So there I am at my daughter’s tumbling tots class and a woman sitting near me overhears me say that I’m a MFT and says “Can I ask your advice?” and I actually love this question because I get some really interesting questions and this was one of them…so here was her question- “I have a friend who’s son recently got married, and his new wife never wants to have sex again because the first time it was painful. All the mom’s friends are saying things like “oh-she’s messed up, there must be something wrong with her, because we were like rabbits after we got married.” Or “Maybe she’s a lesbian” and basically the mom of this couple and to some degree the couple themselves are kind of desperately reaching out for help from family-but not getting much help.
And this is a really common problem that many women have, but a lot of people don’t have access to good sources of support or education on the topic, The other day someone asked me about vaginismus on Instagram, So here goes. We’re going to talk about some treatment options for painful sex and vaginismus.
According to the American College of Obstetricians and Gynecologists, “nearly 3 out of 4 women have pain during intercourse at some time during their lives. For some women, the pain is only a temporary problem; for others, it is a long-term problem.” But there are a lot of things that couples can do to decrease or eliminate pain during intercourse...So let’s talk about some basic treatment approaches.
1. Now the first thing that needs to be addressed is the couple’s ability to talk about this issue with someone who is educated on the topic, a marriage therapist, sex therapist or doctor would be able to help point them in the right direction instead of family members who really only know about their own experience or opinions. For many people, talking about sex is a difficult thing to do, and this can be especially hard for people raised in a conservative or religious culture. So for some people, there is almost no education about healthy sexual behavior prior to marriage.
So-the first thing I’d recommend is seeing someone who can help this couple discuss sex in an open, healthy way and receive advice from someone who is educated. It may feel awkward or embarrassing to you, but to a professional, it’s no big deal and there’s so much to be gained. I would say that the majority of problems with sex can be solved by education and conversation.
2. If you’re unwilling or unable to see someone in person, there are some other options. “The Good Girl’s Guide te Great Sex” is a book that carefully educates couples from a Christian background on how to improve their sex lives. In addition to skills and techniques, reading the book together could help open those channels of communication and decrease the awkwardness of talking about Sex.
3. Now that we’ve encouraged you to talk about it, let’s do some super basic sexual education: Women are generally slower to get aroused and lubricated than men are, so intercourse can be painful just because of this- so some basic education and skills can greatly increase her comfort and enjoyment- increase foreplay, more time doing non-genital touching, use some lube, and slow down and do what it takes to let the woman increase her level of arousal and that’s going to help her be more comfortable during intercourse.
4. There are some Techniques the couple can try- for example you can alter the sexual position, or you could try a sex therapy technique like the Sensate Focus exercise, and these can also help improve arousal, comfort and communication.
I think that a lot of people from conservative or religious backgrounds may be really worried about looking up how to improve their sexual relationship on the internet and with good reason, because they may get recommendations that don’t jive with their values such as- masturbate or watch porn together, so it’s important to look for resources or work with a profession who respects your cultural/religious background. Some couples may be open to most everything, and other couples more reserved, but there are many options and lots of different approaches, so if you’re willing to study it out, you can solve a lot of problems. So look for resources that work within your framework.
5. OK, let’s talk about Vaginismus- Vaginismus is when the Pelvic floor muscles contract involuntarily, for many women this is a reflex, something that happens without their control. So just like if I were to poke you in the eye with my finger, your eye would clench up, with vaginismus, women experience that tightness, whether with a partner or just trying to put a tampon in, and it makes sex painful, which makes women more nervous the next time, which makes them tense up more, and thus an anxiety/pain cycle develops.
This anxiety might be caused by past trauma or bad experiences or some anxiety within the relationship or other situations that are causing anxiety.
The good news is that most of the time this can be treated with a psychological approach rather than a medical one. Even though that tightening up isn’t on purpose, you can train yourself to soften those muscles and gradually feel a lot more comfortable during intercourse.
So if you go back to my videos on exposure hierarchy and the anxiety cycle, the basic idea is that if something makes us feel anxious, but it’s actually safe, if we gradually and gently face it, over time, that anxiety will decrease.
So with vaginismus, there’s two basic skills- 1. Progressive muscle relaxation and 2- Using an exposure hierarchy-
So PMR. - if you don’t know this skill yet, learn it, it’s great for all types of anxiety, but basically if you just try to force your muscles to relax or try to make yourself calm down, it backfires, it makes you more anxious. Instead, you train yourself to tense a muscle and then release that tension. You can use PMR for any type of relaxation, but in this case, the muscle group you’ll be tensing and relaxing is your pelvic floor. You’re going to be doing Kegels. There’s a bunch of great videos on that topic so just Google kegels.
And then the second skill is using an exposure hierarchy to gradually increase your skills. So you’re going to start by getting good at doing kegels, you can practice them while peeing-if you can stop your urine flow, then you’re probably doing it right, do this a couple of times to get familiar with what it feels like to tense and then relax.
Then you can practice with “vaginal dilators” this sounds scary, but it’s basically just a term for putting increasingly larger things into your vagina, you can go to your doctor to get a medical device, or you can be creative as long as what you’re using is clean and safe.
And then when it comes to sex, you’re going to back wayyy off, slow way down, and just move forward with a tiny step, and practice that level for a while, it may be a long time, until you’re able to relax into that level, and then move to the next rung on the ladder.
Now I’m going to read two paragraphs from the book “The good girls guide to great sex”
6. The last thing I want to mention on this short video is that there may be other underlying causes of painful intercourse- there’s a bunch of physical conditions that can contribute to painful sex- I’ll include a link below to an article by the mayo clinic on other causes of painful sex, and there’s other causes for a tight pelvic floor that may be best addressed by a physical therapist- and there’s also the chance that she has experienced some sexual trauma in her life (around 1 in 3 women have) and that may be affecting her experience. If any of these are factors, they can also be treated by experts- gynecologists, doctors or therapists who specialize in trauma work.
Regardless of the underlying cause, improving communication and reaching out to expert resources is going to help this couple work together to solve this problem. It is absolutely solvable, they just need to go about it the right way.
VAGINISMUS- page 109