Painful Intimate Contact Is Not Normal: A Doctor Explains Vaginismus

To colleagues and peers, Jennifer Marie Jose, MD is a respected board-certified Obstetrician-Gynecologist and Urogynecologist, whose many contributions to reproductive health in the Philippines include spearheading robotic gynecologic surgery and the practice of aesthetic and functional gynecology.

To her patients diagnosed with vaginismus, the medical term for the involuntary tightening of vaginal muscles that make penetration uncomfortable or impossible, Dr. Jose is a blessing.

“Actually, I have saved 57 marriages already, and I didn’t know I could help them by addressing their gynecologic concerns,” she says with a smile. This includes one couple who have been together for 16 years but have yet to experience sexual intercourse together.

Indeed, while talk of painful or unsuccessful sexual intercourse is usually done in hushed, embarrassed tones, vaginismus is discussed openly in Dr. Jose’s clinic at Makati Medical Center (MakatiMed). “It is more common than you think,” she says. “I see three (3) patients with this condition a week.”

That they come in all ages, shapes, and sizes—from girls in their late teens to ladies in the perimenopausal and menopausal stages—not only confirms vaginismus’s prevalence among women, but that they are willing to do something about a condition that impacts their relationships and self-worth.

Given how it is associated with sex, vaginismus is said to be rooted in a psychological trigger—

perhaps a traumatic or negative experience from childhood, a fear of getting pregnant, or guilt of being intimate before marriage or getting caught with someone other than your partner. Interestingly, vaginismus does not just manifest in women who have never had sex before. Even sexually active females can have vaginismus.

The condition has other causes too, says Dr. Jose. “You could have an infection or irritation. If you’re menopausal, the change in hormones means you are very dry down there. Even sitting in a wrong position for long hours can make your pelvic floor muscles contract, and penetration is not possible because of too much pain,” she explains.

Vaginismus does not just make sex unpleasant. Women with this condition are unable to insert a tampon in their vagina because of the tightness, and a pelvic exam can be very stressful. “Even just to open their legs, they cannot do it,” says Dr. Jose. “They will kick and push you. I have experienced it as a gynecologist.”

An honest, open consultation (preferably with the husband or partner along) and a pelvic exam (to check for tightness) allow Dr. Jose to make a proper diagnosis and recommend the following solutions:

• Botulinum toxin injection. Yes, Botox, the injectable substance that keeps our forehead wrinkle-free, is the same one that temporarily relaxes the pelvic floor muscles, making penetration possible and pain-free. It has a high success rate and lasts between 3-6 months.
  
  
• Biofeedback. This treatment uses a probe inserted into the vagina to monitor pelvic floor muscle contraction and relaxation. The activity is displayed on a screen to make you aware of when to control your muscles.
  
  
• Vaginal dilators. Also known as pelvic wand, the tube-like instrument comes in different sizes. Gently inserted into the vagina, it stretches tight tissues, so you gradually feel comfortable with penetration.
  
  
• Therapy. A psychiatrist or sex therapist can guide you and your partner in resolving issues that affect intimacy.
  
  

Perhaps the best news for women and their mates is that vaginismus is not just treatable, it is preventable.

“Number one, try to avoid vaginal infection. Even a fungal infection can cause irritation and inflammation,” says Dr. Jose. “Number two, all women will go through perimenopause and menopause, which will make us dry. Make sure you are well hydrated and lubricated.”

The MakatiMed OB-GYN also believes that dealing with vaginismus like an adult will bring you the best solutions. “Talk about it with your peers and doctor,” she says. “Do not keep it to yourself because there are ways to address it. Do not be shy to ask for help.”