Vaginismus - The Muscle-Reflex Sex Pain
Vaginismus can be another cause of pain with intercourse and can sometimes prevent any kind of penetrative sex.
What is it?
Vaginismus is the involuntary reflexive contraction of the pelvic floor muscles (in particular those around the vaginal opening) in response to attempted penetration, whether it be from a tampon, speculum or penis. You may or may not experience any pain with this. The muscular response can vary from a slight contraction but still allow for penetration (albeit usually uncomfortable or painful) or completely close the vagina to not allow any penetration at all. For the partner, it can feel like 'running into a brick wall' when the muscles are so firmly contracted.
Vaginismus may or may not be experienced in combination with Vestibulodynia and can even be a learned reflex from pain associated with it. What causes it?
There is not always a obvious cause of vaginismus. In a lot of cases it is a learned response of the muscles due to a painful experience with penetration or after an event such as childbirth, infections or other medical conditions. It can also be associated with anxiety and stress about having sex, difficult relationships, some religious beliefs and past sexual abuse, however this is not always the case.
How is it diagnosed?
A thorough history and physical examination is required by an experienced gynaecologist or pelvic health physiotherapist. There are no specific tests such as blood tests or swabs that would lead to a diagnosis as it is purely a reaction of the pelvic floor muscles.
What can be done about it?
Pelvic Health Physiotherapy can help to teach you how to actively contract and relax your muscles. Sometimes gentle muscle release and stretching is required, as well as a graduated home program. This often involves using 'accommodators' to desensitize the vaginal tissues and experience self-controlled penetration, with the aim of returning to full intercourse.
In some cases, talking to a counsellor or therapist to help overcome the fear of the pain and to resolve any difficult memories can be very helpful.
Some women find they are still able to enjoy pleasurable sexual activities that do not involve penetration and are still able to orgasm. Pain with sex can definitely put a strain on any relationship. Being open with your partner and still finding ways to be close and intimate is key while working to resolve the pain.