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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 A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by Ann V.

I wish i could give this place 10 stars!! 
I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

Read more: Testimonial by Ann V.

Testimonial by R.D., age 38

"I had a severe tear during childbirth that was not stitched together correctly and therefore healed poorly. Even after having a surgery a year later to remove the scar tissue, I was still having pain, and no one could explain why -- there was no overt 'reason' to explain the pain. I had tried other 'specialists' and even saw another physical therapist who had me do hip / leg stretches -- what a joke! I was about to give up and just 'live with it' until thankfully I kept searching online and found Heather.

Read more: Testimonial by R.D., age 38

Testimonial by J.H.

My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

Read more: Testimonial by J.H.

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