Vaginismus occurs when penetrative sex or other vaginal penetration cannot be experienced without pain. It is a condition in which involuntary muscle spasm interferes with vaginal intercourse or other penetration of the vagina. Dr. Alexandra Runnels, a Board Certified OB-GYN, discusses Vaginismus, a form of chronic penetration-related pelvic pain in women.
Vaginismus is a condition where a woman’s pelvic floor muscles are chronically hyper-contracted, making vaginal penetration painful or impossible. This condition often starts in the teenage years and can lead to difficulties with activities like using tampons or engaging in physical intimacy. Many women with Vaginismus are misdiagnosed or dismissed as having a psychological disorder. Treatment options and providers knowledgeable about the condition are limited and include physical therapy, medications, and vaginal dilators.
Dr. Runnels has developed an effective, comfortable, and long-lasting treatment protocol using Botulinum Toxin and Platelet-Rich Plasma (PRP) injections performed in her office. This protocol has relieved the pain and suffering of Vaginismus for many women, allowing for comfortable intercourse, vaginal exams, and other penetrative vaginal activities.
Love relationships, marriage, and starting a family require a functioning, healthy vagina. By giving women a choice for effective, long-lasting in-office treatment, we have made the impossible become possible. Dr. Runnels encourages those who suffer from Vaginismus to seek treatment and not give up hope. We have a solution that may be the answer you or your loved one has been searching for.
Sex is not supposed to hurt, but it does for many women…………
Painful intercourse, like with the condition of Vaginismus and its prolonged experience, can wreak havoc on your well-being and on your intimate relationships. These ill effects are compounded when the problem fails to be taken seriously by healthcare professionals, as is often the case. In this way, the treatment of painful sex has a history parallel to that of other chronic pain syndromes with the added complication of sexual stigma.
“Painful vaginal penetration” is the most current descriptive terminology for a group of chronic Genito-Pelvic Penetrative Pain Disorders that are not limited to sexual intercourse. Painful penetration of the vagina can occur with a penis as well as a tampon, a finger, or a speculum at the doctor’s office or even with tight-fitting clothing. Vaginismus is the term used when penetration or attempted penetration of the vagina causes pain and results in hyper-contracted pelvic floor muscles.
The pain is not explained by other physical findings, medications, anatomic defects, infections, etc. The symptoms of pain with vaginal penetration must be present for at least 6 months to make the diagnosis. The most aggravating criterion needed to make the diagnosis is, it must cause you or the patient “distress”. If it doesn’t bother you to be unable to have sexual intercourse or wear a tampon, without pain, it doesn’t count as a diagnosable condition according to the DSM V Manual of Psychiatric Disorders!?!?!
What??? There are two parts to this that make me crazy!
First, should a condition rendering a woman unable to have sexual intercourse or wear a tampon be a diagnosis in the Psychiatric diagnostic manual of disesase? Shouldn’t it fall under the jurisdiction of an Obstetrician/Gynecologist, Urogynecologist, or other Women’s Health Provider rather than the Psychiatry Department? Seems like a continuation of the old attitude of labeling symptoms of a female nature as “hysterical”. The surgery to remove the womb or uterus of a woman is called a “hysterectomy” as in “hysteros-“ which is the Greek word for uterus.
Second, if a man cannot get an erection adequate for penetrative intercourse, he still has a diagnosis of Erectile Dysfunction even if he isn’t bothered by the condition. But if a woman has a complimentary problem that makes her unable to accommodate a penis with her vagina, it only counts as a diagnosis if it “bothers her”. In my opinion, this criterion serves to only invalidate the seriousness as well as the legitimacy of her pathology.
The sensation of pain is anticipated prior to any penetrative attempts and is associated with significant visceral/autonomic nervous system symptoms. It is unclear how much the contracted and spastic musculature are causative of pain or the result of pain.
The resultant contracted pelvic floor creates an impenetrable vaginal orifice, dysfunctional pelvic floor musculature, impaired pelvic organ function and weakened pelvic floor muscles.
The severity of the condition is scored on the Lamont Classification system and can be mild to severe, with the most severe displaying tachycardia, hyperventilation, diaphoresis, crying, screaming, extreme adduction of the thighs, lifting and squeezing of the buttocks, and even attempts to get away as if an assault were occurring.
Anyone who has ever done pelvic exams on women has encountered this patient and knows what I’m talking about. No amount of calming techniques can talk her out of her distress, despite the fact that they desire to have the exam or in the case of intercourse, desire to accommodate a penis.
Physicians unfamiliar with recognizing the condition will often think the patient is being difficult and somehow is choosing to behave that way. Alternatively, they are often suspected of having been sexually abused in the past. While this is certainly the case for some, it is not the case for most.
Because of the stigma associated with psychosomatic pain and sexual stigma, many women see multiple providers for several years before an appropriate diagnosis is made and effective therapy initiated.
The good news about the condition is when treated appropriately, the chances of a complete cure for the patient is around 80-90%.
The psychosocial implications of this diagnosis are far-reaching. If a woman is unable to consummate a marriage, she will be unable to become pregnant and have a family. Additionally, the difficulties in a marital relationship when intimacy is not possible in the usual way can be utterly devastating. Sexual conversations between lovers are difficult enough in the best of circumstances, but when the cause is poorly understood and complex, relationship breakdown can easily occur.
Treatment for the condition of Vaginismus typically involves multiple modalities including pelvic floor physical therapy, cognitive and behavioral therapy, biofeedback, medications such as antidepressants, benzodiazepines, topical anesthetics and vaginal dilators. Many times, the therapies work somewhat for a while, but if the patient ceases going to therapy, the symptoms return. Many of the medications are merely band aids and have side effects of other types of sexual dysfunction like anorgasmia or hypoactive desire/arousal disorder.
The good news is there is a better solution that works very well in most women with the condition of Vaginismus or Genito-Pelvic Penetration Pain disorder (GPPPD). Beginning in the early 1990’s Botulinum Toxin (Botox®) was approved by the FDA to treat the condition of Vaginismus. It has since been shown in over 200 studies to be both safe and effective for alleviating the pain and relaxing the pelvic floor enough to allow for comfortable penetrative intercourse. What is even more remarkable is it is usually one and done, unlike Botox® for other indications.
Botulinum Toxin has been used for over 4 decades in almost every part of the body to treat multiple conditions in dosages as high or higher than is used in the pelvic floor safely and effectively. Even though there are occasional reports of minor side effects in some, they are usually transient and short lived.
Many doctors will take a patient to the operating room for general anesthesia to administer the treatment secondary to the inherent difficulty of adequately accessing the pelvic floor in these patients prior to treatment. However, it is possible to do it do comfortably in the office under light sedation and topical/locally injected anesthesia.
In our office, I have developed a very effective protocol to deliver Botulinum Toxin comfortably to the muscles of the pelvic floor. In addition, we utilize the restorative effects of Platelet-Rich (Plasma-like we use in our O Shot® procedure) to enhance the health and function of the pelvic floor at the same time. By the time she “wakes up” she will have a vaginal dilator in place without pain secondary to the injected anesthetic combined with the Botox®. Despite a bit of soreness over the next few days, she should not have a return of her symptoms, especially if she follows my post-procedure protocol.
Typically, around the 2-week mark, she will be able to have comfortable intercourse or use a tampon comfortably and without pain. The procedure does not need to be repeated, except for on rare occasions. Many patients have come to me with tears of joy and gratitude after having this treatment, wondering why everyone is not doing it. It is one of the most satisfying procedures I do.
I hate to see love relationships fail and patients suffer needlessly, and I love seeing the condition of vaginismus cured forever. If you or someone you love could be helped with this treatment, please make an appointment in San Antonio, TX or Fairhope, AL with the link below or contact our office.