Vaginal pain and / or cramping
Updated: Apr 14
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.
How many girls and women are affected by one or both diagnoses is difficult to say, as few talk about it, or see a healthcare professional. Why is it like that?
What do these two terms, which refer to women's health, mean?
Vaginismus
... is often described as an involuntary, vaginal spasm in the pelvic floor area during penetration of the penis, insertion of a finger or tampon. The symptoms have been known for many, many years. More precisely, since 1547, although the word vaginismus was not yet mentioned, the condition was known. In 1862, the term vaginismus was used for the first time for this condition.
Unfortunately, the diagnosis is often associated with an anxiety-avoidance behavior and high emotional stress. The girls and women avoid visiting the gynecologist or gynecologist, as well as any sexual acts from masturbation to vaginal intercourse.
Dyspareunie
... dys means false/wrong and pareunie is a bedfellow, so it describes a painful condition during or immediately after vaginal intercourse. Most fail in 50% of attempts to have vaginal intercourse. During penetration, the muscles cramp in such a way that they associate it with negative emotions on the long term.
The International Pain Classification classifies vaginismus as sexual, genital dysfunction. Are both condition present, we talk about genital, pelvic pain-penetration disorder. These two diagnoses are not always easy to distinguish from each other. In principle, the difference is that vaginismus does not necessarily focus on pain and sexual intercourse, but on the cramping of the muscles.
In both situations, the success rate of conservative therapy is very high. It is not always possible to find a cause. Trauma (even abuse in childhood), previous surgeries, births or problems in partnership can lead to these diagnoses.
What conservative (non-surgical) treatment options are there?
It is important in advance, if applicable, that possible medical and if necessary psychological causes are clarified in order to be able to start and successfully complete the treatment.
Even if there are not yet many people who have the courage to undergo one or more possible treatment options, there are various 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 mainly concern the desensibilization, a state of insensitivity. The ability to relax the pelvic floor muscles and cramped muscle tone and thus reducing the pain as much as possible belongs to it. It can be achieved with the help of pelvic floor training, manual therapy, yoga and meditation, and sex therapy.
Pelvic floor training includes biofeedback and electrostimulation. However, this presupposes that the vaginal probe (picture 1) can be inserted. In order to achieve this, it is often necessary to achieve a certain relaxation of the muscles beforehand and to learn techniques that allow the insertion of the probe (e.g. external, manual techniques by the physiotherapist or progressive muscle relaxation).
The biofeedback in the physiotherapy session can help to see muscle tension and relaxation as a graph on the screen of the device and thus influence the ability to relax. The stimulation by electricity should additionally support this. There are studies that prove the 100% effectiveness of biofeedback and we at Physio Restart also see great and quick successes.
Dilators (picture 2) are devices that can also accustom the vaginal entrance to relax. They look like rods and are available in different sizes. The patient can thus practice in a familiar environment (also at home).
Shop Apotheke Vagiwell® Dilators
Sometimes the accompanying sex therapy with or without partner makes sense to restore the connection to oneself, sexual organs / area and partner. It can be helpful to create the sexual arousal of the woman without the penetration in order to moisten the vaginal entrance which may make the penetration of the penis or finger later easier. These and other helpful tips can be discussed with the therapist.
If you have any problems with any of those two conditions, contact a trained professional. Your gynaecologist and Anneke from Physio Restart are familiar with these situations and are happy to support you to go back into your fulfilled, pain-free sex life and pelvic floor health.
Author:
Anneke Penny
Book appointment for Physiotherapy, Massage oder Group classes: here.
References:
1. https://www.womentc.com/de/Vaginismus/statistische-Pr%C3%A4valenz/
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/