How To Deal: Living with Vaginismus

Q. I have vaginismus and have never been able to have penetrative sex. While my boyfriend is supportive, he lives in another state and will be at least 300 miles away for the next 2-3 years. We see each other several times a year (and will see each other twice a month when he moves closer to me in the spring), but we’re both relatively inexperienced/awkward and have been struggling to find pleasurable alternatives to penetration. The whole situation has made me so depressed about having sex that my sex drive has evaporated and none of my regular “fixes” (reading racy novels, sending my boyfriend sexy texts) are helping. My boyfriend is worried about my lack of desire and how we’re going to balance his desire for penetration with my issues. He wants me to be enthusiastic about our sex life but doesn’t know how to help.

First, how do couples in long distance relationships cope with vaginismus? Most of the resources I’ve found online seem to be for couples who live together. Second, how do I tap into my sexual desire again? I miss feeling excited about sex and want to have a positive sexual relationship with my boyfriend.

A. My love, I’m sorry to hear about your situation. It sounds nothing short of frustrating and difficult, a sure stressor on both you and your partner. For full disclosure’s sake, I want you to know that I did not know about vaginismus until recently. I had always heard the insulting, agitating, and sexist notions of what vaginismus was referred to: the frigid, cold, sexless; but all derogatory descriptions of a very real medical condition aside, I want to be clear that as a person who only very recently came to know about vaginismus, much less a person who has not experienced it, that I will be heavily relying on other’s advice, rather than my own. My fear of taking your question into my own experience is to prescribe simply (Try a sex toy! What about anal? Oral sex!) when that so obviously is missing the mark of your experience. Nothing sounds less genuine or is less helpful than someone talking about something they know not shit about and furthermore, there is nothing worse than pathologizing something that obviously lies beyond two step answers and Internet advice.

You certainly deserve more than that.

So my love, let’s do our best to break this down in a way that can leave us with something more than we came in with.

For the folks out there who, much like myself, had never heard of this condition, vaginismus is an “involuntary spasm of the muscles surrounding the vagina. The spasms close the vagina.” Furthermore, “the inability to engage in any form of vaginal penetration, including sexual intercourse, insertion of tampons and/or menstrual cups, and the penetration involved in gynecological examinations. This is the result of a reflex of the pubococcygeus muscle, which is sometimes referred to as the ‘PC muscle.’ The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration–including sexual intercourse–painful or impossible.” This spasm can also limit blood flow to the vagina, making lubrication difficult, resulting in the already sensitive vaginal tissue and mucous membrane in the area subject to intense pain. tearing, and discomfort. The level of pain is different in each individual, and can range anywhere from discomfort during sex, to collapsing into a pile of tears because a pair of jeans is just too much stimulation on the vagina. Gynecologist visits become something to dread, sex becomes a source of anxiety, and the very things that most of us take for granted as “normalcies” become everyday battles, a pain both physical and psychological. Now, here is where things can get tricky and have a danger of veering into hysteria territory. vaginismus is considered specifically to be a sexual problem, with a range of possible causes, that run the gamut from sexual trauma and abuse, to vulvar vestibulitis syndrome, to harm avoidance, to being idiopathic. Frankly, there isn’t enough research going on to find out more on vaginismus, most likely because there seems to be more financial and social interest in making sure men can have boners, rather than making sure women can not only have safe and protected sex, but also sex that is enjoyable. I don’t think we need to concentrate on the why so much, at least not here, since again, I am just a half naked lady on the Internet. I have no medical training, and again, have only become recently aware of vaginismus.

The good news is, you certainly aren’t alone, especially here. One of our own writers, Michelle Miller, wrote an entire series (the six part series is located here) on living with vulvar vestibulitis, a condition that is very similar to vaginismus. Miller, recently married and looking forward to having sex for the first time, found it awful – and not just awful. Horribly painful, as well as depressing and soon, anxiety-provoking.  I think her series might be one of your closest sources of how to move forward. By finding community, it helps reduce the sting of what feels like a curse. You feel less like an outcast and realize that the stigma around your medical condition, is just that; not who you are or your measure as a woman. Finding community will help you not only be able to talk to those who know what you are going through, but be able to let you find ways to cope and deal and help with issues like getting your sex drive back or reducing anxiety. By just doing a simple Google search, I found one large online support group, but certainly it doesn’t stop just there.

So, what to do for you and your partner? Well, it depends, mostly on what works for you. My biggest and what will probably be the most difficult suggestion is to try and let go of the “shoulds.” It seems that your anxiety is not only stemming from the fact that your partner is now far away, thus, physical contact now being that much more important, but the pressure to have penetrative sex seems all the much more necessary. I can’t imagine putting that type of pressure on myself, though I can understand why. So while we will cover some more basic plans of action in a moment, I think the most important thing you can do for now is to try and slow the anxiety and create a better headspace for yourself.  Now, as important as this is, I think it’s probably also the hardest. Changing thought patterns is a hard thing to do, but, I also think it might make a large difference in the way you approach sex. If you approach sex knowing the worse may come, your body is going to prepare for that. Now, I am not saying go in there like it’s going to be a bed of roses at first. Hell no baby, y’mama knows that people recognize sugar-coated bullshit quicker than a fake handbag.  But being able to have a better frame of mind will most likely give you more room to grow your sexual desire back, and if anything, it will help out and vice versa, with some of the following physical exercises below.

So, as far as the physical goes, what can you do? Here are a few schools of thought:

Pelvic exercises: This is where you use your pelvic floor muscle to contract and relax, aka, Kegels. The idea behind these exercises is that you will begin to have more control over the spasms, as well as being able to isolate your vaginal walls.

Vaginal dilation: This seems to be a step for the more advanced. These exercises are when you use plastic dilators. (Please note: every source that recommends this also recommends that this should be done under the direction of a sex therapist or the health care provider you are working with. Do not try this at home, folks.)  Using a dilator can “train” your vagina in a certain way, as well as gradually include more intimate contact, the idea that you train yourself towards penetration and vaginal sex.

Progressive Desensitization: These exercises, unlike vaginal dilation, can be done on your own, at home, but with the same goal in mind. Here is the four-step process recommended by the Women’s Health section of WebMD:

• Start with kegels. Do about 20 contractions at a time. You can do them as many times a day as you think to do them.
• After a few days, do the exercises with a finger inside the vagina. It’s a good idea to clip your fingernails and use a lubricating jelly. Or do the exercises in a bathtub, where water can be a natural lubricant.
• Your finger needs to be inserted five or six centimeters. That’s up to about the first knuckle joint.
• Start with one finger and work your way up to three. Fingers are preferred because they allow you to feel the muscles contracting. They are also easy to remove if you start to feel any discomfort.

Medicate: Many people who have vaginismus have turned to anti-anxiety medications to help with the mental part of vaginismus, so talk to your doctor about potentially finding an anxiety medicine that you could use to calm those roller coaster thoughts. So now that anxiety is covered, what about the potential pain? This may be where you want to talk to your doctor about topical numbing creams and gels, for any form of penetration, whether you are at the gyno’s office or if you want to have penetrative sex.

Taking vaginal sex out of the equation: Depending on how sensitive your genitals are, maybe leave the idea of penetration off the table right now. Let’s look at what that leaves as far as sex goes: there’s clitoral stimulation, whether it be your partner using hands or mouth, or a vibrator. There is anal sex if you want some form of penetration. There is oral sex for him, as well as masturbation. While it seems that vaginal sex is your ultimate goal, this might be where so much anxiety is coming from. Hell, I know if I start getting anxious about sex, I clam up real quick. The amount of anxiety we can build up in our heads is something fierce.  Miller said it best in “Panic Moments”,  part two of her series:

When these panic moments arose, I dodged, mumbled, feigned, and straight-up lied. I did whatever I thought was necessary to save face, appear strong, and betray no indication that my heart and spirit were well and truly broken.The long and the short of it was that I became an emotional recluse. I was suffering inside, and each of these “panic moments” with friends and family became just another wound. And the sad reality is that I allowed my friends and family to continue unknowingly wounding me in this way; and then I let that hurt drive me deeper into anger and depression.If I’ve learned anything about living without pleasurable intercourse, it is that these panic moments, these “play-pretend” interludes, aren’t worth the hurt they leave in their wake. Better to shrug, grimace, and speak the truth–even if it makes others suspicious, triumphant, or uncomfortable–than to drive the pain and shame deeper into your body. Your body is dealing with enough. And so are you.

 

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