Will he leave me?

• Men leave women with vaginismus
• Men will never stay married if intercourse is too painful to be happening
• Men must have sex

How often have you heard or read these statements? Many Moms and Grandmas surely believe these are the facts of life. The media hypes quite a bit about it too: be a good sexual partner or he will not stay with you… So, they must be believable, right?
The fact: not necessarily, not always, not true.

There are many factors that play into a man’s decision to leave a relationship, and although the want for intercourse is an important component, it not necessarily the main reason for breaking up.

Men can survive without sex — it is not a mandatory life-or-death bodily need. Having said that, it saddens us to witness some cultures/religions/male partners who mandate the woman to submit sexuality so that her man can be (sexually) happy. It is doubly sad at these time of striving for women’s equality in the sexual arena.

However, let’s face it: with sexual intimacy being a key vehicle for his intimate expression, repercussions will happen when intercourse is missing. But will he leave???

Not necessarily.

Most men stay because they value the deep friendship/bond that the relationship offers and are willing to compromise their sexual menu by limiting it to outercourse. Are they totally happy sexually? Not really, but the other benefits outweigh the loss. Are they happy with the relationship itself? Typically yes. Are they still hoping the vaginismus will be cured and intercourse added to their lives? Absolutely. On a further note, those who have kids will find a larger purpose for staying.

Naturally, there will be those who may indeed opt to leave and pursue a worry-free sexual path, especially if it has been a short-term relationship. A few may leave if they see that the woman is not doing all she can to cure her vaginismus.

Bottom line: vaginismus is  not a death sentence for a relationship.

Tips for gyno exam

When scheduled for an elective (non-emergency) gynecologic exam, you may want to follow these tips:

• Bring a list containing date of last period, names of prescription medications you are taking, socks if you like your feet kept warm in the stirrups, and questions you want to ask.
• Keep the vagina off limit for about 48 hours prior to the exam so that the Pap smear will not be altered by the presence of leftover semen (ejaculate), contraceptive gel/foam, lubricants, moisturizers, etc. That way you will avoid a phone call telling you that your smear came back abnormal and that it will need to be repeated in the near future. It will spare you of unnecessary worrying while you wait for the next Pap smear…
• Also for 48 hours prior to exam: refrain from using tampons and from sitting in water (bath, jacuzzi, whirlpool, chemically-treated water such as a pool, etc.) so that your vagina will stay naturally moist. Why? To ease the way in for the speculum, that metal or plastic ‘duckbill instrument’ that is used to hold the vagina open during the internal exam. But do take a shower as part of your daily hygiene routine!

Painful sex

A question from a husband:My wife complains of searing vaginal pain upon intercourse and as a result she has been avoiding sex altogether. When I met my wife, she seemed to be so eager and interested in sex that I eventually married her… I am glad I did because we have a good life together - I just miss sex. Help!

Discussion and reply:

Generally speaking, there is no need to end one’s sex life when intercourse is not possible especially because sexual intimacy is the cementing force of any intimate relationship, the vehicle for entering that ’special zone’ that is not shared by the closest of friendships.

A typical sexual menu will include two main entries:

• Intercourse: a ‘penis in vagina’ act, lending to the definition of virginity = one who did not have intercourse (male or female).
• Outercourse: any sexual act that does not involve intercourse: foreplay, oral sex, manual sex, masturbation, humping, rubbing, use of sexual toys on genitals, etc.

Men and women will mix and match intercourse and outercourse as per their sexual preferences. Naturally, there may be other factors which will influence one’s choice, such as a physical limitation, hormonal influence, pregnancy and childbirth, aging, etc.

And then there is the difference between men (male) and women (female)… Whereas a male is easily aroused through his senses (vision, smell, etc.), the female will filter her sexual interest regardless of arousal level, thus being susceptible to ‘killing the mood’ upon a fleeting negative thought. Example: “I am still mad at you for (whatever the reason may be) and you want to have sex????????”

From a psychophysical point of view, men need to be reminded that intercourse is about their penis entering the woman’s body — being the ‘do-er’ to her being ‘done to’ — therefore, they need to be invited and welcomed into her vagina!

Naturally, when intercourse is painful, whether it is vaginismus or dyspareunia, the woman will tend to avoid the act in self-protection. Furthermore, she will often decline outercourse too because she does not want to be reminded of their pain, of disappointing the partner, or because she is worried about his ’surprise move’ into her vagina during outercourse.

This is when it would be very important for the couple to hold a candid discussion about the situation. The man will need to promise NOT to attempt any vaginal penetration (finger and/or penis) while the woman is being encouraged to enjoy herself as much as she can (remember the ‘filter’ that was mentioned above?) without pressure to orgasm — let it happen if/when it does. Make it fun, friendly, and stress-free!

The goal is to maintain an agreed-upon style of comfortable sexual intimacy and avoid slipping into asexual existence, living like ‘brother and sister,’ which will put quite a bid of pressure on the relationship.

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Original work. Insert the following citation if quoting us:

Katz D, Tabisel RL. (enter name of the quoted blog post). Available at http://womentc.wordpress.com. Last accessed (enter today’s date)

 

Vaginismus & pregnancy

Three typical questions often raised by women with vaginismus:

1. Can I get pregnant if I have vaginismus?
2. Can I give birth if I have vaginismus?
3. Will vaginal birth cure my vaginismus?

These are excellent questions! Let’s review them one by one:

There is a basic perception that pregnancy can only happen with a ‘penis in vagina’ activity (vaginal intercourse) and that other sexual activities, also known as ‘outercourse’ (oral sex, manual sex, etc.), are safe. Even women without vaginismus, who prefer to refrain from intercourse, will often forgo the use of contraception because they feel that pregnancy is just not possible. Not a good idea…

The truth is that a woman can get pregnant if the male ejaculates by her genital lips during the week leading to ovulation, when the hormonal chemistry in her reproductive system is conducive to sperm survival! In other words, we have had many patients who were still virgins yet already mothers… As much as they loved their children, they felt a bit of being a ‘fake’ about getting pregnant that way.

That is not to say that getting pregnant with vaginismus is a bad thing. Many women/couples that we met embraced this gift while admitting that they tried all they could to get pregnant: having the man ejaculate as mentioned above, or have the man ejaculate into a small cup and the woman self-inseminating (if she can insert the small syringe), or undergoing assisted reproduction (infertility treatment).

But what happens to the woman with vaginismus during pregnancy? Unless she can tolerate a pelvic (gynecologic) exam and a vaginal ultrasound, she will have to be managed ‘from the outside’ while also addressing her ongoing worries of internal exam/s at time of delivery and whether the baby will come out altogether…

As to the actual childbirth, physicians will typically opt to deliver the baby via a c-section with safety in mind, never having examined the woman’s vagina beforehand for possible anatomical/structural abnormalities. As mentioned above, women with vaginismus who can tolerate an internal exam (albeit under duress) may very well deliver vaginally.

But what about the pelvic floor muscles — won’t their (vaginismus) clenching block the baby’s exit, make a c-section a must??? Not at all. The physiologic process of childbirth provides ample room for baby’s exit, making the pelvic floor muscles a non-player.

Okay, so I had my baby vaginally and now my vaginismus should be cured, right? Yet, it is still here… What is going on? The answer is simple: childbirth (’coming out of the vagina’) did not address nor cured the fear/apprehension associated with vaginal penetration (’coming into the vagina’)…

Conclusions:

• Use proper contraceptive measures if you do not want to get pregnant, remembering that vaginismus is not a contraception method!
• Discuss the pregnancy/childbirth process with your OBGYN so that your vaginismus needs will be addressed.
• Examine the pros and cons of becoming a parent while remaining a virgin, with vaginismus.
• Seek treatment for vaginismus - there is no reason to live with it!

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Original work. Insert the following citation if quoting us:

Katz D, Tabisel RL. (enter name of the quoted blog post). Available at http://womentc.wordpress.com. Last accessed (enter today’s date)