Anyhow, last weekend I was reading a book by AS Byatt, Possession. It’s a beautiful book about two modern English researchers who are studying 2 Victorian poets who they discover had a clandestine love affair. (By the way, writing this book was no easy feat since the author had to write poems that were supposedly written by 2 separate Victorian poets in addition to writing the book around their work!) Anyhow, back to my point that my husband suspects I see vaginismus everywhere. “Hey,” I gasp, “one of the characters has vaginismus.” He smiles knowingly… “No really.” I  say. “Here. You read it!’

A few flames made their sinuous way upwards. She remembered her honeymoon, as she did, from time to time, and deliberately.

She did not remember it in words. There were no words attached to it, that was part of the horror. She had never spoken of it to anyone, not even to Randolph, precisely not to Randolph.

She remembered it in images. A window, in the south, all hung about with vines and creepers, with the hot summer sun fading.

The nightdress embroidered for these nights, white cambric, all spattered with lovers’ knots and forget-me-nots and roses, white on white.

A thin white animal, herself, trembling.

A complex thing, the naked male, curly hairs and shining wet, at once bovine and dolphin-like, its scent feral and overwhelming.

A large hand, held out in kindness, not once, but many times, slapped away, pushed away, slapped away.

A running creature, crouching and cowering in the corner of the room, its teeth chattering, its veins clamped in spasms, its breath shallow and fluttering. Herself.

A respite, generously agreed, glasses of golden wine, a few days of Edenic picnics, a laughing woman perched on a rock in pale blue poplin shirts, a handsome man in his whiskers, lifting her, quoting Petrarch.

An attempt. A hand not pushed away. Tendons like steel, teeth in pain, clenched, clenched.

The approach, the locked gateway, the panic, the whimpering flight.

Not once, but over and over and over.

When did he begin to know that however gentle he was, how-ever patient, it was no good, it would never be any good?

She did not like to remember his face in those days, but did, for truthfulness, the puzzled brow, the questioning tender look, the largeness of it, convicted of its brutality, rejected in its closeness.

The eagerness, the terrible love, with which she had made it up to him, his abstinence, making him a thousand small comforts, cakes and tidbits. She became his slave. Quivering at every word. He had accepted her love.

She had loved him for it.

He had loved her.

So, he did read it – and agreed I was right and it wasn’t my imagination.

I was moved because Byatt describes so dramatically and poignantly the pain and psychological damage associated with Vaginismus.

But all I could keep thinking that night and the next day was: We could have helped her! We really, really could have.

Alas and alack, there is little to no market for “fixing” fictional characters. And then poor AS Byatt would have had to rewrite the entire book.

I obviously can’t give too many details, but I will say that I found the woman inspirational. She has struggled with serious mental illness all her life, and was raised in an incredibly restrictive and dysfunctional family which bordered on the abusive. She lived through one very, very brief “marriage” when she was 21 which was quickly followed by divorce and a nervous breakdown.

Here’s why she’s an inspiration: at 30 she’s pulled her life together, has a job she enjoys, is remarried to a sweet, caring man and is planning on starting a family.

She came to us because she’s been married for 2 years and hasn’t been able to consummate her marriage. She worked seriously and in a focused way on her vaginismus while her husband struggled with the erectile dysfunction that often comes with vaginismus.

And they had intercourse for the first time last week!

Okay, it wasn’t perfect. She sat in our office explaining that it didn’t go too well. He wasn’t comfortable, she was nervous and awkward, he had a hard time maintaining an erection and there was little to no pleasure.

We sat together with the woman and her husband and went through  all the possible mechanics that could get in the way or could help. We all laughed together as we discussed the awkwardness and reassured them that , yes, the first few times could be awkward, mechanical, uncomfortable and far from romantic. But we also reassured her that they would get there. She’s come so far – there’s no question in my mind that this loving couple will pull it all together. She is amazing in that no matter what the setback, she puts one foot in front of the other and moves ahead,  with a smile that reveals the love and pleasure in her life.

They left holding hands.

If, however, you don’t think you can, then by all means try treating yourself. Buy a set of vaginal dilators (they are described and sold in the MCFS Store on our website, and elsewhere) and use them,  starting with the smallest one you can comfortably fit into your vagina. You should try to progress to a new size every week and understand that each size will be uncomfortable. As your vagina stretches to accommodated the larger sizes you can put in a small size and see the progress. You probably won’t feel them at all.

Here’s the deal: if you hit a “plateau” in your program - you can’t seem to move up in size after more than 2 weeks or you can’t even get a small one in - you really need to see a professional. Vaginismus is one of those conditions that women ignore. When they are having trouble, they just leave the dilators on the shelf and figure maybe they don’t have  to think about it. Time has a funny way of flying by when you are avoiding something, and then you turn around and another half year has gone by and the same problem is there. 

So do yourself a favor, find a specialist in this area and make an appointment. It’s such a treatable condition and you will feel so much better when you can put the dilators on the shelf because you are really and truly done with them.

It’s not in her head . . . there are physical symptoms!  Now, of course there is a connection between what goes on in your brain and how that translates to your body and psychosomatic symptoms, but this is not always the case.  But when there is a physiological symptom, why would anyone recommend  cognitive therapy to treat a raw, irritated vagina?  If I broke my arm snowboarding, would the treatment be to go to therapy to see why I decided to go snowboarding to begin with . . . or would the treatment be to set and cast my arm?  It never ceases to amaze me how when it comes to female sexuality, we forget the biopsychosocial approach and just treat the woman as an emotional creature or think psychologically she is being affected.  What happened to the biological component??? 

Therapists can be quick to find that red flag, that ah ha moment, the root of a particular emotional response to a given situation.  But most therapists work in the psychological realm, talk therapy, and I have yet to meet a therapist who can “talk” to anyone’s vagina and rid them of rawness and irritation.  Although therapist’s intention is to help, I wonder if gynecologists realize how recommending talk therapy when a painful situation exists affects the patient or client. 

Do these women believe it is indeed in their heads and therefore can never be cured?  Do they rack their brains trying to find that one instance that caused or triggered the problem and in essence blame themselves?  Many of the women I see at the Women’s Center are suffering from various issues including low desire, trouble with arousal, difficult time achieving orgasm and pain.  In every category, I’ve heard a woman say, “My doctor said it must be in my head”, when there is clearly a real physical issue going on.  I think that is the benefit of a place like the Women’s Center.  You get the chance to work with both a sexuality therapist and a nurse practitioner who are both trained in sexual issues.  So if you would like to explore your situation beyond “it’s in your head” make an appointment so we can treat all of you, not just one part.

Regardless of age or sexual dysfunction, every woman should have a bottle of lube next to her bedside.  Whether it is because you suffer from vaginal dryness, want to have a “quickie” and haven’t given yourself enough time to become aroused, or because you just like the feeling of having something ‘extra’ down there to help the penis and/or toys slide inside you.  Lubrication is also extremely helpful when applied to the clitoris to help the fingers slide and glide over it. 

Most people have seen the KY jelly commercials and the various products that are available offering ‘warming’, ‘cooling’ and even ‘intense’ sensations from the lube itself.  What you may not know is that there are more brands available than just KY and, depending on preference, you may enjoy one of these even more.  Typically, lubes come water-based or silicone.  Both are condom compatible but you don’t want to use the silicone with any sex toys.  Some people have never even heard of silicone lube, but this is an excellent option because it coats the skin rather than soaking into it like water-based lubes can.  The other thing women have recently been concerned with are the chemicals that make up the product.  Most women do not have any problems with the chemicals in KY, but some women find KY irritates them.  If this is the case, or if you are trying to reduce your contact with chemicals, you may want to look for one that is glycerin and paraben free.  Glycerin can break down into the body and turn to sugar which can affect women prone to yeast infections.  Paraben is a preservative added to the product which can cause irritation and an allergic reaction to the vulva area.  Liquid Silk is an excellent option for glycerin free lube and Wet Platnium is a silicone based, glycerin and paraben free product. 

Shameless plug: our website now recommends products of all kinds that have proven to be effective with our patients over the past 12 years that the Center has been open! Take a look.

 So what’s the good news?

It just so happened that immediately following her appointment was a patient who was finishing treatment for vaginismus, a magnificent and beautiful woman (inside and out) in her 40′s who 3 months ago thought she would never be “normal.” I asked if she’d be comfortable talking to the new patient and she happily agreed.  

Sitting there with the two of them almost made me cry. As I watched our “graduating” patient talk about all her fears and concerns when she came to us, and how empowered and  normal she now feels, I felt so proud of her. And watching the new patient realize that her situation is not so unique and not so hopeless — watching her light up with a new found feeling of hopefulness — made me grateful for being in this profession.

Daily I feel privileged to have the opportunity to watch our patients struggle with their worst fears and conquer them — and privileged to be a part of the solution. But in the end, they are doing it themselves. I am blessed to be able to be a part of their lives.

“The last time I was in the office I told Dr.Marcus that she will be remembered for her contribution to Female Sexuality the way that Margaret Sanger was with birth control.

I read the article (in the latest e-newsletter from the Medical Center for Female Sexuality) and I could not agree more. It took a great deal of courage for me to pick up the phone and make that first appointment. I had spoken with a psychotherapist at length about the problem itching. discomfort and pain in my vagina; loss of desire that had nothing to do with my attraction to and love for my partner and finally my inability to achieve orgasms after being someone who previously had no sexual problems and certainly no problems achieving an orgasm. As I was in a new relationship my therapist said it was just a matter of getting comfortable with a new person. I know my body and I knew she was wrong. I tried the ‘herbal cures”, specifically Thandia from Native Remedies. Three months and I felt no difference.

I have been on Dr. Marcus’ s treatment regime for less than a month. The vaginal dryness and discomfort ended the first week. My level of sexual desire has returned almost to the level it was before I noticed a change and this weekend I had an orgasm that was as good as some of the ones I had at 30. So, I am a firm believer that there is no “magic pill” but a complex mixture of supports that Dr. Marcus has developed for each patient. You saved my sexuality and thus my relationship which is a huge part of my ongoing happiness.”

“M”, July 2010

Women who come to the Center generally have their own primary gynecologist for routine cervical screening.  That said, when we treat women with vaginal pain, painful intercourse or  vaginismus (a condition that results in extraordinary pain when anything is inserted  into the vagina) one of the first things that crosses our mind is, “how long ago did she have a Pap smear?”.  Women with vaginal pain or vaginismus often avoid pelvic exams and Pap screening because they fear the pain it may cause. 

If you or someone you know is avoiding a Pap because it’s impossible to imagine a speculum entering the vagina without intolerable pain, there is help.  There are different kinds of treatments – from creams to dilators to Botox injections under general anesthesia – that can help a woman take care of her health in every possible way.

http://www.annarbor.com/health/understanding-the-guidelines-for-maintaining-your-cervical-health/

When I am lecturing and trying to explain vaginismus , the analogy I use to describe how a patient feels is to compare it to what your reaction might be if I told you I was going to put a pen into your eye. 

If I said to you,”Listen, I am going to put this pen in your eye. Not to worry, it won’t hurt a bit and actually it will feel good,” you would look at me as though I had three heads and run for your life.

Patients with severe vaginismus feel that way. Often with anti anxiety medications, behavior medication, relaxation exercises we can work with a woman to help her get those first dilators in. Sometimes it just doesn’t work and it’s just too hard.

 This new procedure has the women under general anesthesia while a physician injects Botox (stops the muscles from going into spasm) local anesthesia(so that there is absolutely no initial pain) and put in a large dilator. The patient wakes up having the dilator in and that really is jumping the first few hurdles. There is still significant work for the patient. She has to work with dilators, get comfortable with the idea of inserting something into her vagina, internalize the idea that there is really no pain and then make the  transfer to intercourse.

It doesn’t solve the whole problem, but it can be a big help and relief for the right patient and we are so glad that we will be able to offer  it in our office as well.

I hope you also know that it’s very treatable and you shouldn’t’ t feel like you have to live with it. One of things I’ve noticed with vaginismus patients is that they are often scared to come  in for treatment and therefore put things off for a very long time – and suffer needlessly.

Sometimes they put things off and put things off until there is some crises, a partner leaves, they stop dating  etc.

But if that’s you— here’s something to think about:

more often than not, the fear is way worse than the treatment. Most patients say that once they got in the door, the rest was easy.

So maybe  it’s time you treated yourself!