Category Archives: Vaginismus

How to Rethink Intimacy When ‘Regular’ Sex Hurts

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There’s no rule that says sex has to be penetrative.

By Breena Kerr

When sex hurts, women often feel alone—but they’re not. About 30 percent of women report pain during vaginal intercourse, according to a 2015 study in the Journal of Sexual Medicine which surveyed a subsample of 1,738 women and men ages 18 and older online.

Awareness of painful vaginal sex—sometimes lumped under the term Female Sexual Dysfunction (FSD)—has grown as more women talk about their experiences and more medical professionals start to listen.

Many conditions are associated with FSD, including vulvodynia (chronic vulva pain), vestibulodynia (chronic pain around the opening of the vagina), and vaginismus (cramping and tightness around the opening of the vagina). But they all have one thing in common: vaginal or vulval pain that can make penetrative sex anywhere from mildly uncomfortable to physically impossible. However, you can absolutely still have sex, which we’ll get to in a minute.

First and most important, if you are experiencing any type of genital pain, talk to your doctor.

There’s no reason to suffer in silence, even if it seems awkward or embarrassing or scary. Your gynecologist has heard it all and can help (or they can refer you to someone who can). The International Pelvic Pain Society has great resources for finding a licensed health care provider who specializes in genital pain.

“We don’t yet know why women get vestibulodynia or vulvodynia,” Kayna Cassard, M.A., M.F.T., a psychotherapist who specializes in vaginismus and other pelvic pain issues, tells SELF. “[There can be] many traumas, physical and psychological, that become internalized and add to vaginal pain. Women’s pain isn’t just ‘in their heads,’ ” Cassard says.

This kind of pain can affect anyone—regardless of sexual orientation or relationship status—but it can be particularly difficult for someone who mostly engages in penetrative sex with their partner. The important thing to remember is that you have options.

Sex does not have to revolve around penetration.

Hell, it doesn’t even need to include it. And for a lot of people, it doesn’t. Obviously, if P-in-V sex is what you and your partner are used to, it can be intimidating to consider redefining what sex means to you. But above all, sex should be pleasurable.

“The first thing to do is expand what ‘counts’ as sex,” sex educator and Girl Sex 101 author Allison Moon tells SELF. “Many people in heterosexual relationships consider only penis-in-vagina to count as sex, and everything else is some form of foreplay,” she says. But sex can include (or not include) whatever two consensual people decide on: oral sex, genital massage, mutual masturbation, whatever you’re into.

“If you only allow yourself one form of sex to count as the real deal, you may feel broken for enjoying, or preferring, other kinds of touch,” Moon says.

To minimize pain, give yourself time to prepare physically and mentally for sex.

That might sound like a lot of prep work, but it’s really about making sure you’re in the right mindset, that you’re relaxed, and that you’re giving your body time to warm up.

Heather S. Howard, Ph.D., a certified sexologist and founder of the Center for Sexual Health and Rehabilitation in San Francisco, publishes free guides that help women prepare physically and mentally for sex. She tells SELF that stretching and massaging, including massaging your vaginal muscles, is especially helpful for women with muscle tightness. (Too much stretching, though, is a bad idea for women with sensitive vaginal skin that’s prone to tearing.)

Starting with nonsexual touch is key, as Elizabeth Akincilar-Rummer, M.S.P.T., president and cofounder of the Pelvic Health and Rehabilitation Center in San Francisco, tells SELF. This puts the emphasis on relaxation so you don’t feel pressured to rush arousal.

Inserting a cool or warm stainless steel dilator (or a homemade version created with water and a popsicle mold) can also help reduce pain, Howard says. Women can tailor the size and shape to whatever is comfortable. If a wand or dilator is painful, however, a cool cloth or warm bath can feel soothing instead. Again, do what feels good to you and doesn’t cause pain.

Several studies have shown that arousal may increase your threshold for pain tolerance (not to mention it makes sex more enjoyable). So don’t skimp on whatever step is most arousing for you. That might mean some solo stimulation, playing sexy music, dressing up, reading an erotic story, watching porn, etc.

And of course, don’t forget lubrication. Lube is the first line of defense when sex hurts. Water-based lubricant is typically the safest for sensitive skin. It’s also the easiest to clean and won’t stain your clothes or sheets. Extra lubrication will make the vagina less prone to irritation, infections, and skin tears, according to Howard. But some people may also be irritated by the ingredients in lube, so if you need a recommendation, ask your gynecologist.

Now it’s time figure out what feels good.

Women with pain often know what feels bad. But Howard says it’s important for them to remember what feels good, too. “Lots of people aren’t asking, ‘What feels good?’ So I ask women to set what their pleasure scale is, along with their pain scale. I ask them to develop a tolerance for pleasure.”

To explore what feels good, partners can try an exercise where they rate touch. They set a timer for 5 or 10 minutes and ask their partner to touch them in different ways on different parts of their body. Sex partners can experiment with location, pressure, and touch type (using their fingertips, nails, breath, etc.) and change it up every 30 seconds. With every different touch, women should say a number from 0 to 10 that reflects how good the touch feels, with 10 being, “This feels amazing!” and 0 meaning, “I don’t like this particular kind of touch.” This allows women to feel a sense of ownership and control over the sensations, Howard says.

Another option is experimenting with different sensations. Think tickling, wax dripping, spanking, and flogging. Or if they prefer lighter touch, feathers, fingers, hair, or fabric on skin are good options. Some women with chronic pain may actually find it empowering to play with intense sensations (like hot wax) and eroticize them in a way that gives them control, according to Howard. But other women may need extremely light touch, she says, since chronic pain can lower some people’s general pain tolerance.

Masturbating together can also be an empowering way for you to show a partner how you like to be touched. And it can involve the entire body, not just genitals, Akincilar-Rummer says. It’s also a safe way for you to experience sexual play with a partner, when you aren’t quite ready to be touched by another person. For voyeurs and exhibitionists, it can be fun for one person to masturbate while the other person watches. Or, for a more intimate experience, partners can hold and kiss each other while they masturbate. It feels intimate while still allowing control over genital sensations.

If clitoral stimulation doesn’t hurt, feel free to just stick with that.

It’s worth noting that the majority of women need direct clitoral stimulation to reach orgasm, Maureen Whelihan, M.D., an ob/gyn in West Palm Beach, Florida, tells SELF. Stimulating the clit is often the most direct route to arousal and climax and requires no penetration.

Some women won’t be able to tolerate clitoral stimulation, especially if their pain is linked to the pudendal nerve, which can affect sensations in the clitoris, mons pubis, vulva, vagina, and labia, according to Howard and Akincilar-Rummer. For that reason, vibrators may be right for some women and wrong for others. “Many women with pelvic pain can irritate the pelvic nerve with vibrators,” says Akincilar-Rummer. “But if it’s their go-to, that’s usually fine. I just tell them to be cautious.”

For women with pain from a different source, like muscle tightness, vibrators may actually help them become less sensitive to pain. “Muscular pain can actually calm down with a vibrator,” Howard says. Sex and relationship coach Charlie Glickman, Ph.D., tells SELF that putting a vibrator in a pillow and straddling it may decrease the amount of direct vibration.

Above all else, remember that sexual play should be fun, pleasurable, and consensual—but it doesn’t need to be penetrative. There’s no need to do anything that makes you uncomfortable physically or emotionally or worsens your genital pain.

Complete Article HERE!

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Vaginismus: solutions to a painful sexual taboo

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Many women use terms such as ‘failure’ or ‘freak’ to describe themselves

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Vaginismus is often a problem from the start of a woman’s sexual life but for some it is a secondary problem, developing even though there may have been previous positive sexual experiences

Vaginismus is often a problem from the start of a woman’s sexual life but for some it is a secondary problem, developing even though there may have been previous positive sexual experiences

Vaginismus is a very common but rarely discussed problem. Most women I see with this difficulty will not have discussed it with anyone else, not even female members of their own family or girlfriends. The silence that surrounds the issue and the sense of shame experienced sometimes serves to compound the difficulty itself. Many women with whom I have worked will use terms such as “failure” or “freak” to describe themselves, wishing they were “normal” just like every other woman.

Before seeking therapy, they will often have suffered this distress over a long period of time, not feeling able to embark on or enjoy sexual relationships. The thought that they may not be able to conceive through intercourse is frequently a huge anxiety for these women.

What is vaginismus?
Vaginismus occurs when the muscles around the entrance to the vagina involuntarily contract. It is an automatic, reflexive action; the woman is not intending or trying to tighten these muscles, in fact it is the very opposite of what she is hoping for. Often it is a problem right from the start of a woman’s sexual life but for some it is a secondary problem, developing even though there may have been previous positive sexual experiences. In most cases, the woman is unable to use tampons or have a smear test.

What are the symptoms?
The main symptom of vaginismus is difficulty achieving penetration during intercourse and the woman will experience varying degrees of pain or discomfort with attempts. Partners often describe it like “hitting a wall”. This is as a result of spasm within the very strong pelvic floor or pubococcygeus muscle group. Spasm or tightening may also occur in the lower back and thighs.

What are the causes?
Vaginismus is the result of the body and mind developing a conditioned response to the anticipation of pain. This is an unconscious action, akin to the reflexive action of blinking when something is about to hit our eye. This aspect of vaginismus is one of the most distressing for women as they really want their bodies to respond to arousal and yet find it impossible to manage penetrative sex. The more anxious they become, the less aroused they will feel and the entire problem becomes a vicious cycle.

Vaginismus can occur as a result of psychological or physical issues. Often it is a combination of both. Psychological issues centre around fear and anxiety; worries about sex, performance, negativity about sex from overly rigid family or school messages.

Inadequate sex education is often a feature in vaginismus, resulting in fears about the penis being able to fit or the risk of being hurt or torn. There can also be anxiety about the relationship, trust and commitment fears or a difficulty with being vulnerable or losing control.

Occasionally a woman may have experienced sexual assault, rape or sexual abuse and the trauma associated with these experiences may lead to huge fears around penetration. There are physical causes too – the discomfort caused by thrush, fissures, urinary tract infections, lichens sclerosis or eczema and the aftermath of a difficult vaginal delivery can all trigger the spasm in the PC muscles. Menopausal women can sometimes experience vaginismus as a result of hormonal-related vaginal dryness.

Treatment
Vaginismus is highly treatable. Because every woman is different, the duration of therapy will vary but, with commitment to the therapy process, improvement can be seen quite rapidly. Therapy is a combination of psychosexual education, slow and measured practice with finger insertion and/or vaginal trainers at home and pelvic floor exercises. Women with partners are encouraged to bring them along to sessions so that the therapist can work with them as a couple towards a successful attempt at intercourse.

Vaginismus can place huge stresses on a couple’s relationship as well as their sexual life; therapy can help the couple talk about and navigate these stresses. This is particularly important for a couple wishing to start a family.

What do I do if I think I have vaginismus?
Make an appointment with the GP. It will be helpful to have an examination to out rule any physical problem and have it treated if necessary. The GP is likely to refer you to a sex therapist, a psychotherapist who has specialised in sex and relationships through further training. They have specific expertise in working with this problem on a regular basis. You can also refer yourself to a sex therapist but, because of the very complex and sensitive nature of sex and sexuality, it is important to ensure that they are qualified and accredited. Sex therapists in Ireland may be found on www.cosrt.org.uk

GEMMA’S STORY
Robert was my first boyfriend. We waited six months to try sex, mostly because I was a virgin and very nervous. My mother had always warned me about not getting pregnant and I think I was too scared to try. When we did try, it didn’t work, it was disastrous. We tried again and again but he could not get in.

Every time we tried, I ended up in tears and over time I started to avoid sex. Robert was really patient but I know that it was very tough for him and I felt guilty. We thought it was a phase and it would improve with time. It didn’t stop us getting engaged because we knew we were right for each other.

Eventually I got the courage up to go to the doctor who diagnosed vaginismus – the relief of having a name to put on it was huge. She referred me to a sex therapist. I was embarrassed even talking about it, but quite honestly it was a relief to finally discuss it all. She explained everything about my problem and started me practising with vaginal trainers. I even got to start using tampons, something I never thought I would be able to do.

Robert also came to the sessions and that was a big help. We were given exercises to do at home together that helped me relax a lot. I made a lot of progress over a couple of months and, finally, last Christmas we got to try intercourse again. Success! Our sexual relationship is completely different now, no more worries and lots more fun.

I feel as if a huge worry has been lifted off my shoulders.

Complete Article HERE!

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