- One of the most common methods to treat vaginismus is dilation training, which involves inserting a dilator into your vagina to become accustomed to penetration.
- Another method of treating vaginismus is therapeutic counseling, which can involve a muscle relaxation technique called systematic desensitization.
- In particularly severe cases, botox can be injected in order to stop the automatic muscle response of vaginismus.
- This article was medically reviewed by Jamie Lipeles, DO, OB/GYN and founder of Marina OB/GYN in Marina Del Rey, CA.
- Visit Insider’s homepage for more stories.
Vaginismus is a condition where muscles in the pelvic area contract involuntarily during vaginal penetration, causing extreme pain. Consequently, vaginismus can lead to painful sex and trouble inserting a tampon.
Living with vaginismus can be both physically painful and emotionally draining. The good news? There are several ways to treat this condition.
Why dilation training is effective
One of the more common approaches to treating vaginismus is with dilation training. This involves using a set of vaginal dilators, which are plastic, tube-shaped devices used to gently dilate the vaginal opening.
“Using vaginal dilators can help retrain the vaginal wall muscles to relax and promote blood flow to the area to help decrease pain,” says Sara Reardon, DPT, a pelvic floor physical therapist that treats vaginismus. They can also get a woman more comfortable with the idea of vaginal penetration. When done correctly, she says dilation training can be very effective.
Training for this procedure is typically done in-office or with a therapist who has extra training in this field, such as a physical therapist trained in pelvic floor therapy. After guided training in the office, the ultimate goal is to use the dilator at home as part of a regular routine.
Initially, a small dilator is used, and then you slowly work your way up to a larger dilator. To help ease any discomfort, you can apply a lubricant to the dilator and vaginal opening. Dilators are commonly sold in sets, ranging from three to eight dilators, with the smallest being less than 3 inches long and 0.5 inches in diameter, and the largest around 6 inches long and 1.5 inches diameter.
Dilation training should be done three to four times per week, but no more than two days in a row, or else you risk pain or irritation. The goal is to get to the point where you can fully insert the dilator into your vagina without pain. You should only move up to the next size when your current dilator fits easily, comfortably. That said, your doctor will advise you on the best protocol for your needs.
The American College of Obstetricians and Gynecologists recommends a combination of cognitive and behavioural therapy called systematic desensitization. During this process, you learn muscle relaxation techniques that focus on the vagina.
The goal is to combine these techniques with the use of a vaginal dilator at home in order to “desensitize” yourself to the fear of vaginal penetration. Experts also recommend going to traditional talk therapy.
“Therapy plays a role, especially when there is a history of sexual abuse or trauma coupled with vaginismus,” says Jaime Schwartz, MD, a board-certified plastic surgeon that specialises in vaginismus.
The thing to understand, he says, is that this is a vicious cycle. “Women are so used to having pain, that the mere anticipation of intercourse or inserting a tampon will trigger that subconscious pain response before it happens physically,” says Schwartz.
“Therapy can help stifle the anticipation response, especially after treating it effectively with botox,” he says.
Botox for vaginismus
Botox injections to treat vaginismus is an option when conservative measures such as counseling and dilator training did not produce the desired results, according to an older article review published in Plastic and Reconstructive Surgery.
According to a comprehensive report published in 2017 in the journal Sexual Medicine, a combination of treatment with Botox, progressive dilation, and therapeutic counseling resulted in pain-free intercourse for 71% of the women who participated in the Female Sexual Function Index.
“Paralyzing or freezing the pelvic floor with botox allows you to break the pain-response cycle,” says Schwartz. The Botox can be injected in multiple areas along the lateral side of the vagina and causes numbness to decrease pain. The effects of the Botox lasts about two to four months, which gives women plenty of time to adjust to the dilation training.
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