The vaginal pain that I am writing about here is the pain experienced by many women who often struggle to find help. I’ve heard stories of my patients who went to their GP distressed by the pain they experienced and were told that “it was in their head” and to drink wine before sexual intercourse. Others visited a gynaecologist who was looking up their painful symptoms online while listening to the patient’s complaints in order to find a diagnosis. These stories describe the sad reality of ignorance of some health professionals about vaginal pain; they also reflect the absence of the condition in our society. Hidden and unnoticed this pain leaves women feeling broken, misunderstood, unheard, unhelped and invisible in the public health system.
One of the reasons for that may be that this pain may seem extremely puzzling to physicians. There are often no physical manifestations that would be easily identified as causes of pain, therefore no medication can be resorted to. While some condition may contribute to it, i.e. yeast infections or urinary infections in many cases the pain persists after the treatment. In specialist sexual clinics worldwide and in Aotearoa New Zealand the multidisciplinary approach has proved most successful in the treatment of vaginismus or other vaginal pain . The patient is first seen by a physician who then refers onwards for physiotherapy and counselling. A physiotherapist may help women to be less frightened of their bodies being touched and to become aware of muscle tension by teaching women how to relax during sex and to train their muscles to do so. I have been fortunate to have witnessed multiple cases of recovery in women who either never had sex due to the painful muscle spasms disabling entry to the vagina, or women who avoided sex due to the painful sensations during or after intercourse.
Most significantly I witnessed recovery in women who recovered without physiotherapy; supported in psychotherapy they could identify the sources of their intimate pain. Psychotherapy can offer a safe place to talk about our bodies, our fears around intimacy and being touched, and about relationship with our partner. There may be a newly discovered history of familial discomfort around our bodies, whether they were a focus of constant discontent or touch has not been experienced as an expression of closeness. There may be many other external messages that cause fear of being sexual, be it cultural or religious. Relationship in which sex is experienced can have immense impact on the functioning of our bodies. Lastly, sexual abuse or sexual assault may result in vaginal pain as a symptom of trauma. Once the aspects of our psyche are explored in supportive therapy, the source of this psychological pain experienced physically can be meliorated.
I would like to end this article with a humble caution to women who decide to undergo a recently promoted surgery called vestibulectomy. It is endorsed in the medical world as a remedy for oversensitive nerve endings in the vagina. The surgery is invasive and the success rates are very unstable depending on many variables. As tempting as it may seem that nowadays we trust surgeons to improve our bodies with immediate effect, there may be however underlying issues that surgical tools may fail to effect. Vaginismus or other vaginal pain should be looked at as a psychological distress that is manifested in the physical body.