Advocating to Your Doctor About Possible Vaginismus

Melvin Tillman, Melvin Tillman, MA

Posted by: Melvin Tillman
Melvin Tillman, MA
267-428-2612

Advocating to Your Doctor About Possible Vaginismus

 

Things just haven’t seemed right with sex.  You find yourself avoiding or dreading penetration because you find it difficult, maybe even painful and uncomfortable.  You’ve done the research and reading, and you’re suspecting you have vaginismus.  After all, the prevalence rate of vaginismus is 15% in North America.  Thinking that you might fall in that percentage, you decided to see a gynecologist for a definitive answer.  While you wait for the day of your gynecologic appointment, you may wonder if there’s anything that you can do on your end.  You may be feeling anxious about the gynecologic appointment, wondering how to explain your sexual symptoms, and what to expect from the appointment.  The best thing you can do other than showing up on time is advocating for yourself, and the best way to advocate for yourself is to gather more information about your possible vaginismus diagnosis.

Regardless of the medical issue, advocating for yourself requires information.  This article will help you learn more about vaginismus, as well as your possible connection to it.  To be clear, only your gynecologist or primary care physician can give you an official diagnosis of vaginismus.  The following information and assessment tool will provide you with more in-depth information to bring back to your doctor.  Advocating for yourself simply ensures that you’ll receive the best care.  Let’s start easy by going over the definition of vaginismus.

 

Vaginismus Defined

Vaginismus is the unconscious tightening of the vaginal muscles, which makes penetration challenging, sometimes painful, and for some, even impossible.  Whether it’s a penis, dildo, or finger; vaginismus makes anything going inside a difficult task.  Even the thought of something entering your vagina may make you cringe with discomfort.

Vaginismus shares some similarities with another sexual dysfunction: dyspareunia.  Dyspareunia is the consistent, often intense pain associated with vaginal penetration.  Most women who have dyspareunia also have vaginismus.  Dyspareunia is often associated with being the result of a medical problem such as a sexually transmitted infection, endometriosis, cancer, stones, hormonal changes, whereas vaginismus is more psychological.  You have had painful sex, and now you tense up because you are expecting painful sex. You may even feel bad about sex due to messages you heard as a child (sex is for procreation, not pleasure), you are a survivor of sexual trauma and your body unconsciously tenses up, etc.

In the current literature, vaginismus is frequently referred to as genito-pelvic pain/penetration disorder (GPPPD).  With it being the clinical approved term found in the DSM-V, most doctors often use the name GPPPD.  Though clinicians felt that GPPPD was a more accurate term, many people still refer to the dysfunction by its historical name, “vaginismus”.  Whether you call the dysfunction GPPPD or vaginismus, it’s a good chance that your gynecologist will know what you mean.  Instead, try focusing on the sexuality questions below.  They might prove useful when speaking with your doctor.

 

Questions to Ask Yourself for Your Appointment

Is inserting a tampon easy for me?

When did I first experience sexual pain?

With whom have I experienced the sexual pain?

In what ways is the sex pleasurable – despite the pain?

Prior to penetration, am I aroused? Am I fully lubricated?  

When has penetration of any kind been doable?  Pleasurable?

During sexual intimacy, when am I comfortable, relaxed, or excited?

When was the last, good sexual experience that I had?  Was penetration involved?

When thinking about sex, do I tend to have positive thoughts?

When having sex, what am I focused on?

 

Write out your answers and give them to your doctor.  It may be easier to come up with these answers from the comfort of your home, rather than being put on the spot in a doctor’s office.  Here are some other questions that you want to leave yourself time to think about an answer.  

What makes you think that you have vaginismus?

How long has this been going on?

How do you think this came about?

What do you feel?  Is there pain, burning, or tingling sensations?

Is this experience consistent across your partners?

What are your thoughts during sex?

 

Asking yourself these questions can definitely give you more insight on your possible vaginismus.

Information that might also be helpful to your doctor include, but is not limited to: changes in weight that you have noticed, changes in sleep patterns, the ability to describe your pain (sharp, dull, flat, aching), patterns you have noticed about when, where and how you are feeling what you are feeling, being able to identify the location (s) of the discomfort that you are experiencing.  Just remember, the pain that you are experiencing may not be “just in your head.” the pain could be stemming from a medical problem.

 

In the world of mental health therapy, to help us better understand the physical pain patterns we utilize the Pinky Assessment.  This is not a formal medical evaluation tool. The Pinky assessment is designed to give you language to describe what you are experiencing to both your medical doctor and your therapist.   

 

The Pinky Assessment

Only do this activity if you feel comfortable doing so.  If you’re not ready, it’s okay.  Just being able to tell your gynecologist that the idea of inserting your pinky finger for assessment made you unable to do it is already a great start for gathering and giving information.  If you do begin it, remember that you can always stop; you are always in control.  The pinky assessment simply provides you with information to bring to your health provider.  It’s not an end-all tool for assessing vaginismus, but it is an information gathering tool.  

To carry out the pinky assessment, start with trying to find a portion of your day in which you’re completely free.  This is not something to try to rush through on your way out the door, so please be aware of how and when you make time for this exercise.  Find a place where you feel really comfortable and private.  How and where you choose to do this is up to you: some find it easier for entry purposes to sit over the toilet as if you’re going to the bathroom.  Another option is to sit on the side of your bed or lying down on your bed, belly up, whichever you find most comfortable and feasible for you.

For hygiene and safety purposes, make sure you’ve washed your hands and trimmed the nail of the pinky that you plan to use.  Before insertion, take three deep breaths to help you relax from head to toe.  Now, try to insert your pinky into your vagina starting with just the tip and holding it there for 5 seconds.  Was insertion possible?  Do you feel any clenching, discomfort, or pain?  Take it nice and easy in the beginning.  If you found 5 seconds of insertion simple, extend it for 5 more seconds. If you still have no discomfort and found 10 seconds easy, try to see if you can slide your finger past your pinky nail.  If you can’t, don’t worry; it’s fine.  Don’t force yourself to go deeper than you’re comfortable with.  In fact, try not to go past your second knuckle.  

Remember, the goal of the exercise is to simply assess your level of possible vaginismus.  Whether you can insert the whole pinky or just the tip, there are no wrong experiences.  It’s all great data to bring to your gynecologist.  If you’re looking for more information to bring to your doctor, reflect on your masturbation habits.  

 

Gathering Information Through Masturbation

Your masturbation habits can give you insight on vaginismus.  If you do masturbate, think about how it’s done.  Is it purely clitoral stimulation, or is penetration also involved?  In other words, could you masturbate with a dildo?  Remember, vaginismus is the difficulty of penetration of any kind.  If you can’t personally penetrate yourself for pleasure, then that’s usually a sign of the dysfunction.  

Exploring one’s masturbation habits is also important because it isolates various variables regarding vaginismus.  Sometimes a sexual issue isn’t inherent with us, but with our partner or the relationship.  If the sex is bad and you’re feeling tense during it, yet you can masturbate fine with a dildo, you probably don’t have vaginismus.  You have communication issues with your partner.

Final Thoughts

Having sexual problems, such as vaginismus can be a frustrating and confusing journey. Starting with asking for help can be the most difficult, but essential step. The next best step you can take is to educate yourself on vaginismus and your symptoms in order to advocate for your needs. The more you can understand about your body, the more tools you will develop to help you overcome your vaginismus. If you still feel you could benefit from more support and guidance as you work to overcoming and treating your vaginismus, help is available: (267) 324-9564.