Involuntary Vaginismus

Vaginismus Definition:  Involuntary vaginismus occurs due to the contraction of the muscles of the outer third of the vagina when trying to enter during intercourse.

A woman who suffers from vaginismus does not intentionally or intentionally tighten her muscles, but when penetration occurs, the vaginal muscles contract automatically for psychological or other reasons.

It may occur in different circumstances. It may start with the first full sexual intercourse and is known as “primary vaginismus,” and it may begin after a period of normal sexual intercourse and is known as “acquired vaginismus.”

Some women experience muscle contraction in all situations where penetration occurs, which is known as the “generalized pattern”; While some women experience vaginismus in a few situations or circumstances, for example during a gynecological examination in a doctor’s office, this spasm is known as the “situational pattern”.

In order for the condition to be diagnosed as involuntary vaginismus, it must be caused by psychological factors or a combination of psychological and medical factors and not be caused by medical factors only. This part will focus on the psychological causes of involuntary vaginismus and methods of treatment.

The reasons

There are many possible factors that may cause muscle contraction; For example, patterns of upbringing that consider sex a sin or sin—as is the case with some strict religious backgrounds, as well as a fear of the pain of penetration, as with the first sexual experience; It is also believed that women who feel threatened or oppressed in their relationships may use this involuntary contraction of the vaginal muscles as a defense or silent objection to the relationship, and traumatic childhood experiences such as sexual harassment are believed to be one of the causes of vaginismus. Often the acquired pattern results from sexual assault or rape.

Symptoms

Involuntary vaginismus may result from penetration of the vagina by any means, including attempting to enter using the penis, speculum, or other means.

The outer third of the vaginal muscles contract tightly and may block entry completely or make it difficult and painful; A woman has a sincere desire to engage in sexual intercourse or to allow penetration, but she finds that her unconscious desires do not allow the muscles of the vagina to relax.

Diagnosis

Sexual disorders, including tics, are often difficult to diagnose, mainly because many people feel uncomfortable discussing their sexual relations, even with their doctors. Cultural traditions and taboos often prevent women from seeking help when they have such problems.

If involuntary contraction occurs during sciatica when consulting a doctor or obstetrician-gynecologist, this confirms the diagnosis; After the doctor has ruled out any physiological causes, and when he suspects that there are psychological causes, the doctor must refer the case to a psychiatrist.

The first criterion for diagnosing involuntary vaginismus is the involuntary contraction of the outer third of the vaginal muscles, repetitively or continuously, and the symptoms cause movement or physical pain, especially during relationships, and it must be ensured that these symptoms do not appear in association with any other mental illness; As mentioned before, these muscle cramps must not appear as a result of any physical or medical condition to be diagnosed as involuntary vaginismus.

The incidence of vaginismus

Although many women suffer from sexual disorders, it is difficult to collect correct data regarding the percentage of these problems, as there are many cases that are not counted.

Vaginismus treatment

There are many different treatments for tics, as well as a range of methods for treating most sexual disorders.

A psychotherapist may use techniques of behavioral therapy, hypnosis, psychotherapy, education, or group therapy; Several methods may be used simultaneously in treating the same patient; Most treatments also aim to reduce anxiety related to penetration.

1- Psychotherapy

There are three axes on which psychotherapy is based: individual, marital or group therapy.

Individual therapy focuses on identifying and resolving any real psychological problems that may be causing the disorder, such as problems stemming from things such as childhood abuse or rape; As for dread and fear of sex, whether because of parents’ attitudes or religious upbringing, it can often be discussed successfully if the affected woman trusts her treating doctor.

Marital therapy is referred to as “dual sex therapy”, and the idea of ​​this therapy is that any sexual problem should be treated as a problem for both spouses and not as a one-sided problem. By adopting this point of view, the psychiatrist interacts with patients individually and as a couple. The psychiatrist records the couple’s sexual history and any other problems that may exist in the relationship. Facing these problems may contribute to overcoming the causes of vaginismus. Cooperating with a therapist to resolve relationship issues is very effective—especially in cases of subconscious vaginal muscle contractions as a form of silent objection to one or more aspects of the relationship. Both parties are educated about what involuntary vaginismus is and they are advised of some activities to do together at home that may help overcome the disorder.

Group therapy, which can be very effective, is another form of vaginismus treatment. In this type of treatment, couples or women with the same problem are grouped. For people who feel ashamed or confused by their problem, this type of therapy provides reassurance and strength. There is often a huge benefit in watching someone else discuss sexual issues in an open and honest meeting, as it may inspire some patients to be more open and honest too.

2- Hypnotherapy

Hypnotherapy is effective in some patients. Hypnotherapy focuses on overcoming the vaginismus itself rather than treating the complications and causes. The therapist decides if hypnotherapy is appropriate for the patient. There are usually several sessions during which the therapist and patient set the goals of hypnotherapy. When actual hypnosis occurs, suggestions are made to treat underlying fears and relieve symptoms. For example, the patient is told that she can have sex without pain and that she can overcome muscle spasms.

During hypnosis, the problems causing vaginismus are explained, or even an attempt is made to reverse the feelings or fears that may be causing the disorder. And hinting to women that they are able to overcome contractions of the vaginal muscles, is one of the very effective methods with many patients.

3- Other treatments

Behavioral therapy is also used in the treatment of vaginismus. When choosing behavioral therapy, this disorder is meant to be a learned and acquired behavior that can be forgotten and brought up.

Another type of vaginismus treatment is using desensitization treatment over a period of time by gradual enlargement of the vagina. At the beginning of the treatment, the woman inserts a small size vaginal dilator, and over time, the size of the dilator is gradually increased until it reaches the size corresponding to the size of the penis comfortably, and sexual intercourse can be established.

However, there is some controversy regarding this method, as it treats the symptoms and does not address the underlying causes.

Predicting the course of the disease

Vaginismus is the most treatable sexual disorder. The percentage of successful treatments that have been observed in 63% or more. Different treatment methods have different chances of success for different people due to the variety of causes of vaginismus.

 Generally, a combination of two or more treatment techniques is recommended.

Protection

There is no known way to prevent involuntary vaginismus; In any case, continued open communication between spouses may help prevent this disorder.