"Why Sex Sometimes Hurts…
Feels like - Pain on entry during sex, burning, stinging, tightness, and muscle spasms in the vagina and/or lower back.
Could be - Vaginismus. This condition is characterized by the overtightening of the vagina muscles and causes strong, involuntary muscle spasms or intense pain during intercourse. Vaginismus can be caused by trauma from childbirth or surgery; endometriosis (uterine tissue growing outside the uterus); chronic urinary tract infections; or such psychological triggers as anxiety, stress, or past emotional or sexual abuse.
Solutions - Vaginismus is treatable. A variety of exercises and relaxation techniques can gradually stop the cycle of pain, including muscle-control exercises in which you repeatedly contract and relax your pelvic muscles and insertion training that begins with a tampon or finger and leads to intercourse. Psychotherapy might be useful, but experts emphasize that physical and behavioral techniques often can work on their own."

Reference

1. Wider, J. (2007). Why Sex Sometimes Hurts. Cosmopolitan Magazine, August, 214.

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"If sex is painful - or even impossible - you may have vaginismus, an involuntary muscular contraction. Find out the symptoms, causes and treatments of this all-too-common - and hugely under-diagnosed - condition."

"Once a woman feels more in control of her muscles, the next step is to dilate the vagina to desensitize it … there are vaginal dilator kits available for sale … available at vaginismus.com"

Reference

1. Rae, K. (2007). Clampdown. Glow Magazine, May/June, G5-6.

Completely Overcome Vaginismus - The Practical Approach to Pain-Free Intercourse
By Mark and Lisa Carter

The intent of the book is to provide a self-help program for women suffering from vaginismus. The book can be read alone but also can be purchased as part of a kit which includes; a companion workbook, a set of vaginal dilators, a video, and a password that allows the reader to participate in an on-line forum with other individuals and couples facing the challenge of vaginismus. The approach of the kit is to provide systematic desensitization exercises for the woman and the couple that include:

1. Education about Vaginismus through a video, book and website.
2. Communication about Vaginismus through a restricted on-line forum for those who have purchased the kit.
3. Normalization of issues that contribute to Vaginismus through the use of statistics and descriptors that let the woman know that she is not alone in having Vaginismus.
4. A systematic desensitization format for the woman to use.
5. A series of graduated dilators as well as a q-tip and tampon
6. A systematic desensitization format for the couple to use.
7. Journaling via use of a journal that comes with the kit so that the woman can document her progress.

This approach is very empowering in that the woman has access to all of the information and can proceed at her own pace through the protocols that are presented. The video and books provide information that can be used by the couple to engender hope and provide steps that allow progress while minimizing anxiety.

The kit is a wonderful addition to the armamentarium of the Sex Therapist in that it provides specific exercises for the woman and couple to do. The woman can then discuss with the Sex Therapist any issues that arise in the treatment. The couple that has used the kit with this Sex Therapist needed support in addressing the man's anxiety about using the kit. The woman was more willing to do the exercises but her husband was having trouble with them. The Sex Therapist was able to work with the couple to help the man apply the techniques of mutual pleasuring and to decrease his avoidance of the exercises suggested in the book. The multi-dimensional approach of the kit makes available on-going resources that can be used by the woman with vaginismus. One drawback of the book is that while it acknowledges the importance of communication with the partner, the treatment focuses on the woman. Although vaginismus is a diagnosis that applies to the woman, it is a part of the dynamic of the couple's sexual interactions. Given the model of women's sexuality as embedded in a psycho-relational-cultural context, it would be expected that there would be partner issues that would need to be addressed in the resolution of the vaginismus.

One way to include the partner in the treatment is to predict that he or she will likely have strong responses to the protocols, thus normalizing any strong reactions that occur. A second way to include the partner is to suggest that he/she keep their own journal about the treatment. The Sex Therapist can then inquire about the partner's reactions and journal in such a way that lets the couple know that the relationship will be addressed.

Reviewed by Maya Bat-Ami - DocMaya

http://www.itv-thismorning.co.uk/NewsAndFeaturesArticle.aspx?fid=1746&tid=2

Vaginismus.com Dilator Set

"The set comes with a universal handle that easily attaches to the dilator end … and easily inserted by patients. Appropriate, easy-to-follow written instructions are also included … effective and priced well."

'Treating Vaginismus' - Video

"A sex therapist gives verbal instructions on the use of dilators and the video shows the patient inserting the dilators and progressing to intercourse. Overall, the instructions are good and therapists may choose to show parts of the DVD to their patients as it does show clearly how a patient would insert the dilators herself and shares patient concerns and success."

'Completely Overcome Vaginismus' - Book Set

"The authors are a couple who have experienced vaginismus first hand. Lisa Carter holds a degree in medical rehabilitation and psychology. Mark is an educator and writer. Book 1 explains the 10-step program to desensitizing the vagina for penetration. Book 2 is simply a workbook to be filled out while progressing through the program. Book 2 makes the steps simpler."

"In step 1, relationship issues and other causes of dyspareunia are explored (these are explained more in the appendix). Contract relax and general relaxation instructions are also given. Step 2 identifies negative emotions associated with sex. A detailed sexual history is also listed. This inventory is in check list as well as descriptive paragraph form and is very well done."

"Step 3 shows self discovery techniques and describes anatomy. The workbook has unlabeled pictures to test knowledge. The pelvic floor muscle (PFM) is introduced in step 4 … In step 5 the patient is guided in insertion … Step 6 progresses."

"Clear instructions are given with gradual insertion … Many ideas for trouble shooting insertion are given … Advancing dilator sizes is discussed. Step 7 involved sensate exercises … Gradually getting comfortable with each other is explained. In step 8 … Sensate exercises are then practiced … with attention to keeping the PFM relaxed."

"Step 9 explains the transition to intercourse with partial insertion and the female on top. Clear pictures show the anatomy of insertion. Many suggestions are given for making insertion succesful. Step 10 progresses to movement during penetration and other pleasurable components of intercourse. Appendix C gives program rationale and effectiveness including citation of 8 references with outcomes data."

"The 2-book series is an excellent guide for patients and has many helpful hints for therapists as well. I can recommend use of this resource by all patients with vaginismus." [emphasis added]

Reference

1. Shelly, B., Edwards, D. (Editor) (Winter 2005). Product News & Reviews - Complete Vaginismus Treatment Kit. APTA J of Women's Health Physical Therapy, 29(3), 74.

"What happens when the process of "becoming one" in marriage brings pain, not pleasure? Or when every attempt at intercourse induces intense burning and the sensation of being torn apart inside? Many women live with an invisible handicap that robs them and their spouse of the enjoyment of sexual intercourse. It's called vaginismus, and it's possibly the most common cause of female sexual pain you've never heard of.

Commonly misdiagnosed, vaginismus is the involuntary and unconscious spasm of the muscles surrounding the vagina, making penetration painful or impossible. Estimates suggest that in North America alone, hundreds of thousands of women suffer from vaginismus to some degree. Statistics are hard to gather because many never come forward due to shame and embarrassment. Victims suffer in silence for years, never realizing they can find help.

My journey with vaginismus began 12 years ago. My husband, Brian*, and I had been married eight years when I gave birth to our second child. Labor was traumatic, and the baby was finally taken by C-section. After my recovery and with two babies in the house, my husband and I were tired but eager to resume the joy and comfort of intimacy.

Instead, sex brought anything but joy and comfort. Every time we had intercourse, I experienced intense burning pain. While I wanted to say "yes" to intimacy, my body said "no."

When my physician examined me, he found nothing physically wrong and said the pain should subside. But it didn't. In fact, it got worse. I didn't know what was happening, and fear kept me from telling Brian for two years. Many times I hid the tears. I thought if I told him, he'd be afraid to touch" Read Full Article at www.christianitytoday.com »

Reference

1. Cardwell, K. (2004). When sex hurts. Today's Christian Woman, November/December, 62-64.

"Thousands of women suffer agony if they try to make love or even use a tampon. A simple treatment programme could change their lives."

Kayleigh Morris vividly remembers the pain she felt when she first tried to insert a tampon at the age of 12. She says: 'It was excruciating. It was as though someone was sticking a knife into me. I didn't try to use tampons again.' Kayleigh also avoided sex until she was 24. Then she plucked up the courage to sleep with her boyfriend. 'It was horrendous,' she says. 'Pain shot up into my stomach. He only managed to get the tip of his penis in and said my vagina felt like a vice.'

Kayleigh, 28, is one of 33,500 women in Britain who suffer from vaginismus - an involuntary tightening of the vaginal muscles that makes intercourse and inserting a tampon painful or impossible. It can be the result of a medical condition, such as endometriosis or thrush, or of anxiety caused by a previous painful sexual episode or pelvic examination.

Happily, vaginismus can be successfully treated with a therapy programme including sex education and relation exercises along with pelvic floor exercises that help you get to know your own body better. Patients also use devices called vaginal dilators, which are introduced into the vagina in progressively larger sizes - from that of a matchstick to that of a normal erect penis."

"After four months on the programme Kayleigh, who's from Manchester, felt ready to try sex again. She says: 'This time it was painless. I was so incredibly relieved that I cried. It sounds silly but I really did feel that I'd become a proper woman.' [For] advice and a self-treatment pack call or visit www.vaginismus.com."

Reference

1. Mears, J. (2005). When sex is a pain. Bella Magazine, February, Issue 5, 17.