Vaginismus. Not a dinner time topic, and one not often discussed, yet it is thought to affect about 17% of woman. “We have done over 10 000 sexual pain consultations at My Sexual Health”, says Dr Rudolph. This is a staggering number!
You may have recently heard term as Netflix has had two series broach the subject of vaginismus. ‘Sex Education’ and ‘Unorthodox’ both have pushed the envelope in highlighting women’s sexual health and opened the discussion.
“One in five women have pain during sex” states Dr Rudolph, “this is not normal“. Shocking right? “Vaginismus is sexual pain, associated with muscle spasms and a fear of penetration”.
We wanted to give you holistic perspectives on the topic, as most articles on the subject are very clinical. We brought in experts to help from a medical background, providing a two part series on this topic. Covering the why, what and how in this article.
THE UNHEARD OF AFFLICTION
We asked advice of women, who are experts in the field, to bring you the most comprehensive and up-to-date information.
Dr Elna Rudolph, clinical head at My Sexual Health (the largest team of sexual healthcare providers in South Africa). She is both a medical doctor specialising in woman’s sexual health and a sexologist. Hester Aswegen physiotherapist whose speciality is pelvic floor dysfunction and ante- and postnatal physio.
One of the main reasons why women suffer with sexual pain for as long as they do is because doctors don’t get the training needed to even diagnose or refer woman on for treatment. Sadly, a huge percentage of women never get diagnosed. Dr Rudolph reiterates “I always tell doctors that if they don’t have the knowledge about what is causing a woman’s sexual pain in their head, don’t tell her that it is in her head!”
And honestly that is what women frequently get told. The other option often given is a hymenectomy – surgery to make the vaginal opening larger! Often there is nothing wrong with the vaginal opening. Tragically, this story is not uncommon.
THE REAL LIFE IMPACT
At 24 years old, I got married. I could never insert a tampon and never knew why. I was assured by my mother that it would get easier when I got married. Penetration was impossible! Our marriage was eventually consummated through great difficulty and immense pain. To say the honeymoon was a disaster would be an understatement. My husband felt rejected, while I felt guilty at being unable to satisfy him. It placed a huge burden and strain on both of us.
I had become emotionally worn to a point where I would cringe every time my husband came near me, anticipating the pain. I was determined to resolve this. Our GP was clueless as to where to start with all this. Her advise was, ‘Just try and relax’.
Deflated, I then went to a gynecologist thinking that she would have all the answers, being a woman in this field. She booked me in for a hymenectomy which I did not need. The pain continued, making me feel like a complete failure.
Years later I found the courage to try seek help again after realising that my marriage was hanging in the balance and I could not take the weight of mentally preparing myself for the pain I had to go through to satisfy my husband.
“It can be very hard on relationships as the woman will often avoid sex due to the pain and the partner often doesn’t understand this.” Aswegen says. “Some women are too ashamed to talk to their partners. They feel it’s their fault, especially if they have been misdiagnosed, or they haven’t found the right doctor to help them and have been told they must just relax.”
After the hymenectomy, I attempted to get a second opinion from a renowned Gynaecologist, but sadly the outcome was the same. Another surgery, no answers, more pain and more strain on my psychological, emotional and physical wellbeing. I came to the point of such desperation that I thought that it would be easier if my husband just went and had an affair.
As tragic as this is, it is not uncommon. “Many women continue to have sex, although it is painful, for years and years. They don’t know that there is help or they have asked for help and it did not work. We do a lot to try and get the message out that there is help!” says Dr Rodolph.
“We often recommend counselling both for the individual as well as the couple to help them”, Aswegen adds.
There are unfortunately many misconceptions around Vaginismus, because it never spoken about. Aswegen stresses, “People don’t admit to sexual problems and therefore feel very alone and that nothing can be done about it. This can lead to a huge amount of emotional and psychological trauma.”
Here are some of the misconceptions:
- The problem is in your head
- All you need to do is relax
- You too uptight or stressed – have some wine to loosen up
- Change you position, you are doing it wrong
- Is it that you don’t find me attractive sexually as a partner?
But here is the thing: women who suffer from vaginismus do get sexually aroused. They have normal wants and needs. Aswegen adds, “It is so important to explain to women that this is a physical condition where the muscles are too tight and they often have an unregulated nervous system or other factors like stress.”
Dr Rudolph goes on to add, “The most common cause is actually a strict religious upbringing. Of course, one always has to ask about sexual abuse, but in our clinic it is less than in the general population. Exposure to a traumatic examination or procedure, such as getting a urinary catheter inserted as a child, or a gynaecological examination of a young woman, might cause it. There is a genetic link also and then medical conditions like provoked vestibulodynia or many other medical causes of sexual pain can cause vaginismus, including going into menopause or having gynaecological surgery.”
SOLVING THE VAGINISMUS RIDDLE
I asked Dr Roudolph why is there such a lack of knowledge in the medical field, regarding vaginismus.
“We just didn’t have good training in sexual pain in South Africa up until now. Everything I know about it I learned overseas. I have 6 hour training program in sexual pain that doctors can do online now – that will help them diagnose and treat almost all forms of sexual pain.”
The different classes of Vaginismus according to Lamont Classification of Degrees (1976)
- 1st degree vaginismus slight tightness of the pelvic floor, with reassurance and the patient could relax for her examination.
- 2nd degree vaginismus, generalized tightness of the pelvic floor, the patient cannot relax but allows examination.
- 3rd degree vaginismus, the pelvic floor spasm is severe that the patient lifts her buttocks off the bed and cannot be examined.
- 4th degree vaginismus, the most severe tightness and fear, patient tightly closing the knees to prevent any examination.
- 5th degree vaginismus a complete physical, psychological and physiological reaction -Increased heart rate, palpitations, hyperventilation, trembling, shaking, nausea or vomiting, crying uncontrollably, a feeling of light headedness and fainting, a desire to jump off the table, run away.
VAGINISMUS IS 100% CURABLE
If we could get one message across in this article, it’s that there is so much that can be done about sexual pain and that woman are not alone. Aswegen says, “The goal is to achieve good relaxation of the pelvic floor to allow for pain free sex. Additionally, normal function of the pelvic floor so that there are no other problems with the bladder or bowel either.” She goes on to say, “We want to teach women to have control over their bodies and give them the tools to manage the condition. For some it is once-off and for others they might need to manage it for the rest of their lives.”
Team Beauty Warriors had to ask the big question. Can woman who suffer from Vaginismus achieve a healthy sex life?
“Yes absolutely. Vaginismus can be overcome completely with the correct management and normal pain-free intercourse can be achieved,” Aswegen replied with great confidence. She went on to say “Vaginismus is curable. 100 % curable.”
Dr Rudloph ended off by saying, “Women have to see themselves as being equal to men and claim their right to sexual pleasure. It is theirs for the taking!”
Don’t miss our next article on vaginismus, it will include different treatment modalities, at home interventions and medical aesthetics.