Both are two common conditions that impact the lives of many Australian women – sexually and psychologically.
As GPs, we’re often the first people women turn to when they experience ongoing painful penetrative sex or vulva.
In many cases, it’s either vaginismus or vulvodynia.
We’re not 100% sure what causes these conditions, yet we do know both can be treated effectively with time and patience, typically accompanied by a good dose of physiotherapy.
Let’s take a look.
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.
Symptoms of vaginismus range from uncomfortable sex to an inability to use tampons. For some women, gynaecological examinations and cervical screening can be a nightmare.
What Are the 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. Patients we see for vaginismus sometimes come from conservative backgrounds, and others have experienced some form of sexual, physical, or psychological abuse in the past.
However, we’ve treated women from all walks of life – including people 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.
Lots of options exist for treating this stressful and painful condition.
We regularly refer patients to specialist pelvic floor physiotherapists for vaginismus for physical therapy. They’re experts at educating women about their pelvic floor muscles and how to strengthen and relax these muscles.
For the most part, some therapy to relax the muscles is what’s 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.
Specialist sexual counselling is also commonly advised. This has proved to be very effective when combined with other physical treatments.
While these options can seem quite daunting, please feel assured we undertake all treatment with the utmost care and consideration.
What About Sex?
While being treated, women 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 can 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.
Vulvodynia is a condition in which symptoms include vulvar burning, stinging, itching, or chronic pain and discomfort in your vulva that can’t be 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. Women 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 women and is specific to pain only in the vestibule. The vulvar vestibule is the area inside your labia minora just before the vaginal entry.
We’ve treated patients of all ages for vulvodynia and VVS, though it seems to be more common in younger women. 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
- hormonal changes
As with vaginismus, there are many treatment options for vulvodynia.
Physiotherapy aims to address overactive muscles and nerves in the area. This helps in reducing pain and achieving comfortable sexual intimacy.
Your GP may prescribe medications and recommend topical creams to help with relief. These can 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 heading down this path.
Women that 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.
And What About Sex?
Women who suffer from vulvodynia pain often avoid sex – and understandably so. However, there are numerous options for enjoying sexual intimacy while symptoms present.
Penetrative sex can be made more comfortable by using safe, non-irritating lubricants. Be sure to have plenty on hand, especially when using condoms.
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.
It must be noted that vulvodynia and VVS can impact vaginismus. You may need to address both conditions before you can completely enjoy painless intercourse again.
When to Visit Your GP
If painful sex or vulva are 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.
These specialists may include physiotherapists, psychologists, and dermatologists.