| Caroline Knight
4 Ways to Treat Psychogenic Vaginismus (Pelvic Floor Myalgia)
Pelvic floor myalgia (muscle soreness) is another name for vaginismus, one of the most common causes of sexual pain in women. Most Doctors consider vaginismus to be psychogenic in nature, meaning that it has a psychological origin. With psychogenic vaginismus, it is psychological issues around sex that create fear or anxiety, which in turn causes a physical reaction that seems to be beyond the woman’s control: pelvic floor myalgia.
Pelvic floor myalgia describes the tightening and tension that develops in the pelvic floor region. Not all women are aware of tightness in their pelvic floor muscles until it causes pain. Psychogenic vaginismus will result in pain in the vaginal muscles because the muscles go into spasm and essentially ‘clamp shut’ when penetration is attempted. Any further attempts to penetrate are likely to worsen pelvic floor tension myalgia, regardless of whether the penetration is sexual in nature.
What does pelvic floor myalgia feel like?
This is actually just another way of asking, “What do sore pelvic floor muscles feel like?”, as the muscles in the vagina and surrounding areas react to tension in the same way as other muscles in the body. However, there is a slight difference if you have psychogenic vaginismus, because in response to a thought (or even a subconscious fear) your vaginal muscles may involuntarily contract and feel very difficult to release. Since the pelvic floor is trickier to reach than other muscle groups, pelvic floor muscle contractions can persist for an extended period, causing pain.
The pain of pelvic floor myalgia may feel like:
- Deep, dull aching
- Soreness (akin to inflammation)
Because of the tension in the pelvic floor muscles, vaginismus can give the impression of a ‘blockage’ inside the vagina. This is particularly evident when penetration is attempted, which is often unsuccessful as the vagina is tightly closed. Even urination and defecation can be difficult if you have psychogenic vaginismus.
What causes pelvic floor myalgia?
Pelvic floor tension myalgia can occur for various reasons, including:
- As a secondary reaction to pain around the vaginal opening (vulvar vestibulitis syndrome or vestibulodynia)
- As a response to prolonged and consistent squeezing or clenching of the vaginal muscles (as per psychogenic vaginismus)
- A history of habitually holding onto urine or stools
- A history of urinating too much or pushing too hard when passing stools
- Injury to the pelvic floor muscles during surgery or childbirth
- Nerve damage in the pelvic region
What is psychogenic vaginismus?
There is a clue in the fact that vaginismus is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the American Psychological Association's manual of official psychiatric diagnoses. This certainly does not mean that women with psychogenic vaginismus have mental health problems in general: it simply means that they have a psychological issue around sex that is likely to need professional assistance.
Vaginismus has more recently been classed as a genito-pelvic pain/penetration disorder (GPPPD), which is diagnosed according to the following symptoms:
- Vulvovaginal or pelvic pain when intercourse is attempted
- Vulvovaginal or pelvic pain after intercourse is finished
- Pain during sexual intercourse
- Pelvic floor muscles contractions or tightening at the thought of vaginal penetration
- Fear or anxiety about the pain you experience with penetration
What causes psychogenic vaginismus?
At some point, women who experience issues with penetration or soreness during sex might find themselves asking, Do I have vaginismus? It may help to learn about this issue, so that the link between the various causes becomes clear.
For some, psychogenic vaginismus may happen immediately after the first attempt to penetrate the vagina, whether that is with a tampon, a speculum or a penis. For some women, vaginismus may occur after having normal intercourse in the past, developing into long-term sexual dysfunction (if not treated effectively).
Common causes of psychogenic vaginismus are:
- Difficult or painful past sexual experiences
- A history (or experience of) sexual trauma, such as sexual abuse or rape
- A lack of trust and connection with a sexual partner
- An unsatisfying sexual relationship
- A physically or emotionally abusive partner
- Past experiences of painful or distressing pelvic examinations
- Feeling a loss of control or anticipation of pain around penetration
- Being afraid of getting pregnant
How do you treat pelvic floor myalgia?
The pelvic floor muscles are technically under your voluntary control, but with psychogenic vaginismus it certainly doesn’t feel like that. This is why physical and emotional rehabilitation is often required. Below are 3 of the best ways to treat vaginismus symptoms:
Physical support from a pelvic floor physiotherapist
Pelvic floor myalgia is treated through pelvic floor rehabilitation; a pelvic floor physical therapist is likely to use physical manipulation, biofeedback and dilator therapy to relax your vaginal muscles and get you used to the feeling of penetration. You can also use vaginal dilators alone at home, which your therapist (if you have one) will usually recommend.
Psychological support from a sexual therapist
Treating the psychogenic aspect of vaginismus requires an experienced sexual therapist to address the underlying cause; that is, your subconscious programs around the sexual experience. If you have gone through a lot of stress or abuse, and even if there is no longer any danger, the body may have developed conditioned responses to triggers around sex and penetration. Seeking an experienced sexual counsellor to help work though sexual issues and core beliefs may be necessary, if you are to fully treat psychogenic vaginismus.
Learning to relax
Women with vaginismus are often out of touch with their own bodies, because rejecting the sexual experience is to reject their own sexuality. It can really help to get back in touch with your own body, in your own space and when you have plenty of time to relax. This might feel alien at first, but you will get used to it. It is necessary to feel comfortable with your body if you are going to enjoy sex, or at the very least be able tolerate any kind of penetration.
The point is to become familiar with your body, what it enjoys and dislikes, and what leads to relaxation. It might help to use personal massagers and water-based lubricants, especially if you are going to attempt penetration at any point during this exploration. Over time, when you are more familiar with your body and sexual preferences, you will be able to communicate this more easily to a partner.
Using vaginal dilators
Experts highly recommend using vaginal dilators for vaginismus. We also know from many dilator testimonials that lots of women have great success treating vaginismus with vaginal dilators. Dilators are a form of desensitization therapy in which a woman learns to slowly relax and accept penetration at her own pace. They can stretch the vaginal walls to expand capacity, and help the muscles to become accustomed to the feeling of penetration. At some point you will feel ready to attempt penetration through sex, or to have a health examination.
Dilators treat vaginismus by reducing or completely stopping the muscle spasms that prevent penetration and lead to myalgia. Over time, your pelvic floor will start to relax relaxing and you can even find that you start to enjoy sex – which is surely the goal! It’s important to remember to be patient with yourself, because recovery from vaginismus often doesn’t happen overnight.
We recommend buying magnetic dilators in a range of sizes (from small to large) initially, because they contain Neodymium magnets which help to stimulate blood flow and soothe nerves, making the whole process easier for your body. You can work your way up through the sizes, from small to large, until you feel comfortable with the largest.
You may need to combine therapies, as mentioned above, and it may be a case of trial and error with different therapies (and therapists!) until you find the combination that works best for you.
Don’t worry though - it is definitely possible to heal from psychogenic vaginismus – it happens all the time, and with time and effort, it will surely happen for you too.
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