Vaginismus is a painful and complex condition that affects women of all ages and backgrounds, but even the best doctors struggle to understand its causes and treatments. It can have serious consequences for women and their partners. Below, ASHA blogger Mailande Moran interviews Dr. Hilda Hutcherson, a renowned gynecologist, author, and academic, in order to help us learn more about vaginismus. Read on and share widely - chances are that you know someone who is struggling with vaginismus, and a little knowledge can make a big difference!
What is vaginismus?
If a person has vaginismus, the muscles inside her body that surround the opening to her vagina can tighten up suddenly, without her even realizing it. This tightening, or spasm, can make it hard – or even impossible – to put anything inside the vagina, including a penis, finger, tampon, or speculum (the instrument that a gynecologist uses to see inside the vagina during an exam). If a woman with vaginismus tries to do these things, she may experience a lot of pain and discomfort.
Why does it happen?
Sadly, we don’t really know the cause of vaginismus. Many doctors and other experts think that the causes are often more psychological than physical. For instance, a woman may have had something happen to her in the past to make her afraid of having sex. Maybe she experienced sexual abuse when she was young, or maybe her parents always told her that sex was bad, or maybe her first time having sex was very painful or traumatic. Those are reasons that come up again and again. But sometimes, there is no cause that we can put our finger on. Many women who experience vaginismus don’t have an explanation for what they’re feeling.
What mental or emotional effects can vaginismus have?
For most women that I’ve seen, vaginismus has caused sadness and depression. This is partially because it is physically painful, and partially because it can be hard to deal with when it comes to romantic relationships. If you can’t put a tampon in, or go to the gynecologist, or enjoy the pleasure of sexual intercourse, that’s a tough way to live! Also, because so many doctors still don’t understand vaginismus, women often go from doctor to doctor without finding anyone who knows what’s up and can help them deal with it. Women often feel very frustrated, broken, and depressed. They know that something is wrong, but they don’t know how to fix it.
How can someone determine whether or not they are experiencing it?
Most of the time, vaginismus shows up this way: everything's fine until you try to put something in your vagina! You walk around, sit down, exercise, and everything is fine, but as soon as something tries to go inside there, you feel discomfort and pain.
If someone is diagnosed with vaginismus, what should they do?
The first step is to find a doctor who can help. Once you’re there, it might depend on who your doctor is and what he or she recommends. At my office, I try to learn as much as I can about my patient’s sexual health, as well as her sexual experiences in the past. I want to know how she feels about her body and her relationships. I want to treat the physical pain she’s feeling, of course. But, as I said earlier, that pain often goes hand-in-hand with psychological pain. So I want to find out what might be behind what she’s feeling in her body. Sometimes, if a patient is very frustrated or depressed, or if she has been abused in the past, I’ll send her to a therapist who can help with those specific issues.
To help with physical pain, I introduce my patient to dilators, which are just plastic cylinders that come in different sizes. If a woman needs to practice putting something inside of her vagina, dilators can make that easier by starting with a very small size and working your way up to a larger size. I also want to help my patients reconnect with their bodies. Sometimes, we might start with helping a woman learn about “what’s down there,” where all the parts of her body are and how they work. I want her to feel comfortable touching herself and working with the dilators, and to help her not fear pain when she does that. A patient of mine will usually start using the dilators on her own, so that she doesn’t feel any pressure from anyone, and then use larger dilators as she feels able to. I might also bring a physical therapist who focuses on the muscles that are misbehaving with vaginismus, which is very helpful to some women. There are lots of different exercises and things to practice that can help to relax the muscles in the vagina.
Any tips for communicating with partners vaginismus?
You just have to be honest and straightforward. Explain that it’s a condition that you have no control over, and that the cause and treatment are not well understood. It’s just like having any other kind of illness. It’s not contagious, but it does affect everyone in a romantic relationship. It can be difficult for your partner, too; you just have to be as clear as you can – about what you’re going through, your desires, and your limits – and ask that they be understanding and patient as you work through it. It’s normal to feel as though something like this might threaten a relationship; sometimes, it’s really hard for partners to deal with. But if someone isn’t willing to support you through the hard times, they’re probably not a great person to be with anyway!
What can partners do to help?
Be supportive, patient, and understanding. Be willing to work with your partner to find the right answer, to find the best way to make things work. Remember that the experience of vaginismus can vary from day to day – sometimes women who live with it can be fine one day, but sex might be very painful the next. Be prepared for the fact that sex just might not happen when you both want it to! But there are still so many other ways of “having sex,” where two people can be sexually satisfied without having intercourse. I talk to patients about things like “outercourse,” when partners can rub their genitals on the inner thigh rather inside the vagina. And oral sex, manual sex, fun toys, etc. – those are all things that you can do together to help you feel satisfied and intimate with each other. And you can still snuggle afterward! Just do some thinking together about what other pleasurable activities you can do if intercourse isn’t in the cards. Talking about that ahead of time can make it much easier to change course if you need to, so that you don’t have to stop in the middle of everything. (But if you need to completely stop, that’s okay too!)
Any last words of advice?
Remember that vaginismus has a complicated healing process. If you have a knee injury, you might have to keep working your whole life to make sure you keep it strong; it’s the same thing with vaginismus. It’s likely that you’ll never really be “done” with it; though you can heal, you’ll probably have to keep working with the dilators and other exercises every now and then to keep your muscles healthy. There’s no recipe for this; every woman is different.
My own opinion is that everyone deserves a satisfying sex life, whatever that means for them. It's important for physical and emotional health in all women. So it's important not to just accept the pain of vaginismus as something you’ll have to deal with forever. But you may have to see more than one doctor. Go and keep searching for the right person with the answer for you! Don’t give up if the first or second doctor’s visit doesn’t result in a solution, because there are others out there who can make a difference. Vaginismus can make woman avoid relationships because they feel broken or unsexy. That’s understandable due to the pain, but I urge anyone feeling that way not to give up! Everyone has the right to have great sex, however they define that for themselves. It’s possible, even if it’s not easy. And you deserve it!
Dr. Hilda Hutcherson grew up in Tuskegee, Alabama. She received her undergraduate degree at Stanford University and medical degree from Harvard. She completed an Internal Medicine internship at University of California, San Francisco, and residency in Obstetrics and Gynecology at Columbia University Medical Center. After residency, she remained on faculty at Columbia and served as an academic advisor, Director of the Gynecologic Teaching Associates, Director of Adolescent and Pediatric Gynecology and Director of The Vanderbilt Gynecology Clinic. American Medical Women’s Association at Columbia has twice recognized her with the Gender Equity Teaching award.
Dr. Hutcherson is currently a Clinical Professor of Obstetrics and Gynecology and Associate Dean in the Office of Diversity at Columbia University, College of Physicians and Surgeons. She is also the Director of the Center for Sexual Health at Columbia.
Dr. Hutcherson views patient education as an important component of medical care. Her commitment to women’s education and empowerment is evidenced by her monthly women’s health column in Redbook Magazine, where she is also a contributing editor. She is the former sexual health columnist of Essence and Glamour Magazines. She is a frequent invited speaker on Women’s Health and Sexuality. She is the author of 3 books: Having Your Baby: A Guide for African American Women, What Your Mother Never told You About Sex, and Pleasure.
Dr. Hutcherson was recently named by Black Enterprise Magazine as one of America’s Leading Physicians, one of the Top Doctors in New York in the Castle Connolly Guide, and is included in the Best Doctors in America database.
Mailande Moran is a musician and writer based in Durham, NC. She is a 2013 graduate of the Fuqua School of Business at Duke University, where she served as a Fellow for the Center for the Advancement of Social Entrepreneurship's Impact Investing Initiative and the Center on Leadership and Ethics.
In the summer of 2012, she worked with Enterprise Community Loan Fund to analyze and communicate the impact of green affordable housing and transit-oriented development in Colorado. While pursuing her MBA, she consulted with the healthcare NGO Healing Fields in India, the microfinance start-up Seeds in Kenya, and the for-profit maternity hospital LifeSpring in India.
Prior to Fuqua, she focused on social entrepreneurship and philanthropy in strategy roles at Echoing Green and the Shelley & Donald Rubin Foundation. Mailande graduated from Duke University in 2006 with an A.B. in Art History. She is passionate about creating a safer, more equitable world. You can hear her music on Facebook and follow her other adventures on Twitter.
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