PROBLEMS IN THE SEXUAL SPHERE CAN BE JUSTIFIED BY both physical illnesses and mental characteristics, as well as the consequences of various traumas and shocks. The situation is complicated by the fact that people are often embarrassed to talk about such concerns, and more often they simply do not know which specialist to turn to. One such condition is vaginismus, which is a contraction of the vaginal muscles that blocks penetration. We talked about vaginismus with experts – the head of the gynecological department of the ATE clinic, Oksana Bogdashevskaya, and the sexologist and psychotherapist of the Mental Health Center clinic, Amina Nazaralieva.

Penetration fear

Vaginismus is a state of tension in which penetration into the vagina becomes impossible. It is important to understand that we are talking about a reflex reaction, which is difficult to track and even more so to control. Vaginismus can be accompanied by a feeling of fear, tension of the pelvic floor muscles, painful sensations in the vulva when trying to penetrate. At the same time, often the manifestation of vaginismus does not at all mean a reluctance to have sex or a lack of arousal – it is penetration that causes fear. There are different degrees of severity of this syndrome: if in the most severe cases no penetration is possible – a woman cannot even insert her own finger into the vagina – then in other situations she can react painfully only to one type of penetration.

Women who recovered from vaginismus and talked about it in Cosmopolitan and Jezebel admitted that they wanted sex, but could not control the reactions of their own bodies. The heroine of one of the publications faced vaginismus after a long struggle with the psychological consequences of rape. “I was raped when I was a student, and now my body does not allow me to have sex,” she said. “To be honest, I could never even insert a tampon – it seems to me that I do not know at all where the entrance is, and I do not think that anything can penetrate there at all; pain scares me, ” says the heroine of a post on the website of Israeli sexologist Tilly Rosenbaum.

“I remember the only time in high school when I tried to use a tampon. I took one from my mom’s box, sat on the toilet and tried to get it inside. It didn’t work out. I remember how unpleasant it was for me, and it seemed that everything inside was tight. I didn’t understand what was the matter, and I felt rather stupid – what kind of girl am I, if I don’t even know how to insert a tampon? Since then I have only used pads, ” writes the author of Feministing.

Vicious circle

According to Amina Nazaralieva, who helps couples suffering from vaginismus, in some cases painful sensations can appear from the very thought of penetration. She notes that women describe it as a sharp pain or burning sensation in or around the vaginal opening. These sensations cause a kind of “block”, which prevents penetration, and it seems to them that they are abnormal from the point of view of anatomy, that the vagina is too small and narrow, that the penis “does not fit”. These thoughts make them feel ashamed and inferior, and have an aversion to genitals.

As Oksana Bogdashevskaya notes, gynecologists most often encounter manifestations of vaginismus when trying to examine a patient on a gynecological chair. In severe cases, examination becomes almost impossible, and attempts to obtain at least some information in order to solve the patient’s problem can significantly aggravate the manifestations of vaginismus and turn the problem from a difficult to a difficult one.

The manifestation of vaginismus does not at all mean a reluctance to have sex or a lack of arousal – it is penetration that causes fear

There is still no consensus among researchers about what exactly causes vaginismus. Traditionally, it has been attributed to psychological reasons such as conservative religious upbringing, lack of premarital sexual experience, negative attitudes associated with sex, ignorance, and lack of sexual education. Other hypotheses attribute vaginismus to dysfunctional relationships within a couple, sexual and physical abuse, or trauma. Unfortunately, vaginismus is poorly researched, and there is not enough evidence to support one cause or another, according to Amina Nazaralieva.

The problem is often aggravated by the vicious circle of its mechanisms: the girl anxiously awaits penetration, which she is terribly afraid of, associating with terrible pain. During the first attempt in life to penetrate, most often it is about the introduction of a tampon, the pelvic floor muscles involuntarily contract and, if these attempts are continued, against the background of muscle tension, real pain arises. Of course, this increases the anxiety of waiting for the next penetration. As a result, avoidant or protective behavior, catastrophization in thoughts and muscle tension are formed; the anxiety and anticipation of pain increases and a vicious circle ensues.

Who can help

In patriarchal countries, vaginismus is a more common complaint than in sexually liberated societies. However, the true scale of this problem is difficult to assess: according to various estimates, from 0.49 to 10% of women suffer from vaginismus . It is difficult to accurately determine the prevalence of vaginismus, not least because it is a taboo problem, and many patients hesitate to discuss it with a doctor.

True psychogenic vaginismus is different from the fear and avoidance of penetration that results from gynecological conditions such as postpartum trauma or infections that make penetration painful. Vaginismus associated with psychological problems requires an interdisciplinary approach, and gynecologists treat it together with psychotherapists. “In our clinic there are up to ten such patients a year,” says Oksana Bogdashevskaya, “while we do not treat true vaginismus, but only help those whose pain from penetration is associated with other gynecological pathologies. We refer patients with real vaginismus to other specialists. “

At the initial stage of therapy, it is important for a specialist to understand what thoughts visit a woman before, during and after an attempt to penetrate: what she thinks about herself, about her disease, about the attitude of men towards her, about her partner. This is important in the work of the therapist, as judgments and thoughts influence emotions and bodily responses, leading to appropriate behaviors. For example, catastrophic thoughts are accompanied by fear, which can both force you to avoid dangerous situations and cause reflexive protective muscle contraction. But the more a person avoids what makes him afraid, the more he is afraid, since the brain has no way to make sure that it is not really that dangerous.

How is vaginismus treated?

Currently, there are several treatments for vaginismus: for example, since the 1970s, vaginismus has been treated with paired behavioral sex therapy. Most often, dilators are used in such therapy – a set of plastic tips of different sizes, reminiscent of dildos, which should gradually wean a woman from being afraid of penetration into the vagina.

As Nazaralieva notes, the most effective is the method of gradual exposure (exposure) – an approach traditionally used in behavioral therapy for various kinds of phobias. Within the framework of this method, the patient is asked to build a hierarchy of fears associated with penetration. This is a scale from 0 to 100, where 0 is not scary at all, and 100 is the worst thing that can be. For example, inserting your little finger can be scary by 20 points, a tampon by 30, inserting a husband’s finger – 40, inserting two fingers – 60, wiggling two inserted fingers – 70, inserting a dildo – 90, and inserting a penis by 100 points.

The more a person avoids that
which causes him to fear, the more he is afraid. The brain has no way of knowing that it’s not really that dangerous.

The partner is asked to measure the diameter of his erect penis in order to be guided by this figure when choosing dilators. Then 1–3 sessions are carried out in an office equipped with a gynecological chair, lasting 150 minutes. During these sessions, the woman consistently goes through the scales from 0 to the maximum possible (ideally 100). Then she gets her homework – to train the same at home with the participation of a partner. Specialized dilators, from very small to very large, can be purchased at the clinic or online to practice at home on your own.

There are other treatments, including injecting Botox into the muscles surrounding the vagina and pelvic floor physiotherapy. All of these methods are aimed at achieving one goal: to enable a woman to have penetrative sex. This is not about getting an orgasm or pleasure – these goals are achieved in other ways. According to the sexologist, some of her patients have a positive attitude to sex from the very beginning and enjoy it both before and after the treatment of vaginismus. For others, sex is not associated with pleasure, but is important only for the preservation of the family and procreation. And yet, attitudes towards sex are not directly related to vaginismus and will not necessarily change with the cure of this ailment.