Vaginismus is an increasingly recognized condition, partly due to being a topic addressed in different cultural representations (such as the series “Sex Education” or “Unorthodox” on Netflix), allowing not only to raise awareness and open up about it, but also potentially leading to errors, whether etiological, symptomatic, or related to treatment.
What is Vaginismus?
Vaginismus is characterized by the impossibility or very marked and painful difficulty of vaginal penetration, whether during sexual intercourse (penis, fingers, or sex toys) or in a non-sexual situation that requires this introduction (gynecological exams, tampon use, etc.).
This impossibility of penetration or the fact that it is painful is due to tension and/or contraction of the pelvic floor and vaginal muscles, facilitated and accompanied by a state of stress, nervousness, fear, or tension in the person. It is possible that a person has never achieved penetration, in which case vaginismus will be primary or lifelong, or, conversely, it may occur from a certain point in time, thus being secondary or acquired.
How is Vaginismus Treated?
To treat vaginismus, it is recommended to start therapy by having the patient (as it is usually presented by women) look at their genital area with a mirror to identify the different areas and, in the same way, touch and see what sensations they find in each of them.
This allows the patient to know, in the following phases, which areas are being touched and to have a certain sense of security, as well as to integrate them into their mental map. On the other hand, it is recommended to do psychoeducation since vaginismus is often accompanied by fear, and it is therefore important to identify cognitive distortions and situations that can provoke it.
Kegel Exercises for Vaginismus
On the other hand, and since vaginismus is a tension in the vaginal area, it is recommended that the person suffering from it perform Kegel exercises to identify said musculature, whether it is tense or not, and therefore, learn to relax it.
Given that this tension is usually accompanied or caused by a state of nervousness or fear, guidelines are also provided to aid relaxation in order to proceed with the following exercises, which will begin to involve penetration and should be repeated several times once they can be performed.
Exercises for Vaginismus with a Partner
These exercises will be agreed upon with the patient, but in general, they will follow a similar scheme to the following, if you have a partner:
- Self-introduction of one finger without movement (penetrate with one finger and leave it still for a few moments before removing it)
- Self-introduction of two fingers without movement.
- Self-introduction of one finger with movement (once the finger is introduced, move it a little).
- Self-introduction of two fingers with movement.
- Partner-assisted introduction of one finger without movement (the partner introduces a finger, leaves it still for a while, and then removes it): the person with vaginismus guides the partner and is given control so they can feel more secure. This is always the case when, in the exercises, one involving the other person is started.
- Partner-assisted introduction of two fingers without movement.
- Vaginal containment without movement: this involves introducing the penis, without moving it, leaving it for a few moments, and withdrawing it. Certain positions can be recommended so that she can be the one to introduce it (the cowgirl position is a good option) and have control of the situation.
- Vaginal containment with movement: it is important to be able to try other positions when there is enough security to generalize the results.
Exercises for Vaginismus Without a Partner
In case there is no partner, vaginal dilators (cylindrical tubes) of various sizes can be used, which can be bought in packs so that, once finger introduction is achieved, the size can be increased to reach approximately that of a penis.
In both cases, what is sought with the treatment of vaginismus is, therefore, to break the association between pain and penetration, to eliminate anxiety or fear, and to achieve penetration.