vaginismus
Vaginismus is when the muscles around the vagina tighten involuntarily when penetration of the vagina is attempted. It makes sexual intercourse difficult or impossible and it can be painful. It can also make gynaecological and pelvic examinations and smears difficult or impossible.
why does it happen?
There are many reasons why the vaginal muscles contract against a woman's will. It is not always clear exactly why this happens. Possible causes include:
- An unpleasant sexual experience at a young age, sexual abuse, assault or rape.
- Poor understanding of sex and/or feelings of shame or guilt.
- Injury, infection or inflammation (swelling) of the vagina, pelvis or bladder. Even if the injury or infection has disappeared, vaginismus can still continue to happen.
- Persistent vaginal dryness or irritation caused by spermicides or latex in condoms.
- Fear or dislike of sex because it is difficult or painful. Fear that the vagina is too small.
- Fear of getting pregnant or the after-effects of childbirth.
- Relationship problems.
- Tiredness or depression.
- Alcohol, drugs or some medications.
how common is it?
The condition is fairly common, especially from the late teens until the thirties. It is likely that many women will experience it at some point, even if they have had a history of enjoyable and painless sex.
outlook
Vaginismus is very treatable. If the cause is psychological, it may be treated using counseling or sex therapy, where you are helped to gradually overcome it using vaginal trainers and relaxation techniques. You may be offered counseling or cognitive therapy if necessary. For women who find these treatments unhelpful, Botox can be an option, see below. Botox can also be used in combination with the other therapies.
sex therapy
If the cause is less obvious, you may be taught some self-help techniques to try to resolve the problem. A psychosexual doctor or sex therapist may teach you techniques to retrain your vagina to respond normally to penetration. As well as advising you on self-help techniques, your specialist may offer you counseling to address any underlying psychological issues (such as fear or anxiety), and cognitive behavioral therapy to change any irrational or incorrect beliefs about sex and, if necessary, to educate you about sex.
vaginal trainers
A technique to relax the muscles in the vagina involves gradually widening (dilating) the vagina with a set of vaginal trainers. These are smooth, penis-shaped cones of gradually increasing size and length, which can be used in the privacy of your own home. The smallest one is inserted first, using a lubricant if needed. Once you feel comfortable inserting the smallest one, you can move on to the second size, and so on... It is important to go at your own pace. When you can tolerate the larger cones without feeling anxious or any pain, you and your partner may want to try having sexual intercourse.
Botox
BOTOX® is the commercial trade name for Botulinum Toxin Type A. It is derived from the bacterium Clostridium Botulinum. When injected into muscles, Botulinum Toxin has a local effect. It blocks transmission between the nerve endings and muscle fibres and causes weakness of the nearby muscle.
Before starting treatment, tell your doctor if you have any disorders that affect your nerves and muscles, if you are breastfeeding, or if you are planning to become pregnant soon.
Your doctor will administer several tiny injections of botox directly into the muscles in your pelvic floor. The entire botox injection procedure takes approximately 10 minutes and does not require anaesthesia. Discomfort is usually minimal and brief. You should notice a relaxation in your pelvic floor within 5 to 7 days, the effects of which can last up to 4 months. However, results may vary. You can receive botox injections every 4-6 months.
Possible side-effects of Botox
- headache
- flu-like symptoms
- nausea
- redness at the injection site
- muscle weakness
cautions/contra-indications
You can not have botox treatment if you:
- have an infection where botox will be injected
- are allergic to any of the ingredients
- are pregnant or think you might be pregnant
- have a neurological disorder (e.g. Myasthenia Gravis)
There are also a number of medicines that may interact with botox (e.g. quinidine, some antibiotics). It is important to tell your doctor if you are taking any medication.