Pain and cramping in the vaginal area
Sex can be exciting and pleasurable, but unfortunately it can also be a nightmare for those who suffer from dyspareunia. And the annual visit to the gynecologist is often avoided by people with vaginismus.
It is difficult to say how many girls and women are affected by one or both diagnoses, as few talk about it, let alone see a healthcare professional. Why is this the case?
What do these two terms relating to women’s health mean?
Vaginismus
… is often described as an involuntary, vaginal cramp in the pelvic floor area during penetration of the penis, insertion of a finger or tampon. The condition has been known for many, many years. More precisely, since 1547, when the term vaginismus was not yet used but the condition was described for the first time. Vaginismus was used as a term for the first time in 1862.
Unfortunately, the diagnosis is often associated with fear-avoidance behavior and high emotional stress . The girls and women refrain from visiting the gynecologist and from any sexual activity (e.g. masturbation or vaginal intercourse).
Dyspareunia
… dys means wrong/miss and pareunia is a bedfellow, it describes a painful condition during or immediately after vaginal intercourse. Most girls or women fail in 50% of attempts to have vaginal intercourse. During penetration, the muscles in the pelvic floor area tense up to such an extent that in the long term they associate any touch and advances with negative emotions.
The International Pain Classification classifies vaginismus and dyspareunia as sexual, genital dysfunctions. If both conditions are present, this is referred to as Genito-Pelvic Pain Penetration Disorder (GPSPS). It is not always easy to distinguish between these two diagnoses. In principle, the difference is that in vaginismus, the focus is not necessarily on pain and sexual intercourse, but on the cramping of the muscles.
In both situations, the success rate of conservative therapy is very high. A cause cannot always be found. Trauma (e.g. abuse as a child), previous operations, childbirth or problems in the partnership can lead to these diagnoses.
What conservative (non-surgical) treatment options are there?
It is important that, if possible, the possible medical and possibly also psychological causes are clarified in advance so that treatment can be started and successfully completed. Even if not many sufferers dare to accept one or more treatment options, there are various possibilities that can already be used without great (time) effort or cost.
It is very important that those affected can talk about it in a familiar environment and feel understood and respected in their situation.
The measures are primarily aimed at desensitization, a state of insensitivity. This includes the ability to relax the pelvic floor muscles, to reduce the tense muscle tone and thus the pain as much as possible. This can be achieved with the help of pelvic floor training, manual therapy, equipment, yoga and meditation as well as sex therapy.
Pelvic floor training includes biofeedback and electrostimulation. However, this requires that a probe (Fig. 1) can be inserted into the vagina. In order to achieve this, it is often necessary to relax the muscles to a certain extent and to learn techniques that allow the probe to be inserted (e.g. external manual techniques by the physiotherapist or progressive muscle relaxation).
The biofeedback in the physiotherapy session can help to see the muscle tension and relaxation as a graph on the screen of the device and thus influence the ability to relax. Stimulation by electricity is also intended to support this. There are studies that prove the 100% effectiveness of biofeedback and we at Physio Restart also see great and quick results.
Dilators (Fig. 2) are devices that can also accustom the vaginal entrance to relaxation. They look like rods and are available in different sizes. The patient can use them to practise in a familiar environment (including at home).
Store Pharmacy Vagiwell® Dilators
Sometimes accompanying sex therapy with or without a partner is useful in order to restore the connection to oneself, one’s sexual organs/area and one’s partner. It can be helpful if the couple generates the woman’s sexual arousal without penetration in order to make the vaginal entrance moist, which may make it easier for the penis or finger to penetrate. These and other situations can be discussed with the therapist.
Contact a trained specialist if you have any problems. Your gynaecologist and Anneke from Physio Restart are familiar with these situations and will be happy to support you back to a fulfilling, pain-free sex life and pelvic floor health.
Author:
Anneke Penny
Book your appointment for physiotherapy, massage or group courses: here.
References:
1. https://www.womentc.com/de/Vaginismus/statistische-Pr%C3%A4valence/
2 Lahaie MA, Boyer SC, Amsel R, Khalifé S, Binik YM. Vaginismus: a review of the literature on the classification/diagnosis, etiology and treatment. Womens Health (Lond). 2010 Sep;6(5):705-19. doi: 10.2217/whe.10.46. PMID: 20887170.
3 Fordney DS. Dyspareunia and vaginismus. Clin Obstet Gynecol. 1978 Mar;21(1):205-21. doi: 10.1097/00003081-197803000-00018. PMID: 630754.
4. de Kruiff ME, ter Kuile MM, Weijenborg PT, van Lankveld JJ. Vaginismus and dyspareunia: is there a difference in clinical presentation? J Psychosom Obstet Gynaecol. 2000 Sep;21(3):149-55. doi: 10.3109/01674820009075622. PMID: 11076336.
5 Pacik PT. Understanding and treating vaginismus: a multimodal approach. Int Urogynecol J. 2014 Dec;25(12):1613-20. doi: 10.1007/s00192-014-2421-y. Epub 2014 Jun 4. PMID: 24894201.
6 Pacik PT. Vaginismus: review of current concepts and treatment using botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia. Aesthetic Plast Surg. 2011 Dec;35(6):1160-4. doi: 10.1007/s00266-011-9737-5. Epub 2011 May 10. PMID: 21556985.
7. https://www.vaginismus-selbsthilfe.de/
