Posts Tagged ‘vaginismus’

Update on Vaginismus

Tuesday, January 17th, 2012 by Bat Sheva Marcus LMSW MPH PhD

We’ve been using Botox  now for over a year and it may be time to give you some of my impressions. They are not in any particular order… they are just things we’ve learned along the way, but I think they can be helpful in thinking about Botox as a treatment option:

  • For the right patient it works really, really well! What we have discovered is that for a patient whose pain is primarily tight muscles and who have the fear that goes with the pain, the Botox can bypass months of scary and overwhelming dilator work.
  • It’s really not such a big deal. The entire procedure take 15-25 minutes and seems to have little to no side effects at all.
  • “Waking up” from the procedure with the large dilator inserted is an exciting and moving experience for women who have, until then, not been able to insert anything into their vagina.
  • It will not work if your pain is primarily from hormonal imbalances or structural issues.
  • You really need to be ready to address the problem and face a solution if you are thinking of Botox. Otherwise, the fear of penetration is just overwhelming.
  • A supportive partner can make a big difference! It’s great to have someone cheering for you.
  • If you’re single and avoiding dating because of your fears of sex, Botox can change your life!

I wish more women knew about the possibility of Botox – for that matter, I wish we knew about it before we did.  But I suppose, as with most things, better late than never. But now, a year and a half later, I have to say that I’m a believer.

Vaginismus

Thursday, October 27th, 2011 by Barbara Gross, LMSW

Vaginismus is a condition in which the vaginal muscles involuntarily contract, making penetration painful and sometimes impossible. When we first see a vaginismus patient at the Center, we do a psychosocial assessment as well as a medical one.  Frequently, though women are told that the condition is all in their heads or the result of a sexual trauma, we find that this is often not the case. Though the etiology of vaginismus is somewhat unknown, it seems its roots are most likely a combination of physiological, psychological,  hormonal and environmental factors. Vaginismus could be reconceptualized as an aversion or a phobia of vaginal penetration.

We have found de-sensitization or exposure therapy to be the most effective treatment for vaginismus.   We use dilators which are silicone cylinders of gradually increasing size to slowly and gently stretch the vaginal muscles over time.  And  it really works! Though we find the addition of therapy and relaxation may be helpful, it is primarily the slow and gentle but consistent use of dilators that tends to help women most.  Particularly when it is done properly in conjunction with a Physician’s Assistant  or Nurse Practitioner.  There are other forms of treatment available and obviously every individual is unique and some may require other forms of help, but I would strongly suggest this type of treatment if you are suffering from vaginismus. Very few gynecologists/ obstetricians and therapists are trained to deal with it so seek out the proper help and don’t suffer alone any longer.

“Staying Well with Guided Imagery”

Thursday, October 13th, 2011 by Barbara Gross, LMSW

I highly recommend the book, “Staying Well with Guided Imagery” by Belleruth Naperstek. Ms. Naperstek is a psychotherapist who has worked with patients of all kinds, from the “worried well” to the chronically ill. In her work as a therapist she began to use guided imagery tapes to help individuals work towards healing and health.

Naperstek has created many cds; some are focused on a particular ailment or illness like cancer or anxiety, and some are geared towards overall health. In my work at the Center we work with many women struggling with Vaginismus. These patients often have an intense fear of any kind of vaginal penetration. Guided imagery may be helpful both in viewing penetration in a new and more positive light and in terms of managing anxiety  throughout the process of dilation (which can be very anxiety producing).

I recommend both the book and the cds.  Not everyone likes Naperstek’s voice but the ideas and research behind her work are powerful and guided imagery is certainly worth a try for anyone struggling with an issue either acute or chronic.

Seeing Vaginismus Everywhere

Monday, August 29th, 2011 by Bat Sheva Marcus LMSW MPH PhD

My husband claims I see vaginismus everywhere. Okay. Maybe he’s right. Maybe I do….it kills me. When I see a woman who is totally avoidant of relationships I suspect she is fearful of penetration. When I see a young girl fearful of tampons, I suspect she is panicked at the idea of putting something inside.  What kills me is that I know how unbelievably treatable the condition is!! And it kills me that anyone is letting it ruin their relationships or their life.

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.

 

The Unconsummated Marriage/Relationship

Thursday, July 7th, 2011 by Bat Sheva Marcus LMSW MPH PhD

 

Here is the most important thing to remember: NO ONE NEEDS TO LIVE WITH AN UNCONSUMMATED RELATIONSHIP. EVERYONE CAN BE HELPED!

Really and truly. I promise you.

So if you are sitting there thinking “I am the worst case ever. I can’t possibly do this, ” I’m here to let you know that it just isn’t so. And now you are probably shaking your head saying “But you haven’t met ME and you can’t imagine how bad my case it.”  Oh yes I can. “No, really,” you’re saying. “My gynecologist made it clear to me (by their looks and impatience?) that I am like the most hopeless case ever” or  you’re saying “ You don’t know ME. I am really nuts. I can’t let anyone touch my thighs without hyperventilating or shaking.” Yes… I do know you. We see someone like you every single day here at the Center.

We won’t scream at you. We won’t make you feel guilty. We won’t shame you. And we never, ever make you feel like a freak. Because you’re not. Because every day there are hundreds and thousands of women walking around with the same issue. Just no one talks about it. So when you come in to see us for the first appointment, all we will ever think, is that we know how incredibly scary this is for you… and you? You are incredibly brave!

Sexuality and Religion

Tuesday, July 5th, 2011 by Barbara Gross, LMSW

 

At the Medical Center for Female Sexuality, I treat a lot of women who come from religious backgrounds.  I see people from all kinds of religions and all different levels of religiosity. The thing that strikes me is that many of our world’s religions do not support sex before marriage. Many people have been told their whole lives not to have any kind of sexual thought or activities up until the moment  of marriage and then suddenly one day all that is supposed to change. I have seen that with so much pressure on the moments just after marriage and the belief that only after that ceremony should one be sexual, I see that sex can become fraught with a lot of anxiety and ambivalence. In that period, just after marriage, all those cognitive pathways are supposed to be  reversed, which I think is incredibly difficult to do.

Human beings are generally creatures of habit. It is through repetition that we arrive at mastery. And one of the ways to change your behavior is to explore your thoughts or ideas about that behavior. Of course you can just start trying a new behavior as well. At the Center we try to do both. The moment  at which I come in to the picture is when an individual or couple is struggling to break in to a new pattern or behavior.  Though many women with sexual dysfunction are told it is all in their heads.  I have found this is rarely the case.  Sexual dysfunctions are generally a combination of multiple factors-physical, psychological, physical and possibly hormonal. And we do a thorough assessment to determine what is causing the problem and exactly how to go about treating it. My point is that women need to be gentle with them selves when they are in the process of changing their behaviors. And if you have never had sex and then all of a sudden you have it, it can be scary. It is often a process to learn to enjoy, so be patient. It will happen!

Botox for Vaginismus: “It has the Potential to Change your Life”

Friday, May 6th, 2011 by Shannon Bertha, ACS, PhD

Sometimes we like to share what our patients say about a particular condition and their experience with MCFS.  Here’s an inspiring testimonial from a woman who had great success with treating vaginismus with Botox.

I’ve suffered from vaginismus my whole life. I initially hoped it was something that would resolve on its own, but unfortunately it persisted. The pain was intense, and having sex became a huge emotional and physical effort. I consulted multiple doctors, often to be told that ‘I needed to relax, and should try having a couple of glasses of wine’.

 

I found out about the Botox procedure while trying to research my condition online. That’s when I decided I’d lived with vaginismus long enough and made an appointment at the Women’s Centre. Everyone here was empathetic and extremely helpful, and the procedure itself was quick and minimally invasive. The results were incredible. For the first time I am able to have sex without fear and actually enjoy it. My husband doesn’t feel like he’s hurting me anymore. The whole experience has been empowering and liberating. I sincerely encourage anyone with vaginismus to explore this treatment, as it has the potential to change your life.

Pain-free Intercourse in a Week

Friday, April 15th, 2011 by Bat Sheva Marcus LMSW MPH PhD

 
One of our recent botox patients just had intercourse with her husband after 9 years of marriage. Pretty cool, no?
 
She had been trying to have intercourse for years with no success.   She tried traditional dilator therapy and though she could insert the smallest sizes, she felt pain when she got to the medium one. It was just too severe, and the years went by…
 
Then she tried traditional talk therapy. She spent two years “doing really great work” with a sex therapist.  I question the nature of that work, since the problem was pretty clearly in her vagina and not her head. A therapist who keeps a patient in therapy for two years talking about why they can’t have intercourse instead of getting them to find more appropriate help is nearly irresponsible. But the patient found it helpful… and maybe, ultimately, the work she did in therapy gave her the courage to call us.
 
About a month ago, she found our website and, despite having to fly in from Denver for the treatment, she made the decision to do so. She called and had a phone consultation, and decided that she had spent enough time trying “everything,” and that she wanted to arrange for a Botox procedure to help her overcome her severe vaginismus.
 
She received her pre-op review from her primary care physician in Denver, and then flew in to see us about two weeks ago. She came in the day before the procedure so that we could meet her and give her a last minute consult on her feelings about the procedure, and her physical preparedness to proceed.  The next day she had the procedure.
 
This patient could not believe that by the evening she was inserting and removing a large dilator with no pain.
 
She stayed in town to see us four days later and flew back to Denver and to her husband.  A week after the procedure, they got clearance to have intercourse. It took a few tries, a little bit of coaching from our staff and a sense of humor; but by this past weekend – within two weeks of the procedure – they were really and truly having pain free intercourse.
 
Now that’s what I call a week well spent!!

When Sex Seems Impossible

Monday, March 28th, 2011 by Barbara Gross, LMSW

At the Center, I frequently see patients suffering from Vaginismus. Vaginismus is a “female sexual dysfunction,” specifically a genital pain disorder. Vaginismus is defined by involuntary spasms of the vaginal muscles which interfere with sexual intercourse. It goes without saying that this condition causes distress and tension in a couple’s relationship.

In my search to find ways to explain this disorder and help clients who suffer, I recently discovered Dr. Peter Pacik’s book, When Sex Seems Impossible, Stories of Vaginismus and How You Can Achieve Intimacy. Dr. Pacik skillfully explains what vaginsimus is, how it is differentiated form vulvodynia, why many women suffer from it and how it can be successfully treated. Many women who suffer from vaginismus have been told that it is all in their heads. This is definitely not the case. Even under sedation, these women often have severe and intense muscular contractions. There is a lot we can do to treat this condition and Pacik’s book is a great way to learn more about it.

Healing Vaginismus: An Inspiring Story

Thursday, February 10th, 2011 by Bat Sheva Marcus LMSW MPH PhD

Tonight I met with a very special couple.

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.