Power of Questions in Your Vaginismus Journey

Three questions you need to ask your doctor

One-in-Five women in the United States experience sexual pain! There are many reasons for painful sex, but vaginismus-related pain (pain related to involuntary vaginal tightening) by far has the most success rate with treatments¹. In a study in 2017, nearly 73% women suffering with vaginismus were able to achieve pain-free intercourse when they received the necessary treatments¹. Getting access to the right intervention starts with finding the right provider and asking the right questions. That is exactly what we will talk about here – Three questions you need to ask your doctor if sex hurts!

We cannot treat what we cannot understand.

Vaginismus is a condition that causes pain and fear with vaginal penetration making it difficult to use tampons, have sex or get a pap smear. It is understandably a difficult and private topic for most of us. Women often struggle in isolation because this condition is mostly unknown to women and clinicians. Vaginismus has been around for over a hundred years and is still sadly not routinely taught in medical school or residency training.

Rita felt puzzled as her gynecologist finished a pelvic exam to hand in the “all good” report card. “Well, if everything is good down-there, then why does sex hurt so much? Is it all in my head?” Rita is not the minority when it comes to women experiencing penetrative pain with seemingly nothing abnormal in their vaginal tissue. But what if

The issue is not in the tissue?

This is the very reason why YOU might have to advocate for yourself more than usual to get the answers you deserve.

1. Is this really vaginismus?

There are many medical causes for sexual pain and a medical screening can help identify the specific issue. A standard gynecological exam will involve reviewing your history and discussing your problem. The doctor might run some blood and urine tests to get more information. A diagnosis of vaginismus is based on a combination of symptoms and lack of any other causes that explain the pain. When it comes to vaginismus, there is no diagnostic test; to make matters worse, some are still using the outdated diagnostic criterion of a vaginal spasm. Unfortunately, it is not uncommon for my patients to be dismissed by their providers by saying, “everything looks normal” in the absence of a spasm. The lack of “proof” can be confusing for many women. Vaginal spasm used to be the hallmark for diagnosis of vaginismus but for most women with vaginismus, speculum exams are extremely painful and traumatic. Hence the current recommendations do NOT require a vaginal exam to confirm a diagnosis of vaginismus.

2. What are my options?

There are several treatment options depending on your unique situation and needs. Vaginismus may have physical components of pain, muscle tightness, and spasms. It may also have an emotional component of fear or anxiety. Some women need to start with DIY dilator treatments, and others may need to start with physical therapy and sex therapy (counseling) simultaneously. There are also more invasive options, such as botox and laser treatment. An open dialogue with your physician will help to navigate your path to find the best fit for your needs.

3. How bad is my vaginismus?

We know that your treatment options differ based on the severity of your symptoms. For example, some women can tolerate a tampon but cannot tolerate penetrative sex, while others have inconsistent pain or the inability to tolerate any penetration, even a cotton swab. Usually, doctors use the following five dimensions to assess the severity of vaginismus: success rate of vaginal penetration, level of pain, fear of vaginal penetration, pelvic floor muscle problems, and other medical problems².

To summarize, advocating for yourself is more important than ever when it comes to intimate health issues. Having a handy list of questions for your doctor can ease your mind in an otherwise emotionally heavy appointment. There are several successful treatment options for painful sex, but successful treatments start with successful assessments!

Sources:

1. 1. Pacik PT, Geletta S. Vaginismus Treatment: Clinical Trials Follow Up 241 Patients. Sex Med. 2017 Jun;5(2):e114-e123. doi: 10.1016/j.esxm.2017.02.002. Epub 2017 Mar 28. PMID: 28363809; PMCID: PMC5440634.

1. 1. Pacik, P. T. (2011). Vaginismus: review of current concepts and treatment using botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia. Aesthetic plastic surgery, 35(6), 1160-1164.