Apart from the cyclical changes in both physiological and psychological terms that women have to endure and become resilient, women also need to change to external circumstances.
They are probably designed to be flexible enough for change. However, depression can get the better of even the so called toughest woman and it is something that can be treated to the fullest degree.
Among the various symptoms of depression that are easily modified with medications, the one symptoms that is rarely discussed is that of sexual problems or sexual disinterest due to physical causes resulting in depression.
A specific sexual disturbance that comes to the fore especially during the initiation of first sexual contact or encounter is that of dyspareunia. Dyspareunia is the difficulty to perform sexual acts due to pain or discomfort either in the male or the female. And the female version of dyspareunia is called vaginismus.
So vaginismus is the condition where pain and spasms occur as a result of physical contact or pressure during sexual intercourse.
There are various successful vaginismus treatments that do not require medications, surgical operations, psychotherapeutic measures, nor any other complex interventional procedures.
Vaginismus is treatable and the success rates are quite high.
Among the most effective treatment approaches are a combination of pelvic floor control exercises very commonly known as kegel exercises, insertion or dilation training using objects that are specific to the sexual treatment procedures, pain elimination techniques using psychotherapeutic measures like exposure and response prevention, transition steps with incremental tolerance to pain and enjoyment of the act, and exercises designed to help women identify, express and resolve any contributing emotional components either from the past experiences or from ill-informed sexual learning experiences which are mostly hearsay.
Treatment can often be done by the woman at the privilege of confidentiality at home, allowing a woman to work at her own pace in privacy, or in cooperation with her health care provider.
The sexual pain, tightness and penetration difficulties that are due to vaginismus are completely treatable and can be fully overcome with no remaining pain or discomfort, over the course of time.
Women experiencing pain or tightness during sexual activities, penile penetration problems including unconsummated relationships, can expect a very high degree of resolution of their vaginismus. This would allow for full pain free and adequate intercourse to the satisfaction of both partners.
Vaginismus treatment exercises follow a manageable, step-by-step process
Step 1 – Understanding Vaginismus
It is a mostly educational part where the patient is provided education about vaginismus and the various causes of the condition. It provides an overview of vaginismus and how sexual pain, tightness, burning sensations or penetration difficulties may result from it. This helps women to get started by being proactive about their sexual health as understanding vaginismus is fundamental to the process of overcoming it.
Step 2 – Sexual History Review & Treatment Strategies
A balanced approach is taken to help women review and analyze their sexual history. Exercises help identify and evaluate any events, emotions, or triggers contributing to vaginismus sexual pain or penetration problems. Checklists map out the woman’s sexual history. Topics also include blocked or hidden memories and how to move forward when there have been traumatic events in a woman’s past.
Step 3 – Sexual Pain Anatomy
Psychoeducation about sexual anatomy and function can also help alleviate many misconceptions about the causes of vaginismus. The causes of pelvic pain and penile penetration problems, may become overt and an understand of the same is helpful in diagnosis of the condition and treatment. Confusion regarding problems with inner vaginal areas and vaginal muscles frequently lead to misdiagnosis and frustration. Topics include how to distinguish what kind of pain or discomfort is normal with first-time or ongoing sex and what physical changes take place during arousal to orgasm cycles in the context of sexual pain or penetration problems. Anatomy areas such as the hymen and inner vulva are explained.
Step 4 – Vaginal Tightness & The Role of Pelvic Floor Muscles
Female sexual pain and penetration difficulties typically involve some degree of involuntary tightening of the pelvic floor. This step focuses on the role of pelvic floor muscles, especially the pubococcygeus (PC) muscle group, explaining in great detail how once they are triggered they continue to cause involuntary tightness with attempts at intercourse. Effective vaginismus treatment focuses on retraining the pelvic floor to eliminate involuntary muscle reactions that produce tightness or pain. Learning how to identify, selectively control, exercise and retrain the pelvic muscles to reduce pain and alleviate penetration tightness and difficulties is an important step in vaginismus treatment.
Step 5 – Insertion Techniques
For women with penetration difficulties or pain, techniques must be learned to allow initial entry without pain. In this step, women practice pubococcygeus (PC) muscle control techniques as they allow the entry of a small object (cotton swab, tampon, or finger) into their vagina, working completely under their control and pace. Any involuntary muscle contractions that had previously closed the entrance to the vagina and prevented penetration are overridden. Women begin to take full control over their pelvic floor and learn how to flex and relax the pelvic floor at will, eliminating unwanted tightness and allowing entry.
Step 6 – Graduated Vaginal Insertions
When used properly, vaginal dilators are effective tools to further help eliminate pelvic tightness due to vaginismus. Dilators provide a substitute means to trigger pelvic muscle reactions. The effective dilator exercises in Step 6 teach women how to override involuntary contractions, relaxing the pelvic floor so it responds correctly to sexual penetration. Graduated vaginal insertion exercises allow women to comfortably transition to the stage where they are ready for intercourse without pain or discomfort.
Step 7 – Sensate Focus & Techniques for Couples To Reduce Pelvic Floor Tension
Helping with the transition to pain-free intercourse, this step explains sensate focus techniques for couples to use to reduce pelvic floor tension and increase intimacy. Couples begin to work together during this step as exercises teach how to successfully practice sensate focus (controlled sensual touch) and prepare for pain-free intercourse using techniques from earlier steps. The exercises are designed to build trust and understanding and assist in the process to adjust to controlled intercourse without pain.
Step 8 – Pre-Intercourse Readiness Exercises
Finalizing preparations for couples to transition to fully pain-free intercourse, this step completes pre-intercourse readiness. Couples review and practice techniques that eliminate pelvic floor tension and prepare to transition to full intercourse. Preparing ahead of time to be able to manage, control and eliminate pain or penetration difficulties, the exercises assist with the final transition to pain-free intercourse.
Step 9 – Making The Transition to Intercourse
Step 9 explains the techniques used to eliminate pain and penetration difficulties while transitioning to normal intercourse. Many troubleshooting topics are covered (with supporting diagrams) such as positions to use to maximize control and minimize pain, tips to ensure more comfortable intercourse, etc.
Step 10 – Full Pain-Free Intercourse & Pleasure Restoration
The final step toward overcoming vaginismus includes penis entry with movement and freedom from any pain or tightness. Step 10 exercises are designed to educate, build sexual trust and intimacy, and complete the transition to full sexual intercourse free of pain. Couples can begin to enjoy pleasure with intercourse, initiate family planning, and move forward to live life free from vaginismus.
Dr SUSHIL KUMAR S V
MB BS, MHA (USA), MD (PSYCHIATRY)(USA)
MIMA, MISDA, MIAN, MARDSI, FIPS (National, South Zone and Karnataka Chapters)
KMC Reg No 71444
IPS No LF-19557
3036 "KONDAJJI BASAPPA"
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