Vaginismus Treatment Methods

Vaginismus is when sexual intercourse becomes painful or impossible as a result of involuntary contraction of the muscles around the vaginal entrance. Involuntary vaginal reflex; It can be triggered during sexual intercourse, with a tampon, during a doctor’s examination, or even with one’s own finger. The resulting spasm closes the entrance to the vagina, making sexual intercourse impossible. If continued, it will cause pain. It can also cause spasms in other muscle groups of the body, sometimes causing difficulty in breathing. Once the event is over, the muscles relax and return to their previous normal state.

Vaginismus Treatment at Liv Hospital

Those who have never had painless sexual intercourse before due to involuntary contraction of the muscles are called ‘primervaginismus’. This primary type occurs during sexual intercourse or the first gynecological examination. The type called secondaryvaginismus describes situations in which vaginismus appeared later, although there was normal painless sexual intercourse before. Sometimes, after trauma and surgical procedures, they cannot have sexual intercourse even if the primary problems disappear completely.

To plan appropriate treatment, other medical and physical conditions that cause painful intercourse must be ruled out. Some conditions that cause painful sexual intercourse can be listed as follows: Vulvodynia/Vestibulodynia, inflammatory diseases of the pelvis (PID), ovarian cyst, bladder or urinary tract infections, vaginal atrophy, vaginal dryness, vaginal prolapse, rigid or thick hymen, birth trauma, vulvar cancer, vaginal infections, skin diseases (Lichen sclerosus, eczema, psoriasis), rheumatic diseases that affect the joints and restrict joint movements.

Treatment Methods for Vaginismus

Removal of Hymen: Most women with vaginismus think or are directed to overcome the problem by removing their hymen. However, most of the time, removal of the membrane causes scar tissue to form and therefore more pain. In rare cases, if there is a rigid or thick hymen, it can be surgically removed. However, this procedure does not mean that vaginismus will be cured.

Psychotherapy: Relaxation is a skill that must be learned. Saying this verbally to someone who doesn’t know how to relax won’t get any results. Therefore, psychotherapy alone is not an effective treatment method. However, women who have been exposed to sexual trauma in their past require psychotherapy. The fear of failure causes anxiety in someone who does not know how to relax. Therefore, heartbeat increases, muscles tense, breathing becomes shallow and blood pressure rises. Since vaginismus occurs as a result of involuntary contraction of the pelvic floor muscles, treatment should be aimed at relaxing these muscles.

Exercises:

Kegel Exercises: These are exercises to strengthen, relax and control the pelvic floor (Pubococcygeus) muscles.
Breathing Exercises: These are exercises to control breathing.
Relaxation Exercises: These are exercises for learning to relax all body muscles.
Application of Botox: It is a toxin obtained from the bacterium Chlostridium botolinum and causes partial paralysis and relaxation in the injected muscles. Botox provides its effect through the substance acetylcholine, which enables muscle contraction in the muscle-nerve junctions. The duration of effect is 2-6 months. Urinary or fecal incontinence may occur as a side effect. Vaginismus may occur again after its effect disappears.
Vaginal Dilators: It is a self-training and relaxation method using vaginal dilators of various sizes.
Electrostimulation – Biofeedback Treatment: Electrostimulation – Biofeedback is the most effective, painless, and side-effect-free treatment method for vaginismus. 95 percent of patients recover completely after two to three weeks of treatment. When combined with other treatment methods or home exercise programs, the treatment period becomes shorter and the success rate increases. With this method, the patient is taught relaxation in a shorter time. Muscles can be strengthened with electrical stimulation. Additionally, muscle spasms are resolved with other physical therapy agents used, and pain can be relieved with analgesic currents. During treatment sessions, the patient can see on the monitor how the pelvic floor muscles contract and relax or hear the sound of contraction. In this way, contraction and relaxation are learned in a short time through feedback. Patients also notice how successful they are at relaxing as treatment sessions progress.
Urogynecological Physiotherapy: It is one of the recently developing branches of physical therapy. In this branch, in addition to vaginismus, urinary incontinence caused by looseness of the pelvic floor muscles, pelvic inflammatory diseases, muscle weakness before and after pregnancy, exercise and physical therapy practices to prevent and correct body deformations and reduce pain, preventing birth vomiting, during birth. Physical therapy methods are applied to reduce pain.