What is vaginismus?
Have you ever experienced pain during penetrative sex, or when using a dildo, or even when inserting a tampon? When you’re having sex does it sometimes feel as if the opening of your vagina is ‘too tight’ and being painfully stretched? If so then it’s possible you have some degree of vaginismus. Vaginismus is medically understood as spasm, tightness and tension in the muscles of the pelvic floor and the soft tissue of the opening of the vagina. This tension causes pain (ranging from mild to severe) when penetration is attempted. Vaginismus can be ‘total’ – where penetration is impossible, or ‘partial’ – where penetration is possible, but painful. Primary vaginismus is defined as a woman always having had this pain and perhaps having never been able to experience any kind of penetration. Secondary vaginismus refers to a latter onset of pain and tension – so you may have been able to experience penetration without pain in the past, but now cannot. Or you experience pain only in certain situations i.e. no pain when masturbating with your fingers or a dildo, but pain when having penetrative sex with a partner. This can be a brought on as a result of trauma, forced penetration, increased anxiety levels, STI’s, childbirth, surgery or menopause (amongst other things).
How common is vaginismus?
It’s a frequent issue that my female clients bring to sessions. Some are in their 20s and realising relatively early that their bodies are holding fear and tension around penetration, sometimes before they have ever been sexually intimate with a partner. Others are in their 40s, 50s and 60s and beyond, and have dealt with a lifetime of painful intercourse, dwindling intimacy in relationships and lack of pleasure. It’s my experience that it’s extremely common but well hidden. This is partly due to the damaging misconception that, for women, sex is just always meant to be a little bit uncomfortable or painful. This is a narrative we MUST change. So many of us had a painful first sexual experience and that just set the stage for the rest of our sexual lives! Lack of education, dialogue, understanding and confidence – not to mention the shame and awkwardness that many people associate with the topic of sex and their body – all lead to a ‘grin and bear it’ approach, or a sense of resignation, an under-reporting of the issue and a lack of awareness that it can be changed.
What causes vaginismus?
Vaginismus is usually categorised by having no ‘physical’ cause: i.e. there is no infection, scarring or underlying cause for the pain such as cysts or pelvic inflammatory disease. Whilst many women will find it really difficult to not have a solid ‘reason’ for the cause of their pain and discomfort, it is hopefully empowering to know that overcoming vaginismus is absolutely something that is within your power. By learning more about your genital anatomy and the way that your body unconsciously responds to stress, fear and anxiety, you can re-train your mind and muscles to relax and let go of the tension. This can take time, and it definitely takes practice and gentle determination. Undoing unconscious patterns of tension in our muscles and fascia requires regular and attentive work and a willingness to trust in the possibility of something different. As you’ll see from the image above, NOT addressing the pain absolutely compounds the issue and keeps your body stuck in the cycle of pain.
What impact can vaginismus have on intimacy?
For many women, living with vaginismus means they try to avoid any kind of intimate situation because of fear and apprehension associated with penetration. This leaves many women distressed, unsatisfied and isolated from intimacy. The contraction and tension of the pelvic floor and vaginal muscles with vaginismus is involuntary: it’s not something you consciously control. It’s a reflex action based on conditioned thoughts or previous experiences stored and stuck in the muscle memory. Trying to hide this from your partner can put huge strains on your relationship. I really want to stress that vaginismus is nothing to be ashamed of: you haven’t done anything wrong and you’re certainly not alone in the experience. Talking and sharing with your partner can go a long way to helping you feel more relaxed: if you’ve never told your partner that you are in pain, they probably don’t know. If they know that something doesn’t feel right they can support you in changing the situation.
LIMITING YOUR SEXUAL EXPERIENCE:
The pain experienced during penetration can limit your enjoyment of sex by making certain positions ‘off-limits’. It also often means that sex is a quick, abrupt experience designed to minimise the exposure to pain. This is in fact counter-productive: your body actually needs a LONGER time to be able to access relaxation. This doesn’t mean more time ‘enduring’ penetration, but more time spent on foreplay and giving your vagina and pelvis a chance to actually relax. It also means more variety in your sex life: taking the focus off penetrative sex and exploring ‘slow sex’, sensual massage, sensate focus and different erogenous zones.
IMPACT ON FERTILITY AND HEALTH:
For anyone struggling with vaginismus, starting a family and trying to get pregnant can feel like a huge uphill struggle. For many of my clients this is a cause of deep emotional distress. Many women also avoid gynaecological check ups (smear tests, STI check ups etc) because of their fear of pain, which can lead to more serious issues going undiagnosed. Please take a read through my blog article ‘Pain during sex’ where I talk about how you can take charge of your interactions with medical practitioners and make these experiences easier.
How genital massage can help to improve vaginismus...
Many women are incorrectly told that the problem is in their head and if they just change their negative thoughts they’ll be able to get over it. The thing is, the involuntary muscle contractions are controlled by your autonomic nervous system – the part that deals with the unconscious aspects of your body’s function (like your heart beating, your respiratory rate, your digestion and the ‘fight or flight’ response). You cannot consciously THINK your way out of a reflex action. As Bessel van der Kolk writes in ‘The Body Keeps The Score’…
‘When the alarm bell of the emotional brain keeps signalling that you are in danger, no amount of insight will silence it’.
The emotional brain does not respond to logic, to language, to concepts or clever analysis. To convince your emotional brain that you are safe, that nothing bad is going to happen, that you can relax alert and tense muscles you must be able to FEEL. We feel through touch, through breath, through movement and through sound. Massaging the muscles of the pelvic floor and vagina with gentle, mindful touch will…
- Help the muscles to let go of their chronic tension patterns by increasing blood flow and softening/relaxing individual muscle fibres.
- Give you a new ‘script’ when it comes to genital touch: giving you an association of having your genitals touched, but not necessarily penetrated, will interrupt the cycle of anticipation and reaction that causes the muscles to spasm and contract.
- Re-wire the neural pathways and alter the experience of sensation in the tissue to override the pain circuit, by exploring and playing with different types of touch, stimulating different sensory receptors in the skin and re-sensitising numbed areas.
- Offer an alternative to penetrative sex that will support you to build solid foundations of trust, communication and empathy within your relationship.
When I work with female clients it’s not uncommon for their first experience of genital massage to be accompanied by deep emotional release: all the fear, anxiety and pain that has been stored in those muscles and fascia is given a chance to be expressed. This is why it is important to feel safety and trust in the setting: whether that is with your partner or with a professional practitioner. If you’re exploring with your partner I absolutely recommend talking and sharing beforehand about the boundaries and expectations for the massage. It needs to be really, really clear that the massage is not necessarily foreplay and that penetration is not expected. Setting clear boundaries is vital:
- how long do you both want to spend on the massage
- what position do you want to be in (it’s important for you BOTH to be comfortable and relaxed)
- how will you communicate that you want your partner to pause/hold still/end the massage
- what can your partner do or say in the moment to help keep you present and relaxed
- what kind of feedback will be helpful to guide your partner’s touch (for example, some people find it easier to work with a scale of 1-5 to gauge pain whilst others prefer to say ‘firmer’ or ‘softer’ to guide the pressure of touch)
- anything else that you know will be important to help you feel as relaxed, safe and loved as possible.
The three best techniques to include in genital massage for improving vaginismus...
All of the following techniques can be applied as self-massage but I will outline them for a partner giving touch to the person with vaginismus.
1. Holding and stillness with a full hand
One of the biggest causes of anticipated fear and tension when it comes to genital touch is that things are happening too quickly. The skill of being able to simply hold, be still and be present (without ‘fiddling’ or trying to ‘do something’) can go a long, long way in helping your partner’s pelvic muscles, and their entire nervous system, relax. Place the palm of one hand over the whole vulva (the outside of the genitals). You can place the other hand on top, or it can rest over the front of the pelvis with the heel of the hand resting on the pubic bone. The warmth and contact of your hand will bring blood flow to the labia, to the PC muscles and the fascia surrounding the introitus (the opening of the vagina). Pausing and holding in this way gives your partner time to feel the initial reflex action and then have space to let it release.
2. Holding at the entrance and being invited in
Again, one of the main held triggers for the spasm and contraction of the pelvic floor muscles is the experience of being entered/penetrated before your body is ready. So, as the giving partner, I encourage you to try this technique of placing your finger over, not in, the opening of the vagina. This requires a relaxed, light touch and patience. Tell your partner that you will not enter her, you will wait and be still until her body, her vagina, invites you in. Place all your attention into your finger, and tune in to her body. For many of my female clients this is one of the most profound and transformative experiences they’ve ever had. Simply being met at the opening of their vagina, without being penetrated, or penetration being expected. You can do this by placing the heel of your hand on her pubic bone and letting your middle finger point down, resting lightly over the opening to her vagina. Or you can sit between her legs with the heel of your hand on the floor and your fingers pointing upwards (this requires a little more flexibility in the wrists and is not as comfortable for everyone). Gradually you might feel the band of muscle that forms the introitus start to soften and it will feel almost as if your finger is being ‘sucked’ in. Alternatively your partner can gently wiggle and move her hips/pelvis down onto your finger when she is ready.
3. The clock face
Imagine 3 ‘gates’ or ‘doorways’ moving from shallow to deep at the entrance of the vagina. Gradually introduce internal touch at the first ‘gate’, no more than the depth of half your fingernail bed. Start with the pad of your finger lightly pressing down towards ‘6 o’clock’ (the palm of your hand will be facing downwards). Hold here, and allow your partner to guide you when she is ready to move to the next point (i.e. when she feels that spot has relaxed). Encourage her to breathe, sigh, make sound, and allow any emotions that want to move. When she’s ready, move ever so slightly with your finger so the focus of the touch rests at the 7 o’clock mark. Repeat round to 10 o’clock, then (still at that initial ‘gate’, not having moved any deeper into her vagina) very, very slowly and smoothly slide the finger back round the semi-circle of the vaginal opening to 6 o’clock. Repeat these steps round to 3 o’clock at the first ‘gate’ depth of penetration (you might want to switch hands here). That might be enough for your partner on that day – check in, be guided by her body. If it feels good, you can move to the second ‘gate’ depth (perhaps up to the cuticle of your nail) and repeat the clock face steps, and then the third ‘gate’ (to the first knuckle joint on your finger). DO NOT RUSH. Be prepared to stay on each clock point for 3, 4, 5+ minutes.
It is absolutely vital as the giver of touch to BE RELAXED: in your body and in your hands. Any tension that is being held in your body will be felt by your partner through your touch. So, set up your space so that you can both be comfortable: you can learn more about how to optimise your massage space for comfort in my online courses in genital massage.
Do not dive straight into genital touch. Warm up: spend 30+ minutes massaging the rest of your partner’s body (or your own body if you’re working with self-massage).
Other things to be aware of...
If you are experiencing Total vaginismus, or extremely high levels of pain with even small penetrative items (such as a tampon or your little finger) then I absolutely recommend:
- speaking with your GP
- Speaking with a women’s pelvic health specialist: they will be experienced and knowledgeable in addressing extreme cases using a blend of physiotherapy, self-massage homework, dilators and potentially muscular injections to support your healing.
These are often recommended to women suffering with vaginismus, but it’s not always the best idea to further tense a chronically tense muscle! If you do these I encourage you to really focus on the ‘letting go’, the relaxation phase. So, contract or squeeze with only about 20-30% effort and then focus on letting the pelvic floor relax, visualising the vagina ‘opening outwards’ and softly melting or expanding with the long sighing exhale.
Vaginal dryness, or a lack of lubrication, is a big contributing factor when it comes to experiencing pain during penetration. If you’re not already using lube then try adding it in: this could be a simple solution to help you experience more comfortable, smooth, pain free penetration! Check out my guide to lube to help you choose the right one for you. I definitely recommend using lubrication with the massage techniques suggested above.
Restricted breathing is one the most common factors that I see in people’s bodies that is preventing them from accessing relaxation during intimacy. Be aware of your breath: can you allow the inhale to flow through the nose, and the exhale through the mouth with an ‘aaaah’ (so that the jaw and throat relax)? Try letting the exhale be a little bit longer than the inhale – this activates the parasympathetic branch of the nervous system and helps you let go of tension. Add a gentle hum, a sigh, some sustained soft vibration and sound to the exhale – this stimulates the vagus nerve, and gives you another ‘hack’ to flip the body out of the ‘fight or flight’ state.
Mirrored pattern in the jaw, throat and mouth
What I see very often is that there is a mirrored pattern of tension in the jaw, mouth and neck/throat in women with vaginismus. Paying attention to this area during sex, and letting the jaw unclench, can create a knock-on relaxation response in the pelvic floor. Can you allow a little gap between your back teeth, and connect to a sense of heaviness in the base of the skull? Maybe explore massaging or cupping/holding your jaw and neck whilst receiving the genital massage techniques above.
Stage of your cycle, variation in hormones, menopause
Our bodies vary a great deal, from month to month and in different phases of our lives. Your sexual pleasure can be impacted and altered due to the natural cycle of your hormones, the kind of birth control you are using, being pre and post natal, going through and moving beyond the menopause. Knowing your body, and getting familiar with its rhythms and changes, allows you to access compassion and kindness to yourself as well as knowing how to communicate with your partner what you need at that particular point (i.e. less focus on penetration and more on other kinds of sexual intimacy).
If you, or your partner, are struggling with vaginismus and you want support in addressing the issue from the core, then get in touch via email on firstname.lastname@example.org