.  Keeping in touch with your body and what gives you pleasure is healthy and important. Pleasurable sexual behaviour creates positive signals for your brain and will help you convince yourself that you can enjoy sexual activity. You may need to put the sexual behaviour on the calendar – desire can fade if it is not being called upon. Read The Love Bit of inspiration.

DATING

First off, do not worry. If it is too much to tell a potential partner about vaginismus on your first date, consider to tell him you have pains around the tailbone or jittery nerves in your pelvis. At your own speed, you can add on to the story. What you started out by telling was not a lie, just a smooth way of building up to reality. Eventually, it is a good idea to explain what is going on. Give your partner the possibility to learn more. Having vaginismus is not a life-long sentence of not being sexually active. But many women explain that they are super nervous to try intimacy or intercourse even after vaginismus. If you’re withholding because you don’t believe a partner will be understanding, know that a lot of women who have vaginismus have great partners; and intercourse is not the only way to be sexually intimate. Vaginismus in a relationship is very much what the two of you make of it. So if you wish a to be in a relationship, give it a chance. You might risk meeting a jerk, but that’s a chance everyone has to take when entering a relationship. Make sure you trust and engage a possible partner.

IN A RELATIONSHIP

Tell your partner what does and doesn’t feel good. Tell them in a nice way. Share if you have had bad experiences. That way you show that you trust them and that you believe they will help you feel good and safe.

Communicating about what both of you want or need is a healthy way to open up your sexual dialogue. Telepathy between couples hasn’t yet been proven to work. Sex isn’t going to become easy all of a sudden. Talking about how your relationship and sex life is a work in progress and helps to facilitate a feasible path for the two of you. Read As a Couple of inspiration.

TIPS’N’TRICKS

Many women tell us they have come far in treating their vaginismus. They just need that last bit of the way – penetration.

All that training on your own is partly meant for you to get a toolbox to use when penetration is about to happen. Of course, it takes time for sex to be pleasurable and safe. Do yourself a favour, choose someone to be with to whom you can say “today is not the day either – let’s do something else”.

Some women tell us they have their first try with another woman. Just a thought. Whoever it is, make sure to be present at the moment. Try not to get wrapped up in “what if it is going to hurt?”

When you are in it, try to enjoy each stage of sexual pleasure without feeling pressure to move to the next. If the next step is not going to be right now, maybe a baby step will be enough for today.

Remember to set the right pace. If you like it slow, make slow sex your new thing. If penetration is fine, maybe just for a short while, be happy about that. How you consider it has a lot to do with expectations.

If possible, find positions that aren’t painful or try to modify positions to stop the pain.  Maybe leaning to one side might help. If you feel fine with just having the head of a penis inside you, use your hands to create a barrier and prevent deeper penetration. Try the woman-on-top position, this allows you to control the depth, speed, and tempo of the intercourse. When Deep Penetration Hurts, Penetration has no veto power

Penetrative sex does not have to be the only way to show that you care. You both can find other ways to express affection. Touching with your hands, using your mouths, stroking bodies can be ways to get close to your partner. Cook in the nude, laugh together, express your affection – lots of partners forget that there is more to intimacy than intercourse. Maybe your thing is to be odd/silly together. Read The Love Bit of inspiration. 

PREGNANCY/FERTILITY

Getting pregnant with vaginismus can be challenging, especially if penetrative sex itself is difficult or impossible. Natural conception and childbirth are possible if you work on your vaginismus first. If you can progress from touching yourself or using dilators up to attempting intercourse, the closer you are to your goal of pregnancy.  If not, it may be beneficial to seek advice from a fertility specialist. You can read further in the Pregnancy section. Consider self-insemination, or maybe pain and anxiety relievers. Of course only if they are safe and responsible options for the ones involved. Talk it through with your doctor.

MYTHS ABOUT VAGINISMUS

“There is no cure for vaginismus”

This statement is completely false. Vaginismus is treatable.

“Women who have vaginismus are frigid” 

Most women with vaginismus are sexually responsive and desire deeply to have sex. When the thought of sex is uncomfortable, or if it hurts every time, who wouldn’t begin to avoid intimacy?

“Vaginismus will go away on its own”

Vaginismus does not get better on its own. It requires treatment. The earlier the treatment is started, the sooner pain-free intercourse can be attained.

“If we just try harder, trying to have sex, it will happen”

Continuing to attempt penetrative intercourse while there is pain only makes the vaginismus worse – not better. Forcing it does not help.

“Taking special vitamins, relaxing, and drinking wine, all cure vaginismus”

These things in themselves do not cure vaginismus. Relaxing, meditating, regular exercise, and eating healthily are all important to one’s overall health but do not cure vaginismus.

“Sex is supposed to hurt”

Sex is NOT supposed to hurt. First-time sex may be somehow uncomfortable, but ongoing sexual pain is not normal and needs to be treated.

“My partner is “too big” for me”

Although it may seem a likely reason, penis size usually has nothing to do with vaginismus.

“All women with vaginismus have been sexually abused”

There are many causes for vaginismus and sexual abuse is one of them.

“Surgery will fix my problem”

There is no surgery to fix vaginismus.