Vaginismus and orgasm

Can a woman with vaginismus be sexually aroused and have an orgasm?

Of course!

Unlike the penis, which is a one-for-all body part (urination, sexual activities), the vagina is not a sexual organ but rather a passageway connecting the uterus/cervix to the outside.

The clitoris - the female’s sexual organ - is located way above the vagina and the urethra… In other words, totally outside of the vagina!

Do women need anything - finger, penis, dildo - in their vagina for sexual arousal? No, they do not. Women can be sexually aroused by clitoral stimulation without EVER involving the vagina.

Had the vagina been a sexual organ, every tampon insertion would have been a thrill… Every gynecologic exam would have been a delight…

Bottom line (no pun intended): a woman does not have to give up on her sexual arousal even if she has vaginismus or any other vaginal concern that restricts penetration.

Share this post with everyone you know — help us clarify a huge confusion out there!

Orgasm - mini or maxi?

A husband of a former patient emailed us recently with the following question:

“I still have not been able to give my wife sensual pleasure during sexual intimacy. I tried many suggestions mentioned in the books as well as what you taught us, but her body just does not feel the sensation of pleasure that I expect. Is there anything I can do about it?“

Based on our clinical experience with sexual intimate matters and their subjective nature, we arranged for a discussion with the couple to clarify the situation.

The wife said that:

• She is having orgasms just fine
• They are typically mini-orgasms (not necessarily ‘big ones’)
• The orgasms are satisfying, body and mind
• She is very happy

The discussion continued to include an explanation of the differences between male and female orgasms, the ejaculation factor that is typical to men only, and the importance of satisfaction by each party as the key to successful sexual intimacy.

The husband came to realize that he expected her to feel the same ‘explosive’ orgasms that he has been experiencing.

The couple left happy and armed with a better understanding of their sexual expectations and of the need for honest communication.

Vagina - use or lose?

A 20-something patient arrived at the office today and told us that she has not been having intercourse for over 8 months now. One of her concerns was whether she will be able to have pain-free sex when she resumes having intercourse. In other words, does the vagina operate under a ‘use or lose’ premise?

• Fact: the vaginal canal is not a voluntary muscle that needs to be exercised to maintain its function, but rather a structure that is built to expand with penetration, then go back to its smaller size — kind of like a tube-sock.
• Fact: women can go years between intercourses without a problem.
• Fact: doing the Kegel exercises will strengthen the PC muscle, which support the pelvic floor (a good thing!), but will not stretch the vagina.
• Fact: certain life events will impact on vaginal elasticity. Examples include estrogen decline (natural, surgical, or induced menopause), vaginal radiation, or scars from surgical procedures, causing dyspareunia and/or vaginismus and requiring medical intervention.

Because the vagina is an invisible part of the woman’s body that cannot be easily stretched/inspected, it is susceptible to all kinds of worries. This is in contrast to the penis, which is always available for ‘review.’

Bottom line: it is okay to take the vagina on vacation…

Hymen and vaginismus

Can a hymen cause vaginismus?

Typically, NO — but, read on.

The hymen is a thin, vascularized membrane, an embryonic remnant of the vaginal separation from the urogenital sinus = the tissue that forms the genitals. The hymen will usually perforate during embryonic development and will vary in thickness, size, and shape from one female to another. The hymen does not regenerate (grow back)!

There are 3 typical variations of hymenal presence (excluding anomalies):

1. An imperforate hymen, which means it did not perforate (did not develop an opening within it). An imperforate hymen is uncommon, and is typically diagnosed during onset of menstruation when the blood that cannot ‘come out’ of the body keeps accumulating on the inside. This is a painful and a potentially life-threatening situation that needs immediate medical attention.
2. A partially-intact hymen, which means that there is leftover hymenal tissue present, typically between the 4 o’clock and the 8 o’clock, if we use that description. The opening within the hymen can be large enough to accommodate a tampon or a finger, or so small that even the pinky (smallest finger) will not pass through. A partially-intact hymen can be elastic and responsive to stretch (common), or fibrous and rigid (less common).
3. Minimal or no hymen, even in the absence of vaginal penetration! Despite it being quite common, there is no explanation for it; bike riding or gymnastics are not the cause…

Imperforate and rigid hymens require a hymenectomy, a simple procedure during which the hymen is removed.

An partially-intact elastic hymen will respond to vaginal penetration, may it be a finger, tampon, gyno exam, or intercourse. There may be initial discomfort and/or bleeding, but not necessarily as not all hymens react the same. So, when it comes to intercourse, do not assume that the first-time will be painful or bloody!

Note: the presence of a hymen cannot be established just by looking at the vaginal opening. Clinicians who attempt a gyno exam on a woman with vaginismus will often interpret her tight (and anxious!) vaginal opening as an intact hymen and offer a hymenectomy as a solution… Remember: a digital (finger) exam is necessary to arrive at a definitive conclusion!

The presence of a hymen does not cause vaginismus. It may restrict or limit vaginal access, but the woman will typically be cool about her vagina and able to face vaginal management without distress.

So when may the presence of a hymen bring about vaginismus? When the woman is

• Anticipating pain upon first-time penetration (but maybe it won’t really hurt?)
• Is anxious about ‘breaking’ the hymen (maybe there is no hymen?)
• Cannot handle physical discomfort (maybe there will be none?)
• Cannot handle the site of blood (maybe it won’t bleed?)
• Stressed about an unknown; what will it be like to have something inside my vagina?
• Forced into having intercourse/losing her virginity

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On a humorous note, check the following quote from a book by the name of Sex Revelations and The New Eugenics, published in 1936 by two physicians, Whitehead and Hertel:

“Regarding the hymen… It sometimes grows again in widows, or in women who have been a long time separated from their husbands…”

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