Vaginismus Treatment Methods

What is Vaginismus?

Vaginismus is a condition in which sexual intercourse becomes impossible due to the involuntary contraction of the muscles around the vagina. Involuntary vaginal reflex may be triggered during sexual intercourse, insertion of tampons, doctor examination and even the insertion of the patient's own finger. The resulting spasm closes the vagina entrance, making sexual intercourse impossible. If prolonged, it causes pain. It may also cause spasms in other muscle groups of the body, sometimes even cause difficulty breathing. When the contraction ends, muscles relax and return to their normal state. Vaginismus can be seen in different forms in women. Some only occur during sexual intercourse but don’t cause any problems during examination or tampon insertion. Others, deny the entry of any objects. Some allow partial entry of the penis; but cause painful intercourse.



 

What is the incidence of vaginismus?

Although its incidence is unknown, it is estimated to be around 15 percent. Various reports offer various statistics on the subject. The reason for this discrepancy is that couples are ashamed about the problem and keep vaginismus a secret. This causes delays and makes getting medical assistance difficult. Hundreds of thousands of women from all communities around the world suffer from a type of vaginismus.

Types of Vaginismus

People who never had painless sexual intercourse before due to involuntary contraction of the muscles are considered to have 'Primary Vaginismus.' This primary type is identified during sexual intercourse or during the first gynecological examination. The type called secondary vaginismus consists of cases in which sexual intercourse was previously normal and painless. Sometimes, even if primary problems completely disappear after surgery, they still fail to have sexual intercourse.

Causes of Vaginismus

For most women, it is surprising that vaginal muscles can involuntarily and unconsciously contract. Even though the woman feels sexual desire, intercourse is impossible. The cause of this reaction is different, false and unhealthy sexual messages being present in the subconscious mind, involuntarily causing the contraction of muscles around the vagina. These messages may be caused by fear of pain, fear of pregnancy, sexual abuse, medical or physical conditions, excessive excitement, inadequate sexual education, excessively conservative or unbalanced education, domestic violence, fear of family or distrust. 

In order to plan appropriate treatment, other medical and physical conditions that cause painful intercourse should be ruled out. Some conditions that cause painful sexual intercourse are as follows: Vulvodynia/Vestibulodynia, inflammatory diseases of the pelvis (PID), ovarian cyst, bladder or urinary tract infections, vaginal atrophy, vaginal dryness, vaginal prolapse, rigid or thick hymen, birth trauma, vulvar cancer, vaginal infections, skin diseases (Lichen sclerosis, eczema , psoriasis), rheumatic diseases that involve joints and restrict joint movements.

Treatment Methods in Vaginismus

Removal of the Hymen

Most women with vaginismus think or are led to think that they will overcome the problem if the hymen is removed. However, in most cases, the removal of the membrane causes a scar tissue to form and thus leads to more pain. In rare cases, the hymen can be surgically removed if it’s very rigid or thick. However, this does not mean that vaginismus will be cured.

Psychotherapy

Relaxation is a skill to be learned. Nothing can be obtained by telling someone to relax, if they don’t know how to relax. Therefore, psychotherapy alone is not an effective treatment method. However, women who have been subjected to sexual abuse in the past, require psychotherapy. The fear of failure may cause anxiety in someone who doesn’t know how to relax. Therefore, the heart rate increases, muscles become tense, respiration becomes superficial and blood pressure rises. Since vaginismus is the result of an involuntary contraction of the pelvic floor muscles, treatment should also be directed towards the relaxation of these muscles.

Exercises

•    Kegel Exercises: These are exercises aiming to strengthen, relax and control the pelvic floor (Pubococcygeus) muscles.
•    Breathing exercises: These are exercises aiming to control breathing.
•    Relaxation exercises: These are exercises aiming to learn relaxation in all body muscles.
•    Botox Application: This is a toxin obtained from the bacterium Chlostridium botolinum, and allows relaxation by partially paralyzing the muscles. Botox shows its effects through acetylcholine, a substance that enables muscle contractions at the muscle-nerve junctions. Its duration of effect is 2 to 6 months. Side effects may include urinary or fecal incontinence. Vaginismus may recur after the effects disappear.
•    Vaginal dilatators: This is a method of self-education and relaxation using vaginal dilatators of various sizes.

Electrostimulation - Biofeedback Therapy

Electrostimulation - Biofeedback is the most effective, painless, side-effect-free treatment method in vaginismus. 95 percent of patients recover completely after two to three weeks of treatment. When combined with other treatment modalities or home exercise programs, the duration of treatment is shortened and the success rate increases. This method allows teaching the patient how to relax in less time. Muscles can be strengthened by electrical stimulation. Moreover, muscle spasms disappear through other physical therapy agents and pain relief can be achieved through pain-relieving current administration. During treatment sessions, the patient can see how the pelvic floor muscles contract and relax on a display screen, or hear a contraction sound. Thus, contraction and relaxation can be learned in a short time using biofeedback. Patients also realize how successful they are in relaxing, as treatment sessions progress.

Urogynecologic Physiotherapy

This is one of recently developing branches of physical therapy. In addition to vaginismus, this branch uses exercise and physical therapy methods to treat urinary incontinence issues due to pelvic floor muscle slackness, pelvic inflammation diseases, muscle weakness before and after pregnancy, in addition to preventing-correcting body deformation and reducing pain, and includes physical therapy methods for preventing pregnancy-associated vomiting and labor pains.

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