Vaginismus, unbreakable fortress

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By the means of involuntary contractions of the pelvic floor muscles, vaginismus forbids any attempt of vaginal penetration (finger, tampon, speculum, penis) and is therefore a sexual disorder that affects many couples, especially at procreation stage.  This disorder is actually not incompatible with a pleasurable sex life (penetration kept aside), which can sometimes be satisfactory and sufficient for these couples… until they wish to have children.

A psycho-physiological deadlock… in a healthy body:

From the anatomic perspective, the genitals are most of the time “normal”, but the muscles contraction preventing all kind of penetration can be a source of problems, from a slight incomfort to a burning feeling or a strong tearing pain. We usually distinguish between to types of vaginism: The primary one concerns young women still virgin, on their very first attempts of penetration. The secondary one can occur after a fairly normal sex life, most of the time as a consequence of a trauma or dispareunia.

Any attempt of gynecological examination is therefore impossible. By “locking” their legs and moving their body backwards, women protect themselves. Such a primal fear behavior goes together with a strong contraction of the anal muscles.

Vaginismus: Causes

The absence of a proper sexual education can be at the origin of the problem, genitals considered dirty and disgusting and sexuality, disgraceful. Since masturbation is sometimes completely banned, those women have absolutely no knowledge of their own intimate parts, and never had the chance to look at themselves in a mirror to “explore” their own genitals. They imagine that their vagina is a very narrow channel protected by a thick hymen. Hence, they live any attempt of penetration as an assault, potentially causing tremendous pain. Vagina does not enter into account at all when it comes to consider their body. In this scheme, the male’s penis is feared as a dagger.

Sometimes, the woman knows her own body, but the latter protects itself against any attempt of penetration, through an unintentional « deadlock ». Past traumas are often encountered in this case, should they involve childhood or adult assaults or even rape.

Sometimes also, an unconscious problem can interfere (latent homosexuality, sexual phobia, fear of getting pregnant…). In those cases, the classical sex therapies will be unefficient.

The existing options for treatment

Referring to a sex therapist is of course advisable. He will propose a couple’s therapy allowing the woman to discover her own anatomy and physiology. Together with her companion, she will slowly apprehend (at a mental stage at first, then physically) her vagina in order to make it “hers” again, and will then disable this protection mecanism. The therapist could also, depending on his background, propose a psychotherapeutic follow-up or relaxation sessions…

More complex situations can be observed, for which a deeper approach is required (such as analysis), leading to solve the unconscious conflicts that may disrupt the sex therapy.

Prior to the therapy: a few tips…

As a first step, it is mandatory to restore trust and “security” in the couple. Replacing unsuccessful attempts of penetration by tender cuddling involving massages and light touch.

Meanwhile, learn about your anatomy, with documentation at first, then with a mirror, preferably after a warm bath. Once you manage to proceed without any stress or tension, start exploring your vulva from the outside using a lubricated finger… Along this process, you will discover the entrance of your vagina, and as soon as you feel ready for it, slowly introduce this finger inside this warm and humid cavity. Also learn to contract and release your perivaginal muscles around your finger. Once this is done with two fingers and without any pain, you can guide your companion’s lubricated fingers for the same experience. The next step will consist in rubbing your vulva with your companion’s lubricated penis, while riding him. By controlling your moves and his, and as soon as you feel ready, let your vagina “take” your lover slowly.

This process is of course easier to handle in the frame of a therapy, which will quicken the settlement of the problem within a few months, depending on each problematic situation.

Sandrine Atallah, MD

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