Vaginismus is the involuntary contraction of the muscles in the outer 1/3 of the vagina during sexual intercourse, preventing sexual intercourse. During sexual intercourse, the muscles cannot be controlled and contraction cannot be prevented. These contractions can occur even just by imagining an attempt at sexual intercourse.
As can be seen in the drawing below, while the vagina is an open organ (a), the muscles of the vagina are completely stretched during sexual intercourse (b) for various reasons, which will cause vaginismus.
Sometimes vaginismus is so severe that contractions may occur during the gynecological examination or normal vaginal delivery may not occur. For this reason, vaginismus in a broad sense is expressed as involuntary contractions of the vaginal muscles when an attempt is made to insert the penis, finger, vaginal tampon or examination speculum.
In most women with vaginismus, sexual desire and arousal are completely normal and they can have an orgasm.
Women with vaginismus are generally extremely healthy physically.
Some women have vaginismus from the beginning, while others develop it later after a healthy sex life. This condition, called secondary vaginismus, usually develops due to dyspareunia (pain during intercourse).
Vaginismus can cause the woman to feel incomplete as well as to feel guilty towards her partner.
If vaginismus is not treated, the sexual pleasure and satisfaction of the couple and reproductive function will be adversely affected.
It is possible to list the types of vaginismus as follows:
* Primary Vaginismus: Inability to have sexual intercourse even once
* Secondary Vaginismus: A sexual trauma experienced when healthy intercourse was possible before
Vaginismus condition that develops after a period of adverse experience (such as a complicated birth, miscarriage, abortion, rough gynecological examination, exposure to abuse or rape)
* Apareunia: Inability to have sexual intercourse due to some physical reasons
Vaginismus is also a type of apareunia.
* Dyspareunia: Pain during sexual intercourse
Sometimes, the underlying cause of secondary vaginismus may be dyspareunia.
If you have pain during sexual intercourse, the underlying cause may not always be vaginismus.
Vaginismus is seen in approximately 1% of all women in the world. However, as in other sexual issues in our country, there is no statistics based on healthy data on this issue. Vaginismus cases are much less common abroad than in our country. One of the main reasons for this situation is that sexual education is given scientifically in parallel with the development of children and adults in these countries; The other reason is that the concept of sexuality is not combined with honor, shame, prohibition and sin.
Women who apply with the complaint of vaginismus may experience serious psychological traumas such as sexual harassment and rape in the past, or there may be a situation that has caused psychological damage such as a painful gynecological examination or the first intercourse being very painful due to a strong contraction.
It is a fact that sexual orientation disorders also cause vaginismus.
In eastern monotheistic societies like ours, the pleasure aspect of sexuality is forbidden to women. For women, sex is an activity that is permitted for pure motherhood. In addition to this, the importance of virginity, the idea of protecting the hymen (the hymen, the hymen), the tension caused by our young girls’ fear that they will live until they get married or that their hymen will be damaged in their sexual experiences, will be activated when they get married, and coitus by fulfilling the function of conditioning that has been going on for years. It will make (sexual intercourse) impossible. As a result of the combination of sexuality with shame, sin and prohibition while raising our daughters, our daughters cannot cope with these negative records in their subconscious when they grow up, even if they have obtained permission to have sexual intercourse with marriage. It is wrong, rigid and bigoted education that teaches our teenage girls that sex is dirty and bad. For years, a young girl who grew up with the teaching that sexuality is harmful, bad, humiliating for women, something that only men benefit from, and that women should avoid, will reluctantly remember these false ideas embedded in her subconscious while living in this relationship, will feel uncomfortable, avoid and tense from having intercourse. .
In addition, while we are raising our children, we allow the two sexes to get to know each other by dividing them by gender, our girls are not even able to recognize their own genitals – false beliefs about their genitals and the size and elasticity of their vaginas, believing that the vagina is too small for anything to fit inside – we also have no idea about the genitals of men. They get married without knowing.
On top of all this, our teenage girls are often subject to misinformation from older women that first intercourse is very painful. They get false information about sexual intercourse in movies and novels. Thus, the idea that they will experience terrible pain during the rupture of the hymen during the first intercourse takes them away from the intercourse, cools them down, and causes the contraction of the vaginal muscles, revealing vaginismus, a condition that must be treated when our girls get married.
If we list the causes of vaginismus in items:
Missing or incorrect sexual information
Early traumatic experiences
sexual violence
Sexual taboos, myths, beliefs
Negative religious and cultural conditioning
family that humiliates sexuality
Disgust of the genitals
Fear of losing the hymen
fear of being pregnant
authoritarian father
Difficulties in the father-daughter relationship
The form of communication between spouses
sexual communication problems
gay identification
In addition to the factors I have mentioned above, your vaginismus may also have physical causes such as endometriosis, chronic infections, and tightness of the hymen. For this reason, people with vaginismus complaints should undergo an absolute complete gynecological examination. The presence of the spouse during the vaginal examination is a recommended situation in order to contribute to the destruction of the prejudices about the genital anatomy and the dimensions of the vagina.
Sometimes, vaginismus may recur in people who have been treated before, due to various traumas.
Giving sexual education to our young girls before marriage or at the developmental stage will ensure that such problems occur less frequently.
As for the treatment of this problem; In diseases that cause painful sexual intercourse such as vaginismus, the basic rule is to determine definitively whether there is an organic disorder that prevents the formation of intercourse by performing a gynecological examination. Then, with the help of a psychologist, it is necessary to discover and realize the problems. Cognitive behavioral therapy is used in treatment. The goal of therapy is to help the person overcome their fears and anxieties first in thought. In this way, the person realizes himself and his thoughts about sexuality and learns to replace negative thoughts and beliefs with positive ones.
Along with this, the person learns to control their contractions with relaxation exercises.
In the treatment, it is tried to prevent the contractions that occur involuntarily. The person is informed about genital anatomy. Techniques for vaginal loosening prior to penetration are shown. Information about Kegel exercises is given and how to apply them is shown.
Kegel exercises are exercises applied to develop the muscles at the entrance of the vagina by working. It can be applied to women with urinary incontinence complaints as well as in the treatment of vaginismus. To learn how to do this, place two fingers in the vagina and tighten your vagina muscles to prevent your finger from coming out. If you cannot do this, try to interrupt the process while urinating. In both cases, the muscles that contract are the muscles at the entrance to the vagina. The involuntary contraction of these muscles is the main cause of vaginismus. Once you know how to do this exercise, repeat it at least 5-6 times a day.
Another method used following Kegel exercises is to try to widen the vagina using special instruments (vaginal dilator) instead of fingers. This method should only be applied with the advice of a doctor. Dilation exercises are mostly used in the west. The reason why vaginismus is seen in western societies is very different from ours. Since we do not have negative conditioning about sexuality in western societies, relaxation techniques, Kegel exercises and especially dilation exercises are used in addition to psychotherapy. In dilatation trials, the woman is taught to use sticks of various thicknesses that she will apply to the vagina with her partner. The woman who initially applies the thin sticks to the vagina herself can then let her partner apply it. The bar thickness is increased each time. After this is achieved with a sufficiently thick swab, it is possible for the penis to enter the vagina.
The longer the time to consult a doctor for the treatment of vaginismus, the greater the risk of not only the hopelessness of the woman, but also the risk of facing serious problems such as a strong shake in the self-confidence of the man, aversion to sexuality, and erection problems. In addition, the inability to experience a natural process such as sexuality, which has an important role in human physiology and family ties, brings along social problems within the family as well as psychological problems.
Vaginismus is a very common problem in our society. This problem will continue as long as the social, cultural and religious pressures I have mentioned above continue to prohibit sexuality against women. Like many other problems, we must first give importance to the education of our women in order to solve this problem. When women who experience this problem, learn about its causes and get treatment, become mothers, they will give their children a healthier education so that their children do not have the same problem. In addition, more comprehensive teaching of human anatomy lessons in biology classes in schools and absolute sexual education for young people will be other common solutions.
Dr.phil. R. Meltem KAVCAR SIRALI
