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Vaginismus / Genito-Pelvic Penetration Disorder
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Vaginismus Recovery - Diagnoses and Treatments

Vaginismus Recovery is Possible

Is it painful to insert a tampon, get through a gynecological pelvic exam, or engage in intercourse? Have you always just thought maybe it’s just supposed to hurt and began to shy away from it all? You’re not alone. There are many women who have felt and thought the same things. What you are feeling is real and the culprit may be a condition called Vaginismus.

What is Vaginismus?

The definition of Vaginismus has been debated over the years and was first introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM), Third Edition in 1980. It was defined as a “recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse”.1 And now in the DSM, Fifth Edition categorized as a disorder in which any form of vaginal penetration or insertion such as tampons, a digit, gynecological exams, vaginal dilators and intercourse is painful or impossible. Women have described it as “hitting a wall”. This disorder has been put under the umbrella of genito-pelvic pain/penetration disorder (GPPPD) in conjunction with dyspareunia (“recurrent or persistent genital pain associated with sexual intercourse”).2

There are two types of vaginismus, primary or secondary. Primary Vaginismus is when the individual has never experienced pain-free vaginal penetration and Secondary Vaginismus is when someone has had pain-free vaginal penetration in the past and is now experiencing subsequent painful penetration.2

Whether you may have primary or secondary vaginismus, there may be a psychological component manifested by fear and anxiety towards vaginal penetration and the feeling of “hitting a wall” is the physical component in which a spasm or overactive state of the pelvic floor muscles in response to stimuli is occurring. This muscle spasm is used to differentiate the diagnosis from other sexual pain disorders such as vulvodynia or vestibulodynia, although “the validity of the spasm-based criterion for vaginismus has never been evaluated”.3

Diagnosis of Vaginismus

Vaginismus recovery begins with a diagnosis with comprehensive medical and psychosexual questionnaires, digital examination, and pelvic exam. Before the diagnosis of vaginismus can be concluded, other possible sources of the pain (i.e. vulvodynia or vestibulodynia) must be ruled out by a pelvic exam. If you have any similar symptoms to the ones described below, make an appointment with your gynecologist and discuss your treatment options.

Symptoms and Associated Affectsdiminished orgasm caused by vaginismus

The symptoms of vaginismus can vary from patient to patient, and often depend on variables such as the severity of the case, how long symptoms have been evident, and other individual physiological factors.

Some common symptoms associated with vaginismus include:

  • Inability to use a tampon (this is usually discovered at a young age)
  • Pain with the removal of a tampon
  • Sensation of “hitting a wall” when attempting vaginal penetration
  • No toleration of gynecological exams
  • Painful intercourse
  • Fear, anxiety, and pain of vaginal penetration

Etiology and Prevalence

The diagnosis is still fairly new to the evidence-based world, therefore the prevalence of vaginismus may be skewed. This may be due to definitional problems throughout the years and the lack of research data. In a 2018 Systematic Review and Meta-Analysis on the outcome of medical and psychosexual interventions for Vaginismus, they noted prevalence rates of:

  • 30% in primary care settings
  • 42% in specialized clinics for female sexual disorders
  • 0.5-1% of community estimates4

We also have to take into consideration that some may NOT even report their symptoms due to common feelings of shame and embarrassment with sexuality and female genitalia. Unfortunately, living with these symptoms can have such a negative effect on an individual’s life and relationships, resulting in a poor quality of life.

Causes of vaginismus are still not clearly established; however, can be considered pathological and/or associated with psychological factors.

Suggested pathological causes include:

  • Vaginal infections
  • Trauma during childbirth
  • Genital surgery
  • Genital radiotherapy
  • Vaginal lesions
  • Congenital abnormalities
  • Associated psychological factors include:
    • Less positive or even negative attitudes towards sexuality
    • Sexual abuse or trauma
    • Relationship difficulties4

Living with VaginismusLiving with Vaginismus

Millions of women worldwide have dealt with the symptoms of vaginismus at some point in their lives. Women experiencing various symptoms of vaginismus can feel:

  • Shame
  • Embarrassment
  • Isolation
  • Depression
  • Fear
  • Anxiety
  • Silenced from failed treatments
  • Failed relationships or marriages
  • Lack of self-esteem
  • Insecure attachment styles
  • Hysterical traits
  • Alexithymia (“inability to recognize or describe one’s own emotions”)4

As you can see, vaginismus can have a highly negative impact on one’s quality of life, and it’s important that we educate ourselves and our loved ones that may be suffering from this diagnosis, and let them know that there’s hope. There are treatments that have been shown to be effective and improve many individuals' quality of life.

Vaginismus Recovery and Treatments Used

Due to definitional challenges, unclear etiology, limited research, and disorder similarities (ex. dyspareunia) it is difficult to propose a good quality research on treatments for vaginismus. A lot of current treatments are based on expert opinions and clinical experience rather than evidence-based randomized clinical trials.4 However, within these clinical experiences clinicians have found successful outcomes for their patients.

To treat something that has both psychological and physical components, it’s ideal to have a multidisciplinary approach and a supportive team.

Some forms of treatments include:

  • Vaginal dilators
  • Physical Therapy with or without biofeedback
  • Sex and relationship counseling
  • Psychotherapy
  • Cognitive behavioral therapy
  • Lubricants
  • Botox

One 2018 systematic review and meta-analysis found that approximately 80% of cases benefited from various treatments (behavioral sex therapy, CBT, pharmacological therapy, pelvic floor physical therapy and removal of hymenal remnants), with none superior than the other.

A clinical trial published in 2017 also found that 71% of the participants achieved pain-free intercourse within a mean of 5.1 weeks following a treatment involving botox, vaginal dilators and group counseling.

Although the mean time of effective treatment was recorded at 5 weeks, understand that everyone’s path and journey is unique to the individual. One person may take 5 weeks, where another can take 6 months to achieve pain-free intercourse. Everyone’s severity, lives, and environment are so different. Follow your path and enjoy this journey to self care and embrace the tremendous amount of knowledge you’ll gain towards a better quality of life.

Here at Femina Physical Therapy we having a caring and passionate team of physical therapists that can help you through this process. We work hand and hand with gynecologists and sex therapists to create a supportive health care team for you. You can make an appointment today at any of our locations to start the road to vaginismus recovery.

 

References:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Publishing; 1980

Pacik PT, Geletta S. Vaginismus Treatment: Clinical Trials Follow Up 241 Patients. Sex Med. 2017;5(2):e114-e123.

Reissing ED, Binik YM, Khalifé S, et al. Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus. Arch Sex Behav 2004;33:5-17.

Maseroli E, Scavello I, Rastrelli G, et al. 035 Outcome of Medical and Psychosexual Interventions for Vaginismus: A Systematic Review and Meta-analysis. The Journal of Sexual Medicine. 2018;15(6).

Lamont, J, Glob. libr. women's med., (ISSN: 1756-2228) 2011; DOI 10.3843/GLOWM.10430

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What Our Patients Have to Say

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Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

Read more: Testimonial by Lauren B.

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

Testimonial by S.P., Age 26

I would like to start off by thanking Heather Jeffcoat for educating me and curing me of Vaginismus. I had been married for almost three years before I was referred to Heather. I never knew about Vaginismus until almost three years into my marriage. I knew something was wrong when I went on my honeymoon and came back a Virgin. I had always imagined how magical my first night would be but boy was I wrong.

Read more: Testimonial by S.P., Age 26

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