Vaginismus, also known as Genito-Pelvic Pain/Penetration Disorder (GPPPD), is a condition characterised by muscle spasms in the pelvic floor muscles surrounding the vagina, making penetration painful or impossible. GPPPD can cause significant distress for the individual often with increased anxiety around anticipating painful sex, difficulty getting a gynaecological examination or using tampons. The anxiety and avoidance of sexual activity can also impact sexual relationships and intimacy.
Diagnosing vaginismus is usually done by a healthcare professional such as a GP, gynaecologist or physiotherapist as they are able to assess the pelvic floor muscles. Most women's health focused professionals are understanding and sensitive about sexual pain so are gentle in their examination.
The diagnostic criteria include:
Treatment for vaginismus is best done with a multidisciplinary team of healthcare professionals, including gynaecologists, pelvic floor physiotherapists, and psychologists. The primary goal is to alleviate pain, reduce anxiety, increase ability to relax pelvic floor muscles, and improve sexual function and pleasure. Here are some common treatment approaches:
Psychologists play an important role in treating vaginismus by addressing the psychological and emotional aspects of the condition. Through evidence-based therapies (CBT, Schema, Psychodynamic, EMDR, etc), they help patients identify and shift unhelpful patterns relating to sex, anxiety, sexual pleasure and penetration. This may also include processing trauma that may be related to the sexual pain. Couples therapy may also be used to help improve communication between partners and enhance sexual intimacy.
Pelvic Floor Physiotherapists are essential in treating vaginismus by focusing on both physical based intervention and pain management. They guide patients in the use of vaginal dilators to gradually expose and relax the vaginal muscles, improving comfort with penetration. Physiotherapists teach exercises and techniques to relax the pelvic floor muscles, alleviating spasms and tension. They also incorporate breathing exercises to promote relaxation and reduce anxiety during treatment. Additionally, physiotherapists assess and address other muscle tensions and chronic pain conditions that may contribute to vaginismus, ensuring a comprehensive approach to pain relief and muscle function.
Gynaecologists are also involved in the treatment of vaginismus by providing medical evaluation and management. They conduct thorough physical examinations to rule out any underlying medical conditions that may contribute to the pain and discomfort associated with penetration. If necessary, gynaecologists can prescribe medications, such as topical anaesthetics or muscle relaxants, to alleviate symptoms.
The outcome of treatment is usually quite successful, in that a skilled multidisciplinary team approach can usually result in achieving painless intercourse. However, the limited research available has demonstrated that focusing on penetration outcome alone does not improve sexual pleasure or sexual desire. Therefore at CRSW we often have treatment goals that fall into two categories.
We focus on sex therapy principles to assist individuals and those in relationships achieve the second goal. We often follow the good-enough sex model which you can read about on another blog but in essence this aspect of treatment involves a variety of interventions to suit your specific experience/anxieties with sexual activity. Some may be to involve various techniques such as sensate focus, which emphasises non-genital touch to build intimacy and reduce performance anxiety. Masturbation homework/guidance to allow for self-exploration and understanding one's sexual preferences. Sensual mindfulness to help individuals stay present and focusing on sensations to heighten arousal and reduce anxiety. Lastly, non-demand touch, which involves affectionate contact without the expectation of sex, builds trust and deepens emotional and physical connections. Integrating these practices can significantly improve sexual satisfaction and overall well-being for individuals and couples.
