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If you’re looking for advice on vaginismus treatment, this post offers helpful insights, including for vulvodynia.
Both are common conditions that impact the lives of many Australian women* – sexually and psychologically.
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ON THIS PAGE
- What is vaginismus?
- Vaginismus treatment options
- Sex and vaginismus
- What is vulvodynia?
- Vulvodynia treatment options
- Sex and vulvodynia
- When to see your GP
- About Dr Andrea Hickman
GPs are often the first medical professionals people turn to when they experience ongoing painful penetrative sex or vulva pain.
In many cases, it’s either vaginismus or vulvodynia.
We’re not 100% sure what causes these conditions, yet we know both can be treated effectively with time and patience, typically accompanied by a good dose of physiotherapy.
Let’s take a look.
* We recognise and appreciate that not all people identify with binary genders. We’ve chosen to use a cisgender context to discuss this complex area of medicine.
What is Vaginismus?
Vaginismus is an involuntary spasm of your vaginal muscles. The inability to relax these muscles can result in painful intercourse, often too painful for penetration.
In most cases, your vulva and vagina will be entirely healthy.
Vaginismus symptoms include uncomfortable penetrative sex and an inability to use tampons.
For some people, gynaecological examinations and cervical screening can be a nightmare.
Likely Causes
As touched on above, no one really knows what causes vaginismus.
Many doctors believe symptoms are psychologically driven, particularly if sex is deemed taboo or anticipated to be painful.
Sometimes, patients with vaginismus symptoms come from conservative backgrounds, while others have experienced some form of sexual, physical, or psychological abuse in the past.
However, I’ve treated people from all walks of life, most with no history of trauma.
Other causes can include childbirth, urinary tract infections, thrush, or even chronic pain syndromes such as myofascial pelvic pain syndrome.
Vaginismus Treatment Options
Many options are available for treating this stressful and painful condition.
I regularly refer patients with vaginismus to specialist pelvic floor physiotherapists for physical therapy.
They’re experts at educating people about their pelvic floor muscles and how to strengthen and relax these muscles.
For the most part, some therapy to relax the muscles is required.
Your physio or GP may recommend vaginal dilators. These generally come as simple plastic tubes of gradual sizes that you insert into your vagina.
I also commonly advise that patients consider specialist sexual counselling. Such advice has proved to be very effective when combined with other physical treatments.
I appreciate these options might seem daunting. Rest assured, I’ll approach any treatment with the utmost care and consideration.
Vaginismus Exercises
Exercises to help relieve vaginismus symptoms aim to improve muscle control and flexibility, encourage relaxation, and enhance blood flow.
As your physiotherapist will likely show you, some very effective pelvic floor exercises (aka Kegels) can help you regain control of your floor muscles.
It’s important to progress gradually with these exercises.
Often, they’ll suggest you practise Kegels in conjunction with using vaginal dilators and other therapies.
What About Sex?
While being treated, you can enjoy the many forms of non-penetrative sex.
Apart from your brain, your clitoris is your biggest sex organ. While undergoing treatment, taking penetration off the menu and concentrating on clitoral stimulation can be helpful.
A break from penetrative sex may also help re-introduce the concepts of arousal and desire that may have faded.
Patients often find this approach leads to improved attitudes towards sex and a gradual reduction in vaginismus symptoms.
What is Vulvodynia?
Vulvodynia is a condition in which symptoms include vulvar burning, stinging, itching, or chronic pain and discomfort in your vulva that’s not linked to a specific cause.
The condition may significantly impact your sex life, exercise, and work in severe cases.
Vulval pain can occur with the lightest touch and can be localised or felt across the entire vulva area. People diagnosed with vulvodynia typically don’t exhibit any visual vulval abnormalities.
There are a few subtypes of vulvodynia, the most common being Vulvar Vestibulitis Syndrome (VVS).
VVS is claimed to affect up to 15% of people and is specific to pain only in the vestibule. The vulvar vestibule is the area inside your labia minora just before the vaginal entry.
I’ve treated patients of all ages for vulvodynia and VVS, though it seems to be more common in younger people.
The condition can last anywhere from a couple of weeks to years.
Causes of Vulvodynia
Unfortunately, the causes of vulvodynia are also largely unknown.
Some researchers believe that contributing factors include:
- damaged nerve endings around the vestibule, typically due to childbirth or sexual trauma
- past infections
- allergies and sensitive skin
- increased muscle tension in the pelvic floor muscles, and
- hormonal changes.
Vulvodynia Treatments
As with vaginismus, there are many available treatment options for vulvodynia.
Physiotherapy aims to address overactive muscles and nerves in the area. The goal here is to help reduce pain and achieve comfortable and pleasurable sex.
Your physio may suggest you practise similar exercises to those used to help with vaginismus symptoms mentioned above.
I may also prescribe medications and recommend topical creams to help with relief.
These include tricyclic antidepressants, nerve blockers, estrogen creams, and local anaesthetics, such as lidocaine.
You may need to safely try a combination of treatment techniques to discover what works best for you. Speak with your doctor before taking this step.
Those who suffer from extremely painful vulvodynia may consider cognitive behaviour therapy (CBT), hypnotherapy, or acupuncture.
In the most severe of cases, surgery may be required to remove the area causing acute pain.
Sex and Vulvodynia
People who suffer from vulvodynia pain often avoid sexual intimacy altogether, especially if it involves penetration.
However, there are numerous options for enjoying sex while symptoms are present.
Trying different sexual positions that avoid excess contact with the affected area of your vulva may also help.
Some patients report that penetration from behind is an effective position.
You can make penetrative sex more comfortable by using safe, non-irritating lubricants. Be sure to have plenty on hand, especially when using condoms.
It must be noted that vulvodynia and VVS can impact vaginismus. You may need to address both conditions before you can thoroughly enjoy painless intercourse again.
When to Visit Your GP
If painful sex or vulva pain is impacting your happiness and there’s no apparent cause, get to your GP as soon as possible.
We can help diagnose the problem while identifying any underlying conditions contributing to your symptoms.
We can also refer you to one or more specialists and work with them to manage your treatment.
Such specialists may include physiotherapists, psychologists, and dermatologists.
Dr Andrea Hickman is a local GP at Doctors of South Melbourne.
She has a special interest and extensive experience in women’s health.
You can make an appointment online with Andrea or call us on (03) 8579 6838.
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