Vaginismus: Unable to use a tampon
Early signs of Vaginismus
One of the early signs of vaginismus is the inability to use tampons. This is true in about 50-75% of the patients I see for treatment. Just about the time a young women begins to menstruate, she is also undergoing profound psychologic and physiologic changes in becoming a sexually active woman. It is at this time her girlfriends may begin talking about first time intercourse. Rumors about pain, tearing, ripping, bleeding and unwanted pregnancy all begin to create fear of anticipated penetration. She may begin to think that her vagina is too small to accommodate an erect penis. Add to this strict sexual upbringing or strict religious upbringing (“sex is dirty”, “God punishes if you have intercourse before marriage”, “you will go to hell”) and one sets the stage for the fear to become a phobia. This natural reaction to fear can become quite intense manifesting itself in the condition of vaginismus. As with any phobia the fear can be of varying severity from some fear of penetration to extreme fear of penetration. This uncontrolled reflex becomes an involuntary reaction that the patient has no control over.
Fear of a GYN Exam
Women will often spend years wondering why they are unable to insert a tampon. Later they find they have an exaggerated fear of a GYN examination, and again this fear can range from a mild fear to an exaggerated fear with nausea, vomiting, sweating and “going unconscious”. GYN doctors are often not in tune with thinking about vaginismus or may simply not be educated about this condition. Their office nurse may also be uneducated about vaginismus. Telling the patient to relax or “it’s all in your head” is not helpful at all and does not allow the patient to understand what she is experiencing.
Fear of Penetration
The woman with vaginismus then goes on to a fear of any form of sexual penetration be it a finger or penile penetration. She struggles through the dating period and many of my patients make it clear that they want to wait until marriage for intercourse. Of course here too they fail and the stage is set for years of difficulty in a marriage that is not consummated.
Treatment of Vaginismus
The less severe cases of vaginismus can be treated in a variety of ways including self fingering to aid in dilation, use of dilators often in association with Kegel exercise, sex counseling by someone experienced with vaginismus, hypnosis, physical therapy with or without biofeedback and psychotherapy with someone experienced in vaginismus. With each specialist it is important to ask the amount of experience the specialist has with vaginismus, because often this is a more difficult condition to treat. It is also important to ask for a timeline to determine how long treatment should be undertaken before making a decision to move on. I have found that sometimes women with vaginimus are treated for years making no progress. This is far too long.
Lamont Classification of Vaginismus
It is very important to determine the severity of vaginismus, and the patient needs to become acquainted with the Lamont Classification for Vaginismus. The severe forms of vaginismus do not lend themselves well to the above treatments. For more information, please visit our VaginismusMD website.
Botox Treatment for Vaginismus
It is for this reason that I use Botox injections and progressive dilation under anesthesia to treat the more severe forms of vaginismus. By relaxing the spastic muscles with Botox and allowing a patient to understand that penetration is both possible and not painful, patients are finally able to advance to intercourse. Once this happens the use of tampons becomes possible and GYN exams are no longer so feared. To view Dr. Pacik’s blog on Vaginismus Treatment: The 1,2,3, Punch, please visit our vaginismus website.
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