Vaginismus is a sexual pain disorder experienced by women, a sexual dysfunction categorised alongside dyspareunia under the heading of genito- pelvic pain/penetration disorder (GPPPD). Sufferers experience physiological symptoms in the muscles, nervous system and physical body and psychological and psychosexual symptoms in the psyche and mind.
Women with vaginismus may experience an inability to tolerate penetration, face fertility challenges, difficulty with tampons, and concerns about important gynaecological check-ups such as smear tests and IUD contraception. Symptoms can present in adolescence and early sexual experiences and progress untreated.
This multi-dimensional nature of vaginismus means a holistic and integrative approach combining physiotherapy, psychosexual therapy and simple interventions can result in more successful outcomes and, importantly, support, encouragement and empowerment!
Much research and data into vaginismus (available via tandfonline.com) finds the most common therapeutic interventions include sex therapy, psychoeducation, patient information, medications, dilator training (DT), finger training (FT) home exercises, mindfulness-based strategies, marital therapy and pelvic physiotherapy.
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So, contrary to what you might believe about your condition, particularly if you have felt unable to talk to anyone, yet, there is a range of professionals and interventions you can start to consider going forward by embracing a holistic and self-empowered approach. I encourage my clients to focus on progress and developing self-awareness and compassion rather than success as goals shift and change with progress.
A knowledgeable psychosexual therapist can work with you to provide an assessment followed by a proposed treatment plan, support and guidance with signposting to suitable professionals.
As a qualified psychosexual therapist, sexual health facilitator, specialist fertility counsellor and complementary health therapist, I advocate for the holistic therapeutic approach addressing vaginismus and its associated symptoms. Encouraging clients, when they feel ready, to consider engaging with a gynaecologist and, in particular, a specialist pelvic physiotherapist.
There are several health professionals you can consider attending if you experience symptoms of vaginismus, dyspareunia and painful sexual penetration. If you have private health insurance, make sure to check out your policy cover, as many are covered by your insurance providers.
Each of these professionals provides different forms of interventions and various approaches for vaginismus and genito-pelvic penetration disorders. Starting therapy can help you to break through concerns, fears or avoidance of addressing the condition and start to make short, medium and long-term goals with the support and guidance of your psychotherapist.
General Practitioner (GP) and Women’s Health Clinic
Talk in confidence to your GP or women’s health clinic, who can provide medical consultation and onward referral to any of these health professionals listed below. Nowadays, you may not need a referral letter when accessing services and professionals privately. Unfortunately, there can be long waiting periods for public referrals to health services in Ireland.
Some clinics will have a multidisciplinary team, such as the Well Woman Clinic, with access to inhouse psychosexual therapists, psychiatrists and gynaecologists making access to services more convenient.
A Gynaecologist or OBGYN specialises in female reproductive health and sexual health. They provide medical consultation, assessment, treatment interventions, or medications for conditions such as vaginismus, dyspareunia, vulva pain and GPPPD-related problems. Consultation may include physical examination, scans or ultrasound, which is patient-sensitive.
Women with vaginismus tend to experience low to high levels of anxiety and fear relating to physical touch. This can lead to avoidance of discussion or consultation for the condition, particularly in women with lifelong vaginismus (LLV). It is never too late to get help to manage or resolve vaginismus. Rest assured, a Gynaecologist will be very sensitive to your needs and expressed concerns.
It is beneficial to identify or rule out physical or medical factors which may be causing the condition. They can also advise on dilator recommendations, training and dilation exercises. Ruling out medical factors and conditions is beneficial information for psychosexual therapists and physiotherapists as it helps define a more integrative plan.
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Remember to ask for a copy of the medical report from your Gynaecologist outlining details of the consultation and assessment, which you can have available for other professionals you attend in the future.
Psychosexual Therapists and Sexologists
Vaginismus has biopsychosocial factors, which means it impacts women physiologically, psychologically and psychosexually. Unlike other medical conditions, the origins of vaginismus and similar sexual problems can also be rooted in cultural, social, gender, relational and early childhood experiences and factors.
Psychosexual therapists and sexologists are professional therapists specially trained in psychosexual problems, sexual disorders, sexuality and relationships. They therapeutically explore with you the nature of the problem, uncovering and identifying underlying factors that may have led to primary or secondary vaginismus. Their role is also to identify suitable integrative ways to help you manage and resolve the condition and improve total well-being, not forgetting your intimate relationships.
Psychosexual and sex education is essential to the work you will do together. They may incorporate couples therapy and provide beneficial information about dilators, vaginal trainers, sexual well-being products, lubrication and recommended reading and teaching aspects of sex positivity when appropriate.
Sex therapists work with women who experience aversion to sex, sexual trauma, fear of penetration, pregnancy or childbirth, sexual disgust, intimacy problems, desire discrepancy and low sexual satisfaction.
Specialist Pelvic Physiotherapists
A specialist pelvic physiotherapist is a qualified Physiotherapist specially trained in pelvic floor muscles, pelvic discomfort, sexual pain and GPPPD conditions such as vaginismus. They are qualified and experienced in assessing and rehabilitating pelvic function and hypertension, including the pelvic floor, core and vaginal muscles.
They provide assessment, intervention and treatment plans, home exercises, and ongoing consultation, including dilator training, stretching and breathwork exercises.
“Pain and anxiety are closely related, so as women’s health physiotherapists here at Vie Physiotherapy we aim to never be the cause of anxiety. After talking, we will have a holistic picture of the person, and this will guide our examination. We then discuss the assessment options for vaginismus, and they can then decide which type of assessment they would like to have.”Aoibhin McGreal – Director & Specialist Pelvic Physiotherapist at Vie Physiotherapy, Co. Kildare.
Working with a physiotherapist provides another level of support and education, which is beneficial from a motivational and psychological perspective.
Another aspect of working with a physiotherapist, which I believe to be essential as a psychosexual therapist, is bringing awareness, connection and focus down into the body – where often there is a disconnect. This is positive for developing that mind-body connection which is essential to intimacy and the female sexual response cycle.
Couples Psychosexual Therapist
Engaging with a couples therapist following individual psychosexual therapy will benefit the woman, her partner and the couple’s dynamic. Vaginismus affects both partners and the relationship differently and raises numerous challenges for the couple. A skilled couples therapist will help the couple explore and assess the condition’s impact and any related factors helping them to move forward fearlessly with resolving the condition together.
“The therapist can model an empathic, nurturing, sex-positive parental role to give their clients permission, perhaps for the first time, to explore their sexuality.”– Maria McEvoy, author of ‘Vaginismus in the Irish Context (2021)
Recent Irish research shows it is important to engage a partner in the treatment of vaginismus, as they may also experience varying degrees of sexual dysfunction or be impacted by their sexual history, sexual education and cultural and gender factors. Research continually reflects the importance of marital therapy in successful outcomes for vaginismus.
Couples therapy will aim to improve communication between the couple and address psychosexual concerns and blocks to intimacy and sexuality.
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Specialist Fertility Counsellor
A professionally trained and accredited fertility counsellor works with women, men and couples with different types of health conditions and fertility problems. Primary, secondary and situational vaginismus impacts fertility because successful penetration is either not possible or tolerable – restricting conception.
Women and couples who experience vaginismus but are eager to explore their path to parenthood can work with a fertility counsellor to explore and address challenges and potential solutions. it may also include preparing for pregnancy, childbirth and parenthood together or focusing on improving lifestyle and general well-being.
Where there is minimal fear of pregnancy and childbirth but primary vaginismus exists alongside the desire for pregnancy, they may explore other options together, such as assisted fertility treatments, interventions and IVF. Resolving vaginismus may still remain part of a longer-term focus.
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Pain Management Specialist Clinic
A pain management physician is a health professional who provides individual pain management interventions to help patients relieve and manage chronic pain, including sexual, pelvic and penetration pain.
Their multidisciplinary approach may include education, medication, intervention, exercises, mindfulness-based strategies, and workshops to help clients better manage symptoms. They often work within a clinical multidisciplinary team, which means they have a network of health professionals for onward referral within the clinic.
You can talk to your GP about onward referral to a pain management specialist for moderate to severe penetration pain, dyspareunia and other persistent pain conditions.
And finally… a personal trainer (PT) may seem like an unlikely professional to engage with to resolve vaginismus; however, from a holistic perspective, exercise and fitness can not be underestimated when exploring the integrative approach.
A skilled personal fitness trainer who works with women’s health conditions can help you focus on improving physical health and fitness while targeting core and pelvic floor muscles. They are experts in psychological motivation and breaking you through mental, emotional and physical barriers. These are all qualities that will be beneficial to your long-term goals.
The benefits of exercise and fitness are well-researched as an effective way to manage internal anxiety and stress, improve sleep quality, increase endorphins, regulate hormones and improve body confidence and self-esteem so don’t rule it out!
Personal trainers create fitness plans unique to you with your goals in mind providing home exercises which may include related pelvic, kegel and stretching exercises.
Suppose you are also working with a pelvic physio. In that case, you can give feedback to your PT on the treatment plan so they can incorporate it into workouts.
I hope you find this information helpful in your journey and that you feel empowered to move forward fearlessly to resolve vaginismus. Check out my other articles about vaginismus on my blog at orlaghreid.com. If you are interested in joining an online support group, email me at email@example.com or sign up for the newsletter for updates.
To book an online appointment with me, click here and together, we can start to explore a holistic approach to resolving vaginismus.