vaginismus

Vaginismus is a vaginal spasm that occurs as a result of repetitive or continuous involuntary contractions of the perianal muscles surrounding the outer third of the vagina, as a result of an unconscious desire to prevent the penis from entering the vagina in women. These contractions are accompanied by contractions of the whole body, closing of the legs, fear, avoidance response, and the belief that there is no entry.

Women with vaginismus often feel the entrance to the vagina “like a wall” during sexual intercourse attempts. For this reason, they often use expressions such as “there is a wall”, “the penis is hitting a wall”. In addition, women with vaginismus describe the pain and feelings they feel when they experience penile entry or waiting as “tearing, puncturing, fragmentation, burning or tingling”. Ultimately, this situation causes the woman to think that there is a deficiency in her own femininity and to feel guilty towards her husband. In addition, families knowing this situation or asking for evidence of the first night or “do you still not have a child?” Questions like this put the couple’s situation in a difficult situation. They may face constant pressure and humiliation from their families, often the woman is blamed and the man can be forced to end the marriage.

Vaginismus Diagnosis and Types

In the diagnosis of vaginismus, one of the following symptoms should be “persistent or recurrent” difficulty. These:

  • Entering the vagina during intercourse,

  • Significant pain in the vulvovagina or pelvis during the procedures for entering and entering the vagina,

  • Marked fear or anxiety about pain in the vulvovagina or pelvis while waiting for or due to vaginal penetration,

  • It is in the form of stretching or squeezing the pelvic floor muscles too much during the attempt to enter the vagina.

These symptoms must last for at least six months and cause clinically significant distress. In addition, the disorder should not be caused by a non-sexual mental disorder, severe relationship disorder, or other significant stressful factor, and should not be linked to a substance or drug.

Vaginismus can be examined under two main headings as types. These:

  • Primary vaginismus:It occurs in the first sexual experience and the person has never had a successful sexual intercourse in his life.

  • Secondary vaginismus: It is seen in women who have had a painful or painless, pleasant or unpleasant sexual intercourse experience and subsequently developed vaginismus. The reason for this situation is usually a trauma or surgery experience.

Symptoms

The most basic symptom of vaginismus is that the person experiences a panic attack-like situation when the moment comes. That is, he pushes his wife, tenses, worries, fears, worries. Even if he is conscious, he loses control, control passes into the hands of the unconscious. Over time, a person may experience some feelings and thoughts. These:

  • Decreased emotional satisfaction

  • A feeling of guilt,

  • feeling of disappointment,

  • feel no shame,

  • Don’t hate yourself

  • “How can I not do something that everyone can do easily?” thinking and guilt,

  • Asking family elders or relatives, “When will you have children?” fear of questions,

  • Over time, sexual reluctance, etc., which occurs with the feeling of failure and escape. is in the form.

Incidence Frequency

It has been reported in international publications that the rates of vaginismus in women applying to sexual therapy clinics vary between 12% and 17%. Higher rates were mentioned in studies conducted in Canada and Ireland.

In our country, it is one of the most common complaints among those who apply to sexual therapy centers, according to the studies conducted by the Institute of Sexual Health (CISED). In other words, vaginismus cases constitute 56-73% of the women who applied. In addition, it has been determined that one out of every 10 women in our country has a vaginismus problem.

Reasons

We can briefly list the factors and psychological factors that cause vaginismus as follows:

  • Pain at first sexual intercourse attempts

  • A family that devalues ​​and humiliates sexuality,

  • weak, powerless mother,

  • oppressive, authoritarian father,

  • Difficulties in the father-daughter relationship

  • Sexual violence and harassment, disgust and dislike,

  • Involuntary forced marriage, dislike of spouse, incompatibility with spouse and communication problems,

  • Negative religious and moral conditioning

  • gay identification,

  • Fear of failure and performance anxiety

  • Fear of losing the hymen

  • Sexual taboos, misinformation and beliefs,

  • passive, dependent spouse,

  • Fear of pregnancy

  • Carrying obsessive or borderline personality traits

  • low pain threshold,

  • Problems with vaginal lubrication,

  • Warnings such as “cover your legs” and “cover your skirt” in childhood and adolescence,

  • arranged marriages,

  • The psychosomatic effect of an unknown thought or behavior pushed into the unconscious,

  • A painful and challenging gynecological examination,

  • Fear of severe pain or fragmentation due to the symbolically enlarged penis in the mind

  • A blow or trauma to the genital area in the past,

  • Using too many rectal suppositories in childhood,

  • Avoiding a spouse in an inappropriate or undesirable union,

  • Some infections and abnormalities

  • The idea that there will be terrible pain during the rupture of the hymen,

  • problems with sexual arousal,

  • Perception of woman as a sexual commodity or a sexual object,

  • Not knowing the entry point of the genital organ,

  • False beliefs that the vagina is too small to enter anything,

  • Wrong and strict education style that teaches that sex is dirty and bad during the young maiden period, etc.

Vaginismus Men

Being with someone who has vaginismus can be really difficult at times. Some common feelings experienced and described by the spouses are;

  • empathy-despair,

  • anger-questioning,

  • rejection,

  • It is in the form of distance.

During intercourse, men may experience severe premature ejaculation or erectile dysfunction. Because the man who is preparing to have sexual intercourse with his wife, who has vaginismus, usually carries excitement, uneasiness and anxiety about whether he will be successful. When there is no relationship with a problem arising from the woman, the man has no problem. When the woman is treated and ready for the relationship, then the problem usually starts with the anxiety of whether the man will be successful. Now that the woman has recovered, the man may feel obliged to prove himself, and failures may occur under this intense stress. At this point, the negative effect of the treated spouse or the close environment who is aware of the event may also cause the man to lose self-confidence with the feeling that the expectations are not met, and the existing negative situation may enter a vicious circle and hardening may not be achieved for months. Again, depending on this, a tendency to stay away from sexuality and sexual reluctance towards their spouses may begin in men over time.

Treatment

Vaginismus is one of the most promising sexual problems in terms of sexual treatments. In this sense, vaginismus is a temporary disease that can be treated.

In the treatment procedure, the sexual therapy program includes emotional and physical techniques. They are advised to have double courage, to believe that they will succeed, and to wait patiently with confidence. During sexual therapy, double mirroring exercises, urine retention exercises, muscle relaxation and contraction exercises, kegel exercises, finger exercises, extension exercises with rods, limited penile insertion exercises, etc. “invivo desensitization”, “invitro desensitization” and “pelvic floor rehabilitation” studies are done. At this point, the aim is; It is to show the person that the vagina is an expandable organ, to create a small similarity of the panic attack experienced during intercourse and to learn to cope with it. Artificial lubricants can be used during exercises. In parallel with this desensitization, Kegel Exercises are also performed, which allow the patient to recognize and master the pelvic muscles. It will be better if the couple participates in the sexual therapy process together. In addition, since the treatment is a process that requires correct knowledge and technique, the plan to be made should be followed by an experienced and qualified sexual therapist. If the sexual therapy plan is followed, a faster and more definite recovery is achieved than expected. However, especially the woman should stick to this treatment plan and apply it patiently. In addition, in the sexual therapy of vaginismus, no surgical intervention and other interventional interventions are usually required. The woman is not asked to use any medication during the treatment process. All that needs to be done is for the woman to find a sexual therapist who will be a good guide, explain everything clearly, and most importantly, have a desire to heal. If the woman manages to do this, it will be possible for her to self-medicate with the exercises that the sexual therapist will suggest to her.

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