The role of a relationship therapist in helping the couple resolve vaginismus together requires someone with knowledgeable insight, awareness, and experience in contemporary psychosexual teachings, sexual dysfunction, vaginismus, and couple’s therapy. The therapist plays a vital role for the couple seeking to understand and overcome the condition

“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)

When choosing the right therapist they should have an informed understanding of effective interventions for penetration disorders, like vaginismus, and be able to effectively communicate guidelines and advice on how best to use the suggested interventions, and equally identify when they are not suitable or appropriate.

Working through the intimacy and relationship problems often associated with vaginismus requires the right therapist that can cultivate the atmosphere needed for this kind of deep growth as well as an appropriate therapeutic program clearly communicated to the couple. It is important that both partners feel safe and comfortable at every step of the couple’s therapy.

The roles of the couple’s psychosexual therapist

As with any couples therapy, the therapist is responsible for helping the couple understand the basic tasks of couples in therapy, such as:

• Improving communication
• Developing listening skills
• Being respectful
• Respecting boundaries
• Openness and honesty
• And emotional responsiveness

Typically, they also educate the couple on the characteristics of healthy connected relationships, like:

• Strong communication
• Expressing needs
• Openness
• Healthy Sexuality
• Identifying attachment styles
• And continued enjoyment of affection, sensuality, arousal, sexuality, and intimacy in other ways other than through penetrative sex.

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Your couples therapist can also address anything that may be holding the woman, partner, or couple back from engaging fully in the couples therapy process or intimacy blocks affecting the development of a healthy emotional and intimate connection between partners. When there are significant blocks or barriers to overcome which can happen when working with sexuality and relationship issues, individual therapy may also be very beneficial and suggested.

“Many of us were raised in cultures that say our own sexual bodies are disgusting and degrading.” – Emily Nagoski author of Come As You Are

The right psychosexual therapist can help rewrite and redefine both the woman’s and the couple’s sexual script to help encourage and adopt a sex-positive attitude. The couple’s therapist is responsible for assessing each partner’s romantic, adult attachment style, which will influence positively or negatively how partners engage and participate, both in therapy and with each other.

For example, avoidant, or anxious, attachment style types may struggle to engage proactively in exercises, homework, or self-expression but therapy can provide a space to help identify these attachment style characteristics which may be exasperating the condition for the couple and provide a safe space to work towards a more secure attachment style. Research has shown that an anxious disposition is more prevalent in women experiencing vaginismus, while male partners who display avoidant type traits are less likely to provide the support and reassurance necessary to overcome the sexual dysfunction within the couple’s dynamic.

The right plan for each couple

Psychosexual therapy for couples provides a safe, therapeutic space for the woman, her partner, and the couple to learn more about the condition of vaginismus, the factors upon how it may have manifested for the female, and integrative interventions for managing or resolving their vaginismus.

Typically, because vaginismus affects the female, she seeks professional treatment and intervention alone. However, this has several adverse consequences for the partner and the couple’s dynamic when they are not involved in the process.

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This separation can mean the partner does not learn to fully comprehend the potential origins of the condition, is disconnected from the healing process, feels inadequate in supporting the woman, or, similarly, feels unsupported and isolated themselves.

Often, partners may present with their own sexual difficulties or dysfunction. These can be explored and addressed in couple’s therapy. They also may need a safe therapeutic space to develop more effective coping skills and communication styles to feel both confident and motivated in supporting their partner in a positive way.

The therapist should help the couple understand that by working together they can develop their emotional, romantic, and sexual connection and better understand how to manage and resolve vaginismus so that neither partner feels distressed, alone, or isolated, which new research highlights as challenging for many couples.

Working with couples to resolve vaginismus and its associated relationship and sexual problems requires the right plan, which both the therapist and couple can follow. Sessions should maintain a primary focus on treatment goals and outcomes while reducing an over-emphasis on minor relationship issues which are not relevant to the presenting sexual condition.

Additionally, providing homework exercises for the couple to complete will encourage consistent progress and keep the couple motivated, focused and outcome orientated.

The couple’s assessment

The assessment phase for couples should be extensive and involve both the woman and her partner to better help in forming a treatment plan and program to work towards.

Social, cultural, ethical, gender, and religious norms are all factors that must be taken into consideration. Sexual history should respectfully explore perceptions, attitudes, and experiences surrounding pregnancy, birth, miscarriage, fertility, abortion, and trauma.

Understanding previous interventions, the couple has undertaken, including what they have found helpful and unhelpful to date, provides valuable insight into their dynamic and expectations.

While a detailed ongoing assessment over the course of a few sessions may take time, it will be a beneficial process to work through for the couple as it lays the foundation for understanding each other’s perspective and experience of the condition in an informed way and will directly influence the treatment plan and desired outcomes.

The assessment should identify and reflect the verbalised needs, reservations, and desires of the woman, her partner, and the couple as a whole. A strong sense of consent and safety is at the core of any treatment goals. There will of course a possibility that one, or both, do not wish to participate in each aspect of a treatment program and this is always fully respected and assessed on an ongoing basis.

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Identifying goals, measures, and outcomes

Creating a treatment plan for women and couples will identify positive measures and outcomes for managing and resolving the couple’s vaginismus. Every single couple’s needs will be unique to them. Positive outcomes do not need to be specifically related to penetration, but can rather refer to sexual connection, intimacy, and overall relational happiness.

‘Goal setting and a self-help programme is beneficial for women in addressing sexual dysfunction.’- Vicki Ford author of Overcoming Sexual Problems

Your therapist will explore short-term, medium-term, and long-term goals for the couple as part of a proactive and positive approach. An experienced Psychosexual therapist or Sexologist will always be mindful of the clients’ blockages and resistances to engaging in treatment and goals are continually discussed and adjusted appropriately.

Some final thoughts!

Finding the right Psychosexual therapist may seem like yet another obstacle that your vaginismus presents to you, but the insight, empathy, and healing that comes from working with an experienced psychosexual therapist cannot be underestimated as highlighted in recent studies by Maria McEvoy in her study of Vaginismus in an Irish Context. That relationship and alliance may take several sessions to foster together.

Working through a program specifically designed to evaluate your, your partner’s, and your relationship’s needs, and learn to fulfill them, is often the first step in regaining intimacy.

Ultimately, with interactive work and the right couple’s therapist, you and your partner can begin to build a healthy, safe, happy, and intimate relationship amidst your vaginismus condition. If you would like to schedual an online appointment you can book online at www.orlaghreid.com/onlinetherapy/