For Women With Vaginismus, Trauma And Pain Go Hand In Hand

By Hanna Miller

flickr/Gisela Giardino

Monique Pittman didn’t know the first time she had sex, she would wind up screaming in pain. Pittman, a freelance photographer and photographer’s assistant in Chicago, IL, had waited until her wedding night to have sex for the first time — an experience that should have been about growing intimacy between newlyweds. Instead, Pittman was blindsided by a tearing, stabbing, burning pain in her vagina, the result of a condition called vaginismus.

Vaginismus occurs when muscles in the pelvic floor (which supports the bladder, uterus, and anus) contract during penetration. These spasms can be painful enough that any kind of penetration, even with a tampon, is impossible. Pre-existing physical, psychological or emotional anxieties may trigger or compound that pain, and the stress from painful penetration can also cause anxiety, sometimes resulting in a vicious cycle that’s difficult to break.

The road to recovery is complex, because the causes are complex: trauma can cause pain, which makes experiences traumatic, which causes more pain. Women with vaginismus are encouraged to seek a multi-part treatment, balancing gynecological appointments, therapy or sex counseling, and pelvic floor physical therapy. But there’s no set path to recovery that will work for all women. “It takes a different amount of time to get over something like this” for each individual, said Liz Miracle, a pelvic physical therapist in San Francisco.

At the time of her marriage, Pittman says she’d never inserted anything into her vagina; penetration was “foreign.” Raised by her mother and her grandmother in a Roman Catholic household, Pittman witnessed her grandmother “talk so much trash” about sex as a reaction to her mother’s promiscuity. “[My mother] always had a different guy that she was sleeping with,” she said, “and my grandma really frowned upon that.”

With her family’s influence, Pittman decided she didn’t want to have sex before marriage. Years later, after she first stopped believing in God and then became a born-again Christian, she was glad she’d waited; having sex after marriage, Pittman said, allowed her to understand the value of intimacy.

Pittman considers her first sexual experience on her wedding night traumatic because of the unexpected pain. She and her husband thought that, over time and with practice, things would get better, but that hasn’t been the case. Instead, Pittman has internalized the post-trauma pain. “It makes me feel kind of like less of a woman. I don’t feel sexual. I feel weird, like nothing,” said Pittman.

Past trauma or abuse are common causes of vaginismus, said Jasmine De Lung-Thier, a somatic psychotherapist in San Francisco, CA. Especially when a person has experienced “complex trauma,” or repeated traumatizing events, they may come to over-rely on coping mechanisms — like tightening the pelvic floor — that are eventually no longer adaptive. For vaginismus, subsequent instances of stress and pain resulting from this coping mechanism can actually contribute to trauma. That includes attempts to have consensual sex — and it can also include treatment. The significant psychological factors, not to mention the possibility that medical interventions will make the condition worse, pose barriers for treatment.

But the greatest barrier to treatment may be the lack of research needed to label, treat, and spread awareness about the condition.

Statistics about how many women have vaginismus and its causes are disputed among experts because stigmas shame women into silence. The most commonly-shared statistics, says De Lung-Thier, claim that vaginismus affects about 10% of women worldwide, but “it’s kind of an impossible statistic to know at this point. … I think there a lot more women suffering than even can be measured.” And the psychological factors of vaginismus mean that attempts at physical treatment can be retraumatizing, making the condition worse.

Pittman didn’t receive a diagnosis until age 24, when, after a rare intimacy with her husband, Pittman visited a prenatal doctor and learned she was pregnant. At the appointment, Pittman spoke about the complications in her sex life, and after hearing symptoms, the physician diagnosed her with vaginismus.

Pittman miscarried, a dizzying experience. When an OB/GYN cleaned out Pittman’s uterus, Pittman experienced what she called “the worst pain [she had] ever felt in her life.” While she screamed, Pittman says, the OB/GYN put an entire hand inside her vagina to check the cervix for possible further complications.

The miscarriage and painful procedure became another physical and psychological trauma — so painful, says Pittman, that she didn’t attempt sex again for four or five months. “That was worse than my wedding night could have ever been,” she said.

When she was 16, Stephanie Sellers of Panama City, FL had the first of a series of abusive, traumatic events. Her boyfriend at the time was older, and he convinced her to have sex with him, although she got no pleasure out of it, she said. After the experience, she went home and called a friend to process the experience.

Sellers said she didn’t know her mother was listening in on the private conversation until her mom burst into the room, upset and insistent that Sellers immediately see a gynecologist. The compromising situation with her boyfriend coupled with her mother’s invasion of privacy left Sellers feeling tense. Today, at age 22, Sellers does not enjoy anything sex-related. “It’s not a good thing; nothing good comes of [sex],” said Sellers. “Intimacy in itself has caused a very anxious response, because I always feel like I’m going to get in trouble for it.”

Sellers never had physical pleasure with her first sexual partner, and with her second and third partners, she felt intense pain during intercourse. Because sex has not been pleasurable during and after intimacy, Sellers decided to avoid it and identifies as asexual.

Sellers said she doesn’t meet guys at parties. She doesn’t have casual sex. She doesn’t even have a sex drive. “I’m kind of the odd one out, unable to join in the fun and the conversation because I don’t like it,” she said.

The first time she’d ever heard the word “vaginismus” was when she was diagnosed with the condition as a post-trauma response to abusive sexual experiences and shaming. Since labeling her condition, Sellers says it’s eased some emotional pain to know what’s wrong. Whereas she’d find herself in “very uncomfortable” and “confusing” situations without knowing her diagnosis, she can now put into words what’s going on.

While the diagnosis has opened doors for Sellers, it’s also carved out an unsure path for recovery. For patients just starting treatment, physical therapist Liz Miracle suggests baby steps to learn to relax the area and to regain a range of motion that goes beyond “painfully tight.” For women like Sellers who are ambivalent about sex, Miracle recommends a starting point like laying in a bed beneath a sheet, with or without clothes on, and opening the legs, in order to regain physical comfort in intimate settings. Miracle has patients place a hand on their vulva, over their clothing, and use diaphragmatic breathing (deep “belly” breathing) to “learn to how to breathe into their hand so that the pelvic floor muscles open up.”

For more advanced treatment, Miracle uses skin rolling, a deep-tissue massage that brings blood flow into the massaged area. Starting at the knees and working toward the opening of the vagina, Miracle works to get her patients accustomed to “being touched in the area in a non-sexual way,” she said. Once patients are comfortable with touching around the vagina, Miracle’s next step is to insert one finger.

Usually, the final step to treating vaginismus is using dilators, which come in a set of graduated sizes. “Basically, it’s like a little Russian doll,” Miracle described, adding, “It’s not a dildo. … It’s being used for a medical purpose.”

Patients purchase their own set of dilators for use at home. The dilators come in a set ranging from four to eight in number, and each has handle for insertion and removal. Starting with a small dilator, which is about the size of a pinky, patients move up to larger sizes, up to six inches, as they successfully and painlessly insert smaller dilators. The idea is the patient is “the one that’s in control” and that patients can use their own discretion to choose the “most relaxed setting possible until [they] can get comfortable with the insertion of this device,” Miracle said.

Vaginal dilators don’t appeal to Sellers, however, because she has no interest in being sexual or intimate. Being in control of the apparatus entering her, said Sellers, makes her feel a little better, but she doesn’t “like the idea … of insertion itself” because, with no libido, she “doesn’t have any interest in pleasuring [her]self.”

Early in the treatment process, Sellers did internet research on vaginismus and initially sought counseling until it became too expensive for her to maintain. She has read about the dilators and seeks to purchase them in the future, although she isn’t doing it for herself. “If I had the choice, I’d probably go close to the rest of my life without any kind of intimate pleasure,” said Sellers.

At age 25, Alisha Krueger, a 28-year old events marketer in Minneapolis, had sex for the first time. She wasn’t surprised it was painful; her friends warned her the first time is never fun, and she’d found penetration to be painful in the past.

After years of crying through Pap smears and feeling like her OB/GYN inserting a Q-tip was as painful as a dagger, Krueger scheduled an appointment to figure out the root of her intense pain.

Searching online, her OB/GYN diagnosed Krueger with two conditions: vulvar vestibulitis (inflammation and pain only at the vaginal opening) and vaginismus. Krueger began seeing a specialist, and had surgery to remove tissue at the opening of her vagina, which addressed her form of vestibulitis but not the vaginismus.

Krueger still experiences pain upon penetration, but not as intensely. She describes it as a “tearing,” “burning” sensation in her vagina that sometimes lingers for days after penetration. Her specialist diagnosed Krueger’s vaginismus as a post-traumatic response to her pre-existing condition; Krueger’s muscles currently spasm because of the pain she once felt due to her inflammation and nerve pain.

In addition, Krueger says, her pain and her partner’s reaction to the pain turned her sexual experiences traumatic. Although at first he was supportive, when Krueger’s pain did not subside, her boyfriend would try forcing her to fit his penis inside her. “’If you love me, you’ll just keep trying to fit, you’ll just figure it out. It fits,’” she recalls him saying.

Today, Krueger balances a demanding schedule to maintain her treatment for vaginismus. She visits a pelvic floor physical therapist weekly and has sexual health therapy every other week. Krueger also maintains regularly scheduled gynecological appointments. Six days a week, she uses dilators at home. It took three months for her to insert the smallest dilator, the one the size of her pinky, she said. The first time she saw the largest one, she was “freaking out at first” because she didn’t know how she was going to ever fit it into her vagina.

Now, when she has time to date, Krueger questions herself, both because of her vaginismus and her experience with an abusive partner. “Who wants this broken twenty-something year old when they can get somebody who doesn’t have these issues?” Krueger asked, adding that sometimes it’s awkward telling men she’s recently met that she has a condition hampering her sex life. She says sometimes she’ll lie and claim her physical therapy is for her hip, rather than her vagina.

De Lung-Thier, who also had vaginismus before becoming a somatic psychotherapist, agrees having the condition is “an isolating experience a lot of the time.” She recalled trying to have sex with a past partner before undergoing treatment and said, “When I can’t have sex with my partner as a result of something that’s painful, I feel less valuable as a person. … I often felt like less of a woman.”

Pain with sex is disorienting; having a label, “vaginismus” for this specific type of pain helps women to put their pain into words and to seek support and treatment.

For Krueger, treatment is going well, but it’s taking a long time to see the results she wants. She said, “I want to be done with this. I’ve dealt with it for so long.” In addition, because treatment and recovery are highly individualized processes, Krueger feels further frustrated. “It’s hard to know how much to push yourself,” Krueger said, adding, “there’s not like a pamphlet or anything.”

The lack of research leaves patients without a sense of what to expect, as well as hampering diagnosis and acceptance. “Whereas there was research and funding all day long for erectile dysfunction,” says De Lung-Thier, there’s shame, stigma and silence around “women’s lady bits.” For a condition that’s exacerbated by shame, confusion, and trauma, that’s a real problem. Women like Krueger, Sellers, and Pittman have found ways to address their pain without making it worse through stress and anxiety, but 10% of women — and perhaps much more — will have to repeat that difficult journey again and again.

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