Psychosexual Issues

Many people experience difficulties with sex at some point in their lives, both men and women. Psychosexual health is just as important to treat and in this section many problems - and resolutions - are covered. Please contact Conifer House for help and referrals for treatment.

1. Vaginismus

2. Dyspareunia

1. Vaginismus

Is a condition which affects a woman's ability to engage in any form of vaginal penetration, including sexual penetration, insertion of tampons, and the penetration involved in gynecological examinations. This is the result of a conditioned reflex of the pubococcygeus muscle, which is sometimes referred to as the "PC muscle". The reflex causes the muscles in the vagina to tense suddenly, which makes any kind of vaginal penetration—including sexual penetration—either painful or impossible.

A vaginismic woman does not consciously control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The severity of vaginismus and the pain during penetration, including sexual penetration, varies from woman to woman.

If a woman suspects she has vaginismus, sexual penetration is likely to remain painful or impossible until her vaginismus is addressed. Women with vaginismus may be able to engage in other sexual activities, as long as penetration is avoided. Sexual partners of vaginismic women may come to believe that vaginismic women do not want to engage in penetrative sex at all, though this may not be true. Many vaginismic women do wish to engage in penetrative sex, but are deterred by the pain and emotional distress that comes with each attempt.

Experience of vaginismus

The conditioned reflex can create a vicious circle for vaginismic women. One example: if a female is led to believe that the first time she engages in penetrative sex that it will be painful, she may develop vaginismus because she expects pain. If she then attempts to engage in penetrative sex, the muscle spasm will make penetrative sex painful. This and each further attempt at sexual penetration confirms her fear of pain and may worsen the condition. Naturally, penetration may be painful without vaginismus or psychological prerequisite as well.

Primary vaginismus

Primary vaginismus occurs when a woman has never been able to have penetrative sex or experience any kind of vaginal penetration without pain. It is commonly discovered in teenagers and women in their early twenties, as this is when many young women will initially attempt to use tampons, have penetrative sex, or undergo a cervical smear. Women who have vaginismus may not be aware of their condition until they attempt vaginal penetration. It may be confusing for a woman to discover she has vaginismus. She may believe that vaginal penetration should be naturally easy, or she may be unaware of reasons for her condition.

Secondary vaginismus

Secondary vaginismus occurs when a woman who has previously been able to achieve penetration develops vaginismus. This may be due to physical causes such as a yeast infection or trauma during childbirth, or it may be due to psychological causes. The treatment for secondary vaginismus is the same as for primary vaginismus, although, in these cases, previous experience with successful penetration can assist in a more rapid resolution of the condition.

Treatment

There are a variety of factors that can contribute to vaginismus. These may be psychological or physiological, and the treatment required can depend on the reason that the woman has developed the condition. As each case is different, an individualised approach to treatment is useful.

2. Dyspareunia

Is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original cause has been removed. It's a common condition that affects up to one-third of women at some point in their lives.

A medical evaluation of dyspareunia focuses initially on physical causes, which must be ruled out before psychogenic or emotional causes are entertained. In the majority of instances of dyspareunia, there is an original physical cause. Extreme forms, in which the woman's pelvic floor musculature contracts involuntarily, is termed vaginismus.

 The diagnosis of dyspareunia is made when the patient complains of recurrent or persistent genital pain before, during, or after sexual intercourse that is not caused exclusively by lack of lubrication or by vaginismus. Clinically, it is often difficult to separate dyspareunia from vaginismus, since vaginismus may occur secondary to a history of dyspareunia and even mild vaginismus is often accompanied by dyspareunia. It is important to establish whether the dyspareunia is acquired or lifelong and whether it is generalized (complete) or situational. Further inquiry should determine whether the pain is superficial or deep - whether it occurs primarily at the vaginal outlet or vaginal barrel or upon deep thrusting against the cervix. Even when the pain can be reproduced during a physical examination, the possible role of psychological factors in either causing or maintaining the pain must be acknowledged and dealt with in treatment.