By Heather Corinna

Wanted for:

• General and extreme vaginal tightness, burning or stinging with any vaginal penetration (by a penis, tampon, fingers or otherwise)
• Great difficulty or an inability to allow penetration
• Severe pain during attempted intercourse
• Inability or profound difficulty inserting tampons or cups
• Emotional distress during intercourse or penetration that is clearly not about relationship distress or other identifiable issues

Background

Many women who have difficulty with first intercourse or vaginal entry are often quick to suspect their hymen isn't "broken." However, in some instances in which the woman is aroused, lubricated well, and has a patient and sensitive partner, but she still suffers great pain or discomfort with attempted penetration, that isn't the case at all.

The hymen -- a thin membrane partially covering the vaginal opening -- usually doesn't break or tear at all, as a matter of fact. For those women born with hymens (and not all of us are!), the hymen begins with small perforations already in it, which not only allow for menstrual flow, but for proper health of the vagina. Over time, that membrane slowly erodes to the sides of the vaginal opening, and that erosion or stretching is helped along by general physical activity, masturbation, tampon use and aging. In some cases (about one in two thousand), the hymen does not erode, or does not have the necessary perforations, but it cannot be "broken" by forcing it via intercourse. A doctors visit and a minor surgical procedure are what are called for in that instance.

So, if the hymen isn't to blame, what is? There are a few possibilities, but it may be Vaginismus, an involuntary spasm of the muscles around the vagina that force it to close so that it causes penetration to be difficult, painful, or utterly impossible -- remember, the vagina is a muscle, so it shouldn't be too surprising that when it clamps up, it can clamp up very tightly.

Known Accomplices

Vaginismus isn't a physical condition, per se, though it has physical symptoms. It is considered a psychological (and thus, psychosomatic, meaning the psychological condition causes the physical symptoms) syndrome that is likely based in one of the following:

• past sexual trauma, such as rape or sexual abuse
• strong inhibitions (whether you recognize them or not) about sex arising from an upbringing in which sex was portrayed as dirty, sinful, taboo or bad,
• a reaction to painful intercourse experiences had in the past
• as a result of another physical condition
• fears, phobias or neuroses about sex and/or sexual intercourse in general
or even because the person a woman is with isn't someone she wants to be with, either because she isn't attracted to them, is afraid of them, or because she may have a sexual orientation which brings about a negative reaction to a partner (for example, a homosexual woman -- whether she is aware of it or not -- with a male partner).

Vaginismus usually ONLY applies to intercourse or vaginal entry. Women who suffer from this condition are not anorgasmic (unable to orgasm), nor are they unable to participate in and enjoy a myriad of other sexual activities. Most can orgasm freely and have plenty of sexual fulfillment so long as intercourse is not involved.

Advised Approach

A woman suffering most of the symptoms above should visit her gynecologist. Testing for Vaginismus is fairly simple: a gynecologist simply inserts a finger into or around the vagina and watches for a tight, involuntary muscle contraction.

Weapons

Treatment for Vaginismus is done by a sex therapy provider, who may do a number of different things. They may opt to use therapy that includes vaginal dilation exercises by using a series of plastic dilators, beginning with a small size, and working up to a larger one over a series of appointments. The therapist may include masturbation therapy, in which the patient is slowly taught to masturbate in a way that does not illicit the response, but instead allows for healthy, comfortable sexual enjoyment. If a couple is involved, the couple may be coached on other sexual activities (such as manual or oral sex) to work up to intercourse over time. In addition, most women suffering from Vaginismus have a great amount of sexual misinformation, or a lack of basic sexual information including anatomy, sexual response, and other sexuality basics. A therapist will also work to counter these. Sometimes, hypnosis is used in addition to the above treatments.

If a woman suffering from Vaginismus has had previous sexual abuse experiences or other sexual traumas, she is usually encouraged to get counseling to supplement the physical therapy.

Most women diagnosed with Vaginismus are advised not to attempt intercourse or penetration until treatment has been completed.

Level of Danger

Vaginismus can be highly frustrating for a woman and her partner(s) if not diagnosed and treated, because she and her partner(s) will probably assume they are doing something wrong, or that there is something physically wrong with them if they are attempting intercourse or other vaginal entry. Trying to force intercourse when a woman is suffering from Vaginismus is not only physically painful, but because it is based in psychological and emotional factors, it may be very emotionally trying. If a woman continues to attempt intercourse when this sort of pain continues, it can make the response worsen, and make treatment more difficult.

If intercourse attempts cease while treatment is pursued, there are no physical dangers whatsoever. And in about 98% of cases, just a few months of treatment can cure Vaginismus.

As a note, vulvodynia, a severe and constant burning, pain or itching in the vulvar area is sometimes related to Vaginismus, occurs as a secondary condition, or can cause the kind of symptoms vaginismus does. Vulvodynia can make even sitting or walking difficult, and is reported to affect as many as 200,000 women in the United States alone.

Because vaginal tightness and painful penetration can also be symptoms of sexually transmitted diseases, it is important that when seeing your doctor for these symptoms, you let he or she know if you have been sexually active and/or have engaged in unprotected sexual activities in the past.

Protective measures

One cannot really prevent Vaginismus in oneself, as it is a result of past experiences, traumas or upbringing. However, it can be prevented in children and young adults simply by raising children in a setting with healthy, open and relaxed attitudes about sexuality, and without attaching taboo to basic sexuality. Protecting children and young adults from sexual assault or abuse is also highly important. If a woman has been a victim of sexual assault, preventing Vaginismus is one of many reasons to seek out support, counseling or therapy to heal from the assault psychologically, even if the abuse or assault was in the past.