Fertility concerns are often what brings women thinking of starting a family into therapy to begin to address undiscussed vaginismus symptoms. Fear and pain impact how we think, feel and function and both strongly influence our behaviour, which also includes our sexual response system. Sadly for many women sexual intimacy can be a painful and unpleasant experience sometimes leading to fear or avoidance of intimacy. Fertility anxiety can become a real problem and it might feel difficult to get your head around what you are experiencing right now but give yourself space and time with a professional therapist to work through your concerns. Talking can feel empowering.
Find out more about my weekly Women's TLC Online therapeutic group for vaginismus and sexual pain conditions or visit the events page to book online.
What is Vaginismus?
Women who experience difficulties with penetrative sex or who are unable to tolerate or experience penetration may have a condition known as vaginismus. Vaginismus is also known as a GPPPD condition which stands for Genito pelvic penetration pain disorder. There are over 8 vulvar conditions that women can suffer from which we don’t hear much about in society. For those women or couples who are contemplating starting a family who would like to get pregnant naturally or are considering assisted fertility treatments, vaginismus and vulvar pain conditions can be a barrier to fertility.
New Vaginismus Research in Ireland by Dr McEvoy
Dr McEvoy’s recent research ‘Vaginismus in an Irish context‘ about Irish women, couples and helping professional’s experiences of vaginismus makes several references to the challenges women experience with fertility problems, fertility pressures and concerns.
‘Many of the therapists and the physiotherapists spoke about the pressure their clients put themselves under to fix themselves and wanting to resolve the problem quickly. Some therapists mentioned the pressures of fertility, which led in some cases to couples opting out in order to progress quickly through in vitro fertilisation rather than taking the time to resolve the problem.’ – Dr Maria Mcevoy (2021)
If you experience any of the symptoms of vaginismus believe me – you are not alone. Many women whom I talk to in my private practice share their concerns and feelings about living with vaginismus and its impact on their fertility plans, hopes and dreams. They often feel that no one understands what it feels like to experience fertility challenges which are related to being unable to have penetrative sex. ‘I feel like I don’t fit into any area of fertility or infertility treatment because of the condition.’
You might be interested in... [Vulvar, Vaginismus and Female Sexual Wellbeing Resources and Information]
Fertility Treatment and IVF Options for Vagininsmus
Assisted fertility treatments are of course an option however it is worth considering that taking this fertility route comes with its challenges such as fear, anxiety and trepidation about the treatment tests and procedures that are part of working with a fertility clinic. I suggest a more integrative and collaborative approach with encourages women to address the condition and symptoms and also look at fertility planning at the same time rather than focusing just on fertility in the shorter term.
Women with vaginismus experience their internal fears, thinking patterns and anxiety relating to many aspects of sex and sexuality. In my experience, it is also usual to develop a strong sense of mistrust in their bodies which feel like it does not respond in a normal way to sex and intimacy. There can also be fears about pregnancy and related post-natal appointments and checkups and getting through a natural birth. ‘I am terrified of them poking and prodding me down there.’ The problem with fear is that when you don’t work through it, it can hold you back from reaching your full potential.
Throughout this vaginismus series blog, I have introduced many aspects of vaginismus and vulva pain including insights from wonderful health professionals who can be part of your journey and an integrative approach to managing and resolving the condition in particular the role of the psychosexual therapist and specialist pelvic physiotherapist.
Planned parenthood often is not so simple to plan. For women who experience painful sex, difficulty experiencing intercourse for conception and those who have fears and aversions to any form of vaginal touch, penetration and medical checkups, fertility will feel more complicated but do not let that hold you back from finding answers and working through whatever you are experiencing in your life right now.
How does vaginismus affect fertility?
There is a wide range of physical and psychological symptoms associated with vaginismus that will create fertility problems for women and couples. From a physical and physiological perspective, the woman is unable to tolerate penetrative vaginal sex creating a physical barrier to conception. The anticipation of painful PIV (penis in vagina) sex and distressing or failed attempts at sexual intercourse interfere with satisfying sexual intimacy and functional sex. This repeated pattern of experiences can create a perpetual cycle of fear and avoidance (FA cycle). This cycle contributes to higher levels of anxiety and overwhelm connected to partner intimacy, vaginal touch and medical procedures and tests.
Starting therapy to overcome the impact of vaginismus on your life and how you feel about yourself and your body as a sexual person is a positive and nurturing gift to yourself. Talking is empowering and you deserve to empower yourself and feel free from fear and pain.
The Psychological impact of Vaginismus and Vulva Pain
Psychologically, it can also be typical for women with vaginismus to feel greater levels of anxiety, fear and overwhelm associated with pregnancy, maintaining a pregnancy, postnatal appointments and checkups and often the labour process. Working towards feeling more comfortable with uncomfortable experiences, self-touch, smear tests, tampon use or menstrual cups and dilator training can be part of a progressive path towards fertility and pregnancy. At a pace that feels safe and comfortable for you. Sadly, fear of pregnancy and childbirth is often rooted in childhood and inadequate or fear-based sex education.
If you have lost trust in parts of your body you are not alone! My clients often report feeling disconnected from certain parts of their body, sometimes their sexuality, alienating their vulva and vagina region and no longer trusting that their body will do what they want it to do.
There are some assisted fertility treatment options for women with primary vaginismus such as IUI and IVF. However, this option comes with its own set of challenges. There are usually concerns and fears associated with fertility tests, treatments and interventions that require internal examinations, ultrasounds and procedures. Some women may find these types of medical fertility procedures less distressing than attempting penetrative sex while others may feel the opposite.
Whatever your thoughts and feelings are about fertility and vaginismus talk them through with an experienced therapist so that you can make sense of them.
Vaginismus Help and Support
Taking your time to understand how the condition is affecting you and then breaking down into steps the various ways you can begin to work towards fertility, pregnancy and childbirth will help you feel more in control and confident about the future. There is no quick fix but slow and steady progress is always the best route to take through any kind of sexual problems.
Women with vaginismus-type symptoms also regularly express in therapy different degrees and types of fears and frustration about their bodies. One of these more challenging fears is being afraid of their own bodies including the vulva, clitoris, vagina and sexual organs. This can include feeling overwhelmed, deeply uncomfortable or unable to tolerate looking, touching or feeling any of the pelvic and vulva regions, sometimes even discussing the topic early on in therapy can feel challenging. Guess what? It gets easier I promise! It is amazing to see how women progress through therapy being able to connect, discuss and explore their bodies and embody their bodies for the first time in their adult life.
Vaginismus and the Fear of Pregnancy
The idea of trying to get pregnant and being pregnant can feel overwhelming for some women with vaginismus depending on the type of experiences they have had while for others it may be a dream that feels just out of reach in the present.
Pregnancy is not for every woman, parenthood is not for everyone and penetration is not for everyone and that is 100% okay. Sometimes natural conception is not for everyone. What should be for every woman is doing what feels right for you.
But, if you want to start working towards fertility and getting pregnant naturally or through assisted fertility treatments and IVF, then now is the perfect time to start exploring what that means to you.
When I work with my clients coming to psychsexual therapy for vaginismus we discuss hopes, dreams and goal setting early on in therapy. From a coaching perspective, when there are plans and goals in place it gives us focus and motivation.
Moving Beyond Vaginismus Fear
Yes, you can move beyond paralysing fear and it’s called self-coaching and goal-setting. Giving yourself space to think beyond the fear, around the fear and through the fear. Setting goals, visualising your future, making plans, troubleshooting, being creative and looking for solutions are all simple skills that can help you move beyond fear and think with a different part of your brain. Thank you neuroscience!
Goal Setting Timelines
When I work with my client’s vaginismus symptoms we talk about goal setting early on and create a simple integrative treatment plan. Breaking down objectives and goals into smaller steps feels much easier to achieve. I explain the purpose of goal-setting objectives and divide goal timelines into these three categories:
Short term is 0 – 3 months
Medium-term is 3 months to 12 months
Long-term goals are 12 months +
Setting goals for fertility with vaginismus
Get yourself a large A4 page and divide it into three sections, at the top of each section write, short-term, medium-term and long-term. Now think about the types of goals and plans you can place into each section that feel realistic for you and that you would also like to achieve over the coming two years. Under each goal or plan, write a list of ideas, steps, thoughts and actions you can take to begin reaching that goal. A coaching tip is to keep your goals simple, specific, measurable and achievable.
I can help you to set your own goals and objectives to work towards managing and overcoming vaginismus for fertility. Get in touch to book a one-to-one online psychotherapy or health coaching appointment or join the womens TLC online group.
For women with primary and secondary vaginismus or women who have strong fears and phobias about pregnancy, pregnancy or childbirth, fertility plans and preparations may be marked down as a long-term goal. That is giving yourself 52 weeks, one full year to work towards achieving manageable goals, tasks and actions that are part of your short and medium-term plans.
Sounds simple right? The truth is setting future goals and having a vision is simple, what will feel more challenging for you is getting yourself into the mindset of taking action.
Practice makes progress and with the right support, interventions and self-management of vaginismus you can make the type of progress you can be proud of. One year is a long time to make significant changes in your life and also change the relationship you have with your own body. Don’t let fear and overwhelm keep you feeling stuck, feel the fear and make some plans, dreams and aspirations anyway!
Breaking down your challenges, fears and phobias will help make the path towards fertility and pregnancy feel more manageable and less overwhelming. It also reduces the pressure on women to treat and resolve vaginismus symptoms when the focus is on setting smaller manageable goals over time rather than one giant overwhelming goal.
Common goals for women working towards being able to successfully and comfortably have intercourse and penetrative sex or tolerate an IVF fertility treatment process may start with talking about their condition and all the various factors, thoughts and experiences that contributed to the various symptoms. There is no quick fix for working through significant fears and phobias about intercourse, pregnancy or childbirth but giving yourself plenty of time to get support, understand yourself and begin to make progress will give you the confidence to keep making progress.
Integrative approaches for managing vaginismus and psychosexual therapy
Many of the interactive approaches to resolving vaginismus are enjoyable well-being experiences and practices such as breathwork, mindfulness, meditation, pilates, yoga and nurturing yourself with regular self-care practices, complementary therapy and bodywork. These will also complement any stage or phase of your fertility journey.