Many women around the world suffer from the problem of vaginismus without knowing the reason behind the pain. Studies indicate that between 5% and 17% of women may suffer from vaginismus at some point in their lives, so understanding this problem and talking about it is the first step towards treatment, especially with the availability of effective treatment methods that combine psychological and physical aspects. As a result, follow with us the following article to understand the types of vaginismus, its symptoms, causes, and the different treatment methods offered to you by the specialists at Al Mousa Hospital.

What is vaginismus?

Vaginismus is a medical condition characterized by an involuntary contraction of the pelvic floor muscles surrounding the vagina, which makes penetration such as intercourse, inserting sanitary pads, or a medical examination painful or impossible. It can also be primary, occurring from the beginning of attempts, or secondary, appearing after a period of normal sexual activity.

Types of vaginismus

Vaginismus has been classified into several different types based on when it occurs and its nature, and the most common types are listed below.

1. Primary vaginismus

• It occurs from the beginning, i.e. at the first attempt at penetration.
• The woman was never able to tolerate penetration due to involuntary muscle contraction.
• It is often associated with anxiety, fear of pain, or lack of knowledge about sex.

2. Secondary vaginismus

• It appears after a period of normal sexual activity without problems.
• It may result from causes such as trauma such as a traumatic sexual experience or childbirth.
• Or it may result from vaginal infections, hormonal changes, or injuries in the pelvic area.

3. Global vaginismus

• It occurs in all situations and with any attempt at penetration, whether sexual or medical, such as a pelvic examination or the insertion of medical instruments.

4. Situational vaginismus

• It only occurs in certain situations such as during intercourse or during a medical examination.
• While penetration may be possible in other cases, such as using a sanitary napkin.

However, we note that the symptoms may vary in severity from one woman to another, and the spasm can be a combination of these types. Accordingly, treatment depends on the type and cause, and usually includes psychotherapy, relaxation exercises, or medical treatment.

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Physical and psychological causes of vaginismus

Vaginismus usually occurs as a result of the interaction of physical and psychological factors, which leads to involuntary contraction of the vaginal muscles. Below we list the causes in detail.

First: physical causes

• Inflammation or infection: Vaginal infections, such as yeast infections or bacterial vaginosis, may cause pain that leads to defensive muscle contraction, or recurrent urinary tract infections.
• Hormonal changes: Low estrogen levels during menopause or lactation cause vaginal dryness, making penetration painful.
• Physical injuries: injuries resulting from childbirth, such as tearing or stitching, as well as previous surgeries in the pelvic or vaginal area, or trauma resulting from painful medical experiences such as an uncomfortable pelvic examination.
• Medical conditions: endometriosis or fibroids, which cause pelvic pain, as well as tight vaginal syndrome or anatomical abnormalities.
• Vaginal dryness: resulting from a lack of natural lubrication, or insufficient foreplay before intercourse, which leads to a feeling of discomfort during intercourse.
• Congenital malformations: There may be congenital malformations in or around the vagina, or problems with the hymen, which causes difficulty in penetration.

Second: psychological reasons

• Anxiety and fear: Fear of pain during penetration, especially if there has been a previous painful experience, or anxiety about sexual performance or pregnancy.
• Trauma: Experiences of sexual assault or harassment, or previous negative sexual experiences.
• Negative beliefs: False or negative beliefs about sex may lead to fear and anxiety, which increases the chances of vaginismus, as can feelings of guilt or shame associated with sexual activity.
• Stress and psychological pressure: general tension in life or difficulty in the relationship with a partner, as well as lack of self-confidence or negative body image.
• Lack of sexual education: Insufficient understanding of sexual anatomy or the sexual process, leading to fear or stress.

Physical and psychological causes often overlap, making multifaceted treatment important. Therefore, consulting a gynecologist is a necessary step to rule out physical causes and a psychotherapist to address psychological aspects are essential steps. Through Al Mousa Specialist Hospital, we offer you both, as you will find in the Women’s Health Center and the Rafah Center for Psychological Support integrated medical services that guarantee you a marital relationship without any vaginal spasms.

Symptoms of vaginismus

Symptoms of vaginismus relate to an involuntary contraction of the pelvic floor muscles surrounding the vagina, and thus the symptoms are as follows:

• Feeling sharp pain or burning when trying to have intercourse, insert a sanitary pad, or undergo a medical examination.
• Inability to penetrate, insert a sanitary pad, or medical examination tools due to involuntary muscle contraction.
• The vaginal muscles automatically contract when penetration is attempted, making the vagina closed or very tight.
• Feeling nervous or afraid when thinking about intercourse or a medical examination, which may lead to avoiding these situations.
• Decreased sexual desire due to pain or fear, so the woman may avoid sexual activity completely.
• A general feeling of discomfort or pain in the pelvic area, especially during or after penetration attempts.

How does vaginismus affect marital relations?

Depending on its nature and symptoms;

• Vaginismus may prevent penetration, making intercourse impossible or painful, and this may lead to avoiding sexual activity altogether;
• Pain or fear of penetration may reduce one or both partners' desire for intimacy.
• The woman may feel guilty or inadequate for not being able to have intercourse, while the partner may feel rejected, leading to emotional stress.
• The couple may avoid discussing the problem due to fear of hurting the other party's feelings, which increases emotional distance.
• Fear of pain or failure in sexual relations may increase stress in the wife, while the husband may feel helpless or not understood.
• Low self-confidence. The woman may feel abnormal, and the partner may feel frustrated if he does not understand the nature of the condition.
• If the problem is not addressed, it may lead to conflicts or feelings of neglect by one or both parties.
• If a couple is planning to have a baby, vaginismus may delay pregnancy, putting more stress on the relationship.

Book your consultation now at مركز صحة المرأة At Al Mousa Specialist Hospital.

Methods of diagnosing vaginismus

The diagnosis of vaginismus depends on a comprehensive assessment of your psychological and physical condition. The doctor usually begins with a listening session during which you recount your experience with sexual intercourse or attempts at penetration. The doctor then asks questions that help understand the nature of the problem. The diagnostic steps are as follows:

1. The doctor discusses your medical and sexual history by asking questions about your symptoms, when the problem started, past experiences and traumas, as well as your general health history.
2. It is also important for your doctor to ask about anxiety, fear of sex, or beliefs that may affect your experience.
3. After recording the results of the questions, the doctor begins an external examination of the genital area.
4. Then try to examine the vagina using a medical instrument. In the case of vaginismus, an involuntary contraction of the vaginal muscles may be observed.
5. Tests are done to detect vaginal infections, such as yeast infections or bacterial vaginosis.
6. Hormone tests can also be done to check estrogen levels, especially if there is vaginal dryness.
7. In rare cases, imaging such as ultrasound may be used;
8. Whereas if the doctor suspects psychological reasons and not physical ones;

Treatments available for vaginismus

As we mentioned, vaginismus is the result of psychological and health reasons, so it is considered a highly treatable condition, especially upon early diagnosis and adherence to the appropriate treatment plan. Through Al Mousa Specialist Hospital, we offer you a combination of treatment methods, including psychological and physical support.

Psychological and behavioral therapy (CBT).

• It helps get rid of the fear associated with sexual relations.
• It includes sessions with a psychotherapist who specializes in sexual problems.
• It helps change negative thoughts about penetration or sex.

Pelvic floor exercises (Kegel)

• It strengthens the vaginal muscles and helps women control their contraction and relaxation.
• It is practiced gradually with deep breathing and relaxation.
• With a physical therapist, the patient learns how to relax the vaginal muscles.
• It may include techniques such as biofeedback to monitor muscle activity.

Use vaginal dilators

• Use vaginal dilators gradually to get used to painless penetration.
• It is used under medical supervision to help women gradually overcome the fear of penetration.

Medical treatment for organic causes

• If there are infections or other medical problems, the doctor will treat the cause first.
• Local anesthetic creams are sometimes used to reduce sensitivity and pain.
• Treating vaginal dryness using vaginal moisturizers.
• Relying on hormonal treatment if the cause is hormonal.
• Botox injections in severe cases to reduce muscle spasm by temporarily relaxing the vaginal muscles.

Spousal support

• • The husband must be involved in treatment to enhance emotional support and improve communication.

• It aims to reduce pressure on spouses and enhance their relationship.

Complementary therapies

• Yoga or meditation to reduce stress and promote general relaxation.
• Acupuncture may be used in some cases to relieve muscle tension or anxiety.

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The role of behavioral and psychological therapy in recovery

Because we realize that behavioral and psychological therapy is the cornerstone of treating vaginismus, especially when the problem is related to fear or stress;

• Cognitive behavioral therapy changes your negative thoughts about sex and reduces your fear.
• Sex therapy gradually improves communication with your husband and sexual relationship.
• Trauma processing such as exposure therapy to work through your past experiences.
• Relaxation techniques reduce stress and increase your ability to control your muscles.
• Medical sex education to explain your sexual anatomy and reduce your fear.

If you suffer from vaginismus, make a reservation with the “Rafah Center” to receive therapeutic and preventive sessions, through approved rehabilitation programs designed specifically for your condition. We have a specialized team of psychiatrists, psychologists, rehabilitation consultants, and therapists who work to develop treatment plans that ensure optimal care and comprehensive treatments, such as cognitive behavioral therapy, art therapy, and recreational therapy.

The most frequently asked questions about vaginismus 

How do I know if I suffer from vaginismus?

When you feel pain or burning while trying to penetrate, or when penetration is impossible due to involuntary muscle contraction, and this may be accompanied by fear or anxiety about penetration.

How to get rid of vaginismus?

Through treatment programs, including psychotherapy to treat anxiety, pelvic floor exercises, Kegel exercises to control the muscles, gradual use of vaginal dilators, and medical treatment for infections or vaginal dryness, but it requires patience and consultation with specialists.

How does the husband deal with vaginismus?

The husband must be supportive and patient, avoid putting pressure on his wife and participate in a sex therapy program if necessary, along with open communication and understanding that the condition is involuntary, which helps improve the relationship.

Why does the vagina close during sexual intercourse?

The vagina closes due to involuntary contraction of the pelvic floor muscles as a result of anxiety, fear of pain, psychological trauma, or perhaps physical causes such as infections or vaginal dryness.

At the end of the discussion about vaginismus, we emphasize that it is a common medical condition that causes challenges, but it is not the end of your marital relationship. Through accurate diagnosis and appropriate treatment, you can regain your comfort and confidence. Now, do not let shyness prevent you from seeking help and contact the specialists and consultants at the Rafah Center of Al-Mousa Specialist Hospital.

المصادر:

Vaginismus – clevelandclinic

Understanding Vaginismus: Causes, Symptoms, and Treatment – health