Vaginismus Dyspareunia and Vulvodynia

by Cay Crow, M.A., LPC, AASECT-Certified Sex Therapist

Vaginismus Dyspareunia and Vulvodynia

 Vaginismus Dyspareunia Vulvodynia

As an AASECT-Certified Sex Therapist in private practice, I had the privilege of working with many women experiencing sexual pain. The official diagnosis is Genito-Pelvic Pain/Penetration Disorder, an umbrella term that describes conditions such as vaginismus, dyspareunia, and issues like vulvodynia. Women presenting with these problems demonstrated common themes. Many women with pelvic pain do not voice their discomfort. Instead, they white knuckle through each penetrative sexual encounter, believing that it will be better this time. However, the body does not work that way; just one painful sexual encounter is enough for the body to establish a pattern. By the next encounter, the body anticipates pain, thereby creating a feedback loop that tends to worsen with each experience. My first therapeutic intervention with these clients is to bring the partner (s) into the conversation and create an alliance between partners against pain. Sometimes the partner knew about the pain but wanted to try different positions or lube to “fix” the issue.


Vaginal Dilator Therapy


The most effective medical intervention for sexual pain is pelvic floor physical therapy. Women with sexual pain are often appalled by the idea of a PT working inside the vagina. But the internal work does not begin until the client is ready. Pelvic floor PT might start with exercises to stretch the inner thighs and lower back, which are often overused and tight in women with these conditions. Once the client is ready, the PT might begin with dilation at home, gradually increasing the size of the dilator.


What Causes Vaginismus?


Just as some people are prone to headaches or stomachaches under stress, some women with sexual pain carry tension in the pelvic floor. Sexual pain is not always the result of trauma. The cases I worked with included women from conservative religious systems who delayed sexual activity until they married. Without any type of experience with vaginal penetration, including tampon use, these women struggled to adjust to penetrative intercourse. Many of these women felt that their bodies betrayed them; they were depressed and frustrated. They often resented having to do so much work. The idea of ever experiencing sexual pleasure seems impossible. Some women developed sexual pain after pelvic surgery or pregnancy. 


Breathing Techniques For Vaginismus  

The vagina and the pharynx (throat) share physical similarities as well. They are structures supported by a sling of muscles that expand and contract with respiration. Both organs are connected by the vagus nerve. This helps explain the importance of the breath in relaxing and opening these organs. LaMaze breathing is commonly used during childbirth for this very reason; opening the throat helps the cervix open for delivery.  

Sexual pain clients often required a psychological shift in order to heal. While the client’s doctor addressed the physical side of the issue, sex therapy would tackle the emotional side of the experience. Many of these women needed to find their voice. There is a strong correlation between a woman’s ability to express herself sexually and her ability to voice what she does and does not want. In the world of Eastern thought, the connection between the second chakra (lower abdomen) and the fifth chakra (throat) is well known. Often, women with sexual pain also have dental or jaw issues like TMJ or bruxing or thyroid problems. The second chakra is the seat of creativity, the location of the womb, while the fifth chakra is the expression of that creative energy. Bringing this intersection into working with sexual pain, I encouraged clients to experiment with using their voice in different ways. Hum, chant, sing, tell the truth, laugh; get that throat open. Speak up in situations where you normally would not. Be authentic. Speak your mind, express yourself. Sexual satisfaction will probably follow. 

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