Completely overcome vaginismus

Every women who suffers from vaginismus would like to completely overcome it so she can move on with life in a ‘normal’ manner.  But, how does she go from finding the name (vaginismus) for her ‘problem,’ to finding the right treatment, to reaching a cure that will last forever?

For those who can self treat, the road may be short and efficient; but for most, it will be many-years long, quite frustrating, and often never-ending.  Furthermore, despite the Internet providing access to resources like never before, the medical field is still dismissive or ignorant about vaginismus, treatment options are varied and not standardized, and women are hard-pressed to find expert clinicians in their locale.

 

Curing vaginismus has nothing to do with sex or sexual arousal because the vagina can, and should, perform in ‘neutrality’ (without arousal), or inserting a tampon or undergoing a gynecologic exam or vaginal ultrasound would have been desired sexual thrills…

To cure vaginismus, the woman must not only assume ownership over her vagina and all vaginal penetrations, but also recognize the associated anxiety/panic and resolve it to the point of it never ‘ruling’ her vagina again.

Indeed, patience and expert guidance are needed to merge the vagina and the mind into a harmonious relationship  that can withstand the test of time, which defines ‘completely overcoming vaginismus.’

Gynecologic health

The American College of Obstetrics and Gynecologists recommends undergoing annual pelvic examinations starting at age 21.  Screening for cervical cancer is also recommended starting at that age, irrespective of sexual activity.  Pelvic examination of women younger than 21 is recommended only when indicated by medical history/medical need.

A pelvic examination will typically include a visual inspection, an internal examination using a speculum, and a manual exam using a gloved finger.  A breast exam is also an integral part of the visit In the USA,  while not necessarily so in other countries.

With the vagina often being this mysterious, dark structure that a woman never sees, we routinely show our patients their vagina & cervix through an open speculum.  We urge all of you who have not seen them to ask your clinician to use a mirror and show you — it will demystify this body part and will give you a visual of its simple structure and looks.

Wonder about the history of stirrups?  Read here.  You may also want to read  Love Gyno Exam? and Tips for Gyno Exam and Anxious Gyno Exam and Abnormal Pap.

When to see the doctor for a non-routine pelvic exam?

•    If you experience sudden pain in the lower abdomen/pelvis
•    If you bleed/spot outside of your period
•    If you notice an usual smelly vaginal discharge; if you experience burning, itching
•    If you experience unusual vaginal dryness that causes discomfort, and interferes with sexual activity (typical of menopause and during/after cancer treatment)
•    If you notice genital sores, pimples, lumps, etc.
•    Any time you have a concern

September is ovarian cancer awareness month and we’d like you to learn the signs of this disease.  Note: the symptoms are not specific to ovarian cancer and may mimic those of many other conditions, including digestive problems:

•    Abdominal pressure, fullness, swelling or bloating
•    Pelvic discomfort or pain
•    Changes in bowel and/or bladder habits
•    Loss of appetite, or a quick feeling of fullness
•    Increase abdominal girth / clothes fitting tighter around waist
•    A persistent lack of energy
•    Low back pain

An advice for the menopausal women from trusted radiologists: have an annual transvaginal ultrasound to monitor your gynecologic organs.  While this is not (yet!) practiced as routine preventive care, it has proven to provide early detection of cancer.  Transvaginal ultrasound is a simple, painless test — advocate for yourself!

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Abnormal Pap

So your Pap smear results came back ‘inconclusive’ or ‘suspicious’ and you were told to repeat the test in so many months.  You are nervous, worried, and — so typically — convinced you now have cancer…

In reality, fasle-positive results are not unusual and can be due to laboratory errors or to the presence of blood, or mucus or inflammation, or semen/spermicidal, etc.,  that mask the result.  If the abnormalities require close scrutiny, your doctor will proceed with a colposcopy even before recommending a repeat Pap smear.

What can you do to minimize false-positive results? Read our post Tips for Gyno Exam.  Beyond that, try to stay as calm as possible until you do the repeat test — it may very well come back negative and normal after all!

Scraping my cervix?

The term ‘scraping the cervix’ that is associated with the Pap test tends to cause distress to many women because it implies ‘sharp, pain, blood.’

According to Merriam-Webster dictionary, scraping means “to remove from a surface by usually repeated strokes of an edged instrument” as in rubbing off a tissue sample for cytology.

So ladies: by no means is the Pap test to be associated with a surgical procedure or with sharp instruments cutting deeply into the cervix!  Instead, look at it as a ‘throat culture’ to the cervix — simple and harmless (even you tend to spot/bleed a bit afterward, which is common).

Sonogram

Ultrasound is a cyclic sound pressure at average frequency of 20 kHz, above the human’s hearing ability.

Gynecologic sonogram works like a sonar in a submarine: it sends a beam out, and if the beam encounters a solid object (i.e. another submarine, a rock, a cyst, a fibroid, cancer) it returns its image by displaying it on the screen.  There are many other uses for ultrasound and you can do your own search for general knowledge.

There are two (2) types of diagnostic gynecologic sonograms that are typically used to visualize the female pelvis:

  • Trans-abdominal, which is completely external: the transducer (ultrasound wand, or probe) is rolled on the belly/lower abdomen after the patient has drank enough fluid to fill the bladder that will act as the needed water medium for the sound waves.  During pregnancy (obstetric ultrasound), the amniotic fluid acts as the water-medium while the test is done to assess the development of the fetus; the parents-to-be benefit by being given an image photo of their baby.
  • Vaginal, an internal procedure: the transducer is inserted into the vagina and is moved about the organs (uterus, cervix, ovaries, bladder, fallopian tubes) for best visualization.  To provide a water medium, the transducer is inserted into a lubrication-filled protective cover that looks like a condom.  This test provides the best imaging of the internal organs.

Vaginal ultrasound may pose a problem for women who struggle with vaginismus or are just nervous about ‘anything going into the vagina.’  A useful tip: let the person who does the test (the doctor, the radiology technician, etc.) know that you would like to insert the transducer yourself.  Once it is in, have them grab hold of it and proceed with the procedure.

If penetration is not at all possible, ask for a trans-abdominal ultrasound instead, and return for a vaginal one as soon as you have cured your vaginismus.

To learn more about the test and to see what the equipment looks like, click here.

About stirrups

During gynecologic exam, the woman is asked to slide down to the edge of the examination table for best visualization of the area and to accommodate the use of the speculum.  This position is medically known as the dorsal lithotomy position.

Stirrups were invented by Bert H Simpson in 1908 and patented in March 1909 – only 100 years ago.  See photo below.

Many women would rather not use stirrups because they cause them embarrassment and much distress.  Are they mandatory?

Apparently not: a 2006 study suggests an alternative to discuss with your doctor: keeping feet on bed.  The study is worth reading.

stirrups_shrouded

Vaginismus, returns?

Vaginismus is a common condition that affects women worldwide regardless of their culture, religion, education, sexual orientation, or family status.  Vaginismus is a somatic (body-mind) reaction to fear/apprehension of vaginal penetration.  It happens instantaneously and involuntarily.

Women with vaginismus tend to suffer in silence and shame, thinking they are the ‘only one’ with this problem, which is why prevalence is not available.  A certain measure of anxiety is typically associated with this condition, ranging from minimal to severe, the latter may also include panic and OCD (obsessive compulsive disorder).

Vaginismus is curable and the cure should be life-long as long as the woman follows discharge instructions, which should include specific management of the residual anxiety/panic/OCD.  In other words, once the woman can have vaginal penetrations without a problem, why fear them any longer?

Does vaginismus come back? It can, if the woman did not follow up on discharge instructions and is again ‘allowing’ the anxiety/panic/OCD to regain control and interfere with vaginal function.  Sad, isn’t it? To have gone through a treatment process only to then be non-compliant.

On a good note, it is rare that the woman will regress to a complete vaginismus: she will typically be able to have (some) penetration/s but with trepidation and under the effect of her un-managed anxiety.  In some cases, the vaginismus could remain cured but other somatic reaction/s may appear, such as IBS (irritable bowel syndrome), neck or back aches, TMJ (jaw joint pain), headaches, etc.

Bottom line (no pun intended): vaginismus is a body-mind phenomenon and both aspects must be properly resolved for a life-long cure, a joint effort between a skilled clinician and a responsible patient.

Vagina, sterile?

Women often believe that their vagina is a sterile environment and that special cleaning methods are needed to keep it as such.  If it were true, then men should have sterilized their penises before penetration, right?

Fact: the vagina is not at all sterile but rather a a host to many type of bacteria, all composing the vaginal flora that promotes vaginal health.

According to Ann S Botasch MD, the composition of vaginal flora changes with age, stress, hormonal influence, general health status, and sexual activity, and disruption of this balance will lead to breakdowns such as irritation, infection, bleeding, etc.

So, ladies — make sure whatever ‘visits’ the vagina is clean and that you keep a balanced vaginal flora, but do not worry about the vagina being sterile.

Vaginismus or Vestibulitis?

It is common to group vaginismus and (vulvar) vestibulitis into one and it takes a proficient clinician to know the difference.

Generally speaking,

  • Vaginismus = unable to have vaginal penetration/s, or able to have them but with pain and distress.
  • Vulvar vestibulitis = penetrations are usually available but the pain/burning/discomfort surrounding the area may complicate matters.

Unfortunately, vaginismus remains an elusive diagnosis while (vulvar) vestibulitis has become the (quick) answer to vulvogenital problems.

Anxious gyno exam

The reflexive reaction during gynecologic exam is to tighten up the pelvic floor (PC muscles) as the clinician is about to ‘go in.’

The physical fact is that the more you tighten up, the more discomfort you will feel.

So, what is the trick?  Minimizing this reflexive reaction.

As you lie there, feet in stirrups, genitals ‘airing out,’ focus not on the exam (it is not your job anyway) but rather on ‘butt down, legs open, vagina welcoming penetration…’  Keep your breathing at meditation rate – no hyperventilation – and keep telling yourself to just ‘whatever it.’  If you can do that, the exam will be quick and easy.

If you and your vagina are on anxious terms, such as with vaginismus, do your best.  If the exam is not doable, seek treatment and then come back as a WINNER!