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why is sex and inserting tampons painful
Yahoo! Life looks to answer the question "Why is sex and inserting tampons painful?" in this article penned by Jocelyn Solis-Moreira. When Jocelyn reached out to me for my expertise I was of course glad to offer some insights. Here is my take on the subject, with a link to the original article at the end.

Heather Jeffcoat, DPT

Why is having sex and inserting tampons painful for some?

Vaginismus explained

Vaginismus is one of our main areas of focus here at Femina Physical Therapy. Since the founding of Fusion Wellness and Femina PT we have seen great strides being made in the acceptance of a vaginismus diagnosis as something that is not only real, but treatable. So it's good to see a major internet presence like Yahoo! taking note of the subject and spreading the news to a wider audience.

The Yahoo! article defines vaginismus as "the involuntary tightening of the vaginal muscles that makes wanted penetration very painful or even impossible", and it then goes into some depth on some well known causes, myths, and treatments. Here are some snippets from the article interspersed with my own thoughts where needed.

What are the symptoms of vaginismus?

The most noticeable symptom of vaginismus is discomfort or muscle spasms when you try to insert an object into the vagina, whether it’s from sex, a tampon or during a pelvic exam. The pain occurs directly at the opening of the vagina,”

Heather Jeffcoat, a physical therapist and author of Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve, tells Yahoo Life. Jeffcoat explains that vaginismus can be misdiagnosed for another condition called vestibulodynia, “which is also painful, but not so much a burning pain, right at the vaginal opening,”.

Other symptoms of vaginismus may include anxiety over sexual intercourse, unsuccessful attempts at vaginal penetration, and/or burning or stinging pain.

After working with so many women on these types of issues in a clinical setting and writing about it here on our site, we have many informative articles on vaginismus that go in depth into all of its causes, symptoms, and treatments.

What's the best way to get a verified diagnosis?

Though great strides have been made in raising the awareness of vaginismus within the medical community, it really helps to have the opportunity to work with a trained specialist in a professional setting. Jocelyn writes:

A women’s health provider or a gynecologist may perform a clinical exam to rule out any physical causes that could explain pain felt during penetration. Kingsberg says one of the diagnostic tests may involve carefully moving a Q-tip around the entrance of the vagina to identify any tissue sensitive to pain. Other internal exams may look for inflamed tissue or infection, such as a gynecological condition that would cause pain rather than the anticipation of pain.

Kingsberg warns that ‌while the underlying pain disorder can be treated, the anticipation of pain may remain because it has become a conditioned response. “Even if you want to insert a tampon or have intercourse with a partner, the vagina is acting as a reflexive response, just like your hand heading to a hot stove,” Kingsberg explains. “The reflex pulls your hand away before you consciously move it, to avoid third-degree burns. The vagina works in the same way and tenses up to protect from the exploitation of pain.”

The "hot stove" analogy is a valid one that many women have struggled with. Any treatment that looks at these issues as purely physical - or purely psychological - is missing the point by failing to look at the mind and body as a balanced whole. There is no reason why any woman should have to live with something that makes sex and inserting tampons painful.

What causes vaginismus in the first place?

This is in effect a multiple choice question, the answer to which in broadest terms falls into two main categories depending on the woman's sexual history. But in either case, there are many possible causes that can still apply. As Jocelyn states:

There are two categories of vaginismus: primary and secondary vaginismus. Primary vaginismus occurs in people who have never had sex and often arises from the anxiety or anticipation of pain during penetration, whether it comes from a finger, a tampon or sexual activity. As a result, your muscles tense up to avoid any possible pain.

People who have successfully had sex in the past but are now experiencing pain during sex have secondary vaginismus.

She goes on to say that many potential causes explain why some people develop vaginismus later in life, including:

  • Disease or medical conditions that cause pain
  • Sexual trauma or sexual abuse
  • Vaginal tears or lesions
  • Falls on their tailbone
  • Trauma from surgery
  • Scarring
  • Endometriosis or infections
  • Menopause
  • Negative feelings about sex
  • An infection, for example bladder infections, yeast infections or a urinary tract infections (UTI) can worsen vaginismus pain.

Are certain women more likely to get it?

The article states that vaginismus affects about 1% to 6% of women according to an American College of Obstetricians and Gynecologists report. Some U.S. and European studies estimate the number to be higher — around 5% to 15%.

Women raised with what could best be described as Puritanical beliefs are more likely to experience vaginismus because they’ve grown up anxious about the perceived “sinful” act of sex. As I mentioned in the article,

Some women can’t just flip a switch, because they’re told their entire life that sex is bad.”

Jocelyn also points out that women who were sexually abused also have an increased risk of developing vaginismus. She points out two studies that reported more instances of childhood sexual abuse, emotional abuse and emotional neglect among women with vaginismus symptoms.

What are the treatment options?

This article includes much more background on vaginismus and the various treatments we offer. To quote from the article:

Jeffcoat says that vaginismus is “100% curable” and not something that anyone should have to live with permanently. Your doctor can develop a plan to tackle both the anxiety associated with pain and getting the body used to penetration.

Treatments mentioned in the article include:

  • Cognitive behavioral therapy (CBT): If there is no physical pain, a psychologist may offer CBT to address and treat negative feelings toward sexual intercourse and anxiety.
  • Vaginal dilator therapy: Doctors may use a set of static medical dilators that range in size from small to large, which allow for gradual relaxation of the vaginal muscles and exposure to penetration. The approach keeps the woman in control and going at a pace she is comfortable with, and allows backing down to a smaller size if there is any discomfort. “Using the dilators helps decrease the expectation of pain” and provides “that confidence to know that when they get to a larger size, they can look back to their progress,” says Jeffcoat.
  • Pelvic floor physical therapy: A physical therapist can help women relax the muscles that have become tight over time from involuntary tightening.
  • Vibration therapy: Jeffcoat says vibration helps reduce muscle tension and is helpful as an initial therapy because it can be used externally before penetration.

In closing I would like to thank Jocelyn for taking such an in depth look into some of the reasons why you might find sex and inserting tampons painful. Click here if you would like to reach out to us for a consultation.

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      A personal journey and testimonial from one of my patients: My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that...

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