Vaginismus at a Glance
Welcome to the home page of vaginismus. This page will attempt to give you an introduction to understanding some of the basic concepts of vaginismus. More detailed information can be found throughout the website and on our sister site VaginismusMD.
Education of patients has always been my goal. At a time when so little is taught about vaginismus in medical school and during family practice, internal medicine, pediatric and gynecology residencies, it becomes incumbent on patients to self educate. Further, for professionals familiar with vaginismus, little is done to stratify the severity of the condition. I have found that given the tools, patients can self assess the severity of their own condition, which then has an impact on the types of treatment that can be recommended.
Let’s get started
What is vaginismus?
Vaginismus is the inability to have intercourse, or if intercourse is possible, the woman has severe pain. Discomfort with intercourse is different and represents a less severe form of penetration disorder known medically as dyspareunia. In the most severe form of vaginismus, many women are unable to tolerate any form of penetration.
How common is vaginismus?
The prevalence of vaginismus is unknown likely because so many women do not speak about this even to their doctors. Commonly quoted figures are 1-7% of the world population. Studies have shown that about 30% of the world female population struggle with one of many sexual pain disorders.
Symptoms of vaginismus
Extremely painful intercourse or the inability to have intercourse are the two most important symptoms of vaginismus. With severe vaginismus there is in addition an inability to tolerate a GYN exam, and many women with this condition have an aversion to being touched in the pelvic area. For women with the more severe form of vaginismus, any type of attempted penetration such as tampon, “Q-tip”, finger, GYN exam, dilators and intercourse cannot be tolerated. As a result of difficulty in examining women with vaginismus, the clinician uses the history to make a diagnosis. For me one of the most important diagnostic considerations is when a woman tells me that attempted intercourse is “like hitting a brick wall”. This to me represents spasm of the entry muscle of the vagina. On examination (with sedation as needed), the entry muscle, known as the bulbocavernosum, looks and feels like a tightly closed fist that does not permit any entry. Some women have had exams under anesthesia and told that “nothing is wrong”. This is a false diagnosis. It is as a result of the vaginal spasm disappearing under anesthesia as all the muscles relax.
Further, vaginismus, especially the more severe forms, creates high levels of anxiety due to the fear of repetitive pain with attempts at intercourse. For any person who is expected to perform a particular task that each and every time results in severe pain, others should be able to understand the unwillingness of that person to engage in that activity. Labels such as “it is all in your head”, “you’re being a baby”, and “RELAX!!” are all demeaning and make a woman feel like a “freak” or “less than”. Because of the lack of this vital understanding, a condition completely out of the control of the woman and involuntary, relationships struggle and depression and low libido are the aftereffects.
Treatment of vaginismus
In my experience the treatment of vaginismus will depend on the severity of vaginismus and therefore the ability of the patient to relax enough for treatment. In less severe cases of vaginismus the patient can relax enough to incorporate the suggestions of therapists such as psychotherapy, sex counseling, hypnotherapy, biofeedback, physical therapy and the use of dilators. I have found that anti-anxiety and anti-depressant medications rarely work. Kegels without counseling, excess alcohol and hallucinogenic drugs have high rates of failure.
For more severe cases of vaginismus, manifested by visceral responses to penetration, such as palpitations, hyperventilation, sweating, nausea, vomiting, going unconscious, yelling, screaming, wanting to die and thinking of suicide, the above noted treatments are often unsuccessful, even after many years of trying. Instead, these women are examined with sedation and treated using the Botox program under anesthesia followed by intense counseling and follow up evaluation. During anesthesia Botox is injected into the spastic muscles and progressive dilation is done, allowing the woman to comfortably wake up in recovery with a large dilator in place. This program results in a high rate of success. It is rare to re-treat a patient.
In 2010 I received IRB (Institutional Review Board) and FDA approval, as well as Investigational New Drug approval by the FDA (IND 109343) to continue my study treating vaginismus using intravaginal injections of Botox together with progressive dilation under anesthesia and post procedure counseling. This is the only study in the United States so approved.
Familiarize yourself with the more detailed content on the website. Visit our sister website VaginismusMD devoted only to vaginismus with completely different educational articles. Become acquainted with the extensive information of the two websites. Once this is done you will be able to teach the course!
Join the VaginismusMD Forum and introduce yourself. You will become part of an amazing community of women with vaginismus who support and teach each other. It will allow you to throw off the shackles of isolation, tear down the walls of secrecy and become a part of a vibrant community of women who are determined to support one another.
Read the Stories section of VaginismusMD. After reading the stories written by my patients you will see many common areas to the struggles with vaginismus. This will help give definition to what you are experiencing.
Read the book When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy by Peter T. Pacik, MD, FACS available through our office or on AMAZON.
Contact our office to obtain questionnaires. Fill these out so we can review them and advise you. As I mentioned the diagnosis of vaginismus is made by history, so whether you are local or from far away, the history is the backbone of understanding your condition.
Start thinking how you can get the word out so that the world begins to understand that there is a condition called “vaginismus”. When vaginismus becomes as well known as erectile dysfunction, women and men will no longer be embarrassed about a condition that is common, involuntary, uncontrolled and fairly easy to treat.
Consider this as your beginning and expand from there. We are here to answer your questions and to help support you. As my patients say so often, “There is no such thing as a dumb question”.