What is Vaginismus?

Vaginismus is the presence of repetitive and continuous involuntary contractions in the muscles surrounding the outer third of the vagina when vaginal penetration is attempted, and these contractions are accompanied by fear of pain and anxiety about entry.

This contraction is accompanied by contractions in the whole body, closure of the legs, fear, avoidance response, and the belief that there can be no interference.

Vaginismus is traditionally defined as a ‘psychophysiological’ disorder. According to the World Health Organization, vaginismus is defined as the woman’s having difficulty in providing vaginal entry of a penis, finger or other object, although she would like it to be, and usually accompanied by avoidance, muscle contractions and pain expectation, fear, and experience.

Vaginismus causes the woman to think that there is a deficiency in her own femininity and to feel guilty towards her husband.

It can cause resentment, difficulty in erection, and sometimes doubt about virginity, as a man experiences anger, unwantedness and rejection towards his wife.

Vaginismus usually occurs at the beginning of sexual life, from the moment when the first sexual intercourse is attempted. Much less frequently, it develops after a gynecological examination, negative sexual experiences, abuse, rape, miscarriage, or similar experiences.

Although vaginismus is considered a sexual pain disorder, it is not necessary to have pain in order to diagnose it.

SYMPTOMS OF VAGIINISMUS

Entering the vagina during intercourse,

Significant pain in the vulvovagina or pelvis during attempts to enter or enter the vagina,

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

It is seen as continuous or repetitive, such as excessive stretching or tightening of the pelvic floor muscles during vaginal insertion.

Symptoms must last for at least 6 months.

It must cause clinically significant distress to the individual.

This sexual dysfunction should not be due to other causes (for example, partner’s use of force, other mental disorders, substance use, medication, or other health problems).

Primary (Lifetime): Experienced since the person is sexually active.

Secondary (Acquired): This disorder began after a fairly normal phase of sexual functioning.

Frequency of Vginismus

The prevalence of vaginismus is more common in our country and in other traditional cultures than in western countries. It becomes more difficult to determine the true rates when it is taken into account that the couples who cannot get together usually seek help and the cases of mild vaginismus that can unite with pain do not apply for treatment. In a social survey conducted in Turkey to detect sexual problems, it was found that 54% of women described fear, pain, and avoidance behavior at the first attempt at intercourse, and that sexual intercourse did not occur. It has been determined that 17% of these women still cannot unite or describe problems in union. The rate of patients who applied to sexual treatment centers in Turkey due to vaginismus is between 62.2-75.9%. In Western countries, the incidence of vaginismus is 1-6%.

The reasons for the lower incidence of vginismus cases can be shown depending on the appropriate sexual education, the talkability of sexuality, the possibility of constructing sexuality as a pleasure-seeking behavior from childhood, and the existence of societies where women’s sexuality is valued.

COGNITIONS AND TABOOS CAUSED BY VAGINISMUS

Misconceptions and taboos about sexuality play an important role in the development of vaginismus.

The prevalence of sexual myths and sexual ignorance

self-fulfilling prophecy

‘He who protects himself and his vagina best is the most honest’

‘It will bleed, it will hurt, it will bleed more and it will hurt more’

Increased tension threshold level

Failure to act in accordance with nature and creation

Hymen and vagina enlarged with exercises

Most women with vaginismus have the wrong belief that their genitals are too small and abnormal, that the vagina or hymen forms a wall, that the male genitalia is too large, that it will hurt a lot and cause a lot of harm. Even changing these wrong definitions is very effective in learning and treatment.

TREATMENT

Sex therapy is mostly carried out in the form of a couple interview. It is very important to consider vaginismus as the problem of the couple and to ensure active participation in the treatment by convincing the partner of this. Because men do not accept vaginismus as a disease, perhaps they cannot reach the right information, they may perceive the situation as being unwanted and rejected, and may feel resentment or anger. Sometimes, thinking that the situation may be related to their own inadequacies, sexual reluctance and erection problems may develop over time with anxiety. For this reason, a comprehensive sexual life history is taken first. The difficulties of the couple are evaluated and their concerns are investigated. It is a delayed sexual education done in the first sessions. It is aimed to inform the couple about sexual health, to correct wrong beliefs, to convey the truth about sexual organs and sexual physiology. Then, with exercises, the gradual contraction and fears of entry are overcome.

There may be mild cases that improve with one or two interviews and counseling, as well as difficult cases that require long-term treatment. Apart from couple therapy, individual interviews or group therapies can be applied in some cases. Recurrence is not expected after treatments terminated with the approval of the therapist in cases that have fully recovered with sexual therapy methods.

The aim of the treatment of vaginismus is not to allow the penis to enter the vagina in some way, but to ensure that the woman reaches a fulfilling sexual life, where the woman does not experience any negativity such as contraction, pain, avoidance, fear, and where the couple enjoys.

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