Cómo tratar el vaginismo

¿Qué es el vaginismo?

The main symptom of vaginismus is your vaginal muscles tightening in anticipation of penetration. If you attempt penetration, it typically causes a stinging pain.

Vaginismus can happen when:

• Inserting a tampon.

• Having a smear test.

• Attempting vaginal penetration during sex, whether with a penis, finger or sex toy.

• Something is put near your vagina.

Anxiety or fears around sex are often the cause of vaginismus, so you will likely feel anxious too.

Types of vaginismus

There are two types of vaginismus: primary and secondary.

Primary vaginismus is when you’ve always experienced difficulty with vaginal penetration. This is the type that the media most often focus on.

Secondary vaginismus is when you’ve experienced normal vaginal penetration previously, but vaginismus has since developed. This can be total or partial too, where some penetration is possible, but often with pain.

Vaginismus can also occur intermittently - in certain contexts and circumstances only.

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Cómo tratar el vaginismo

NHS guidelines for vaginismus treatments focus on the use of vaginal dilators for desensitisation, psychosexual counselling, and relaxation techniques.

Vaginal dilators

These are smooth plastic devices that help to gently stretch the vaginal tissue in people who have pain during sex or penetration. They come in various sizes, allowing you to progress at your own pace.

Helen Forth is a specialist pelvic and women's health physiotherapist with 20 years' experience treating vulval pain issues like vaginismus, and hypertonic pelvic floor muscles. She says: "Always use dilators within your comfort zone and increase your tolerance slowly: the same goes with any myofascial release of the pelvic floor muscles. This is only something you should do when you've had some guidance from a specialist pelvic health physiotherapist."

Psychosexual therapy

This is a type of therapy that aims to address the psychological and physical aspects of vaginismus. It focuses on managing fear and anxiety around vaginal penetration through education and relaxation.

"What you're wanting to do is chalk up positive experiences when something is inserted into the vagina so that the brain stops anticipating that insertion relates to pain," Forth adds.

Medicación

Drug treatments for vaginismus are less common but include local anaesthetics and muscle relaxants. Injected Botox is also sometimes used, but remains an experimental treatment.

How to treat vaginismus at home

Not all treatments for vaginismus require seeing a doctor. There are several things you can try at home to help you relax too.

Ejercicios del suelo pélvico

Pelvic floor exercises, (also known as Kegel exercises), strengthen the muscles that support your uterus, bowels, bladder and rectum. They can help retrain and relax the pelvic muscles to allow penetration.

Técnicas de relajación

Relaxation techniques such as deep belly breathing, and yoga positions like child’s pose, encourage relaxation and lengthening of the pelvic floor. These techniques allow you to keep calm, leading to pain free and pleasurable penetration.

Forth says, "Using specific breathing techniques and yoga positions are a vital part of treatment too, as they encourage relaxation and lengthening of the pelvic floor. Combining all this with psychosexual counselling (if indicated) will really help."

Dónde buscar ayuda para el vaginismo

If you think you may have vaginismus, visit your doctors or local sexual health clinic to rule out any other cause of your symptoms, such as an underlying infection.

You may be referred to a gynaecologist or vulval pain clinic and can ask to be assessed by a specialist pelvic health physiotherapist. Some vulval pain clinics will offer this service on the NHS, or you can seek a private consultation.

What causes vaginismus?

Vaginismus can be caused by physical or psychological factors, or a combination of both. These factors include:

• A traumatic gynaecological examination (smear test).

• A painful sexual experience.

• Abuso sexual.

• Medical conditions such a thrush.

• La creencia de que el sexo es vergonzoso y desagradable.

Though distinct from vaginismus, difficulty achieving vaginal penetration can also be caused by an hypertonic pelvic floor. This is when the vaginal muscles become overactive and tight, causing pain when stretched. Forth explains:

"El vaginismo es el espasmo de los músculos de la entrada de la vagina. A menudo las mujeres describen la sensación de un bloqueo físico cuando intentan introducir algo. Eso es diferente de la hiperactividad de los músculos del suelo pélvico, que pueden estar en un estado constante y crónico de tensión aumentada gran parte del tiempo, lo que parece ser el caso de algunas mujeres."

Forth atiende a menudo a pacientes con vaginismo secundario a las que también se ha diagnosticado vulvodinia y síndromes de dolor vulvar. "Puede haber más de una cosa en marcha - potencialmente una disfunción pélvica más amplia junto con problemas psicosexuales y dolor neuropático, por lo que es importante adoptar un enfoque multidisciplinar del tratamiento para obtener los mejores resultados."

La historia de Sam

Sam Evans had secondary vaginismus for many years and still has episodes from time to time. She says the condition was triggered initially by using an intimate lubricant containing additives that contributed to recurrent bouts of bacterial vaginosis, thrush and urinary tract infections.

"Cada vez que utilizábamos este lubricante durante las relaciones sexuales me producía irritación o una infección y eso hizo que empezara a ver el sexo y mi vagina de forma negativa", cuenta. "Seguía queriendo practicar sexo e intentaba relajarme, pero mis músculos vaginales estaban tan tensos que la penetración era imposible o muy dolorosa. En cierto modo, me preocupaba contraer otra infección y, con el tiempo, esas preocupaciones se habían convertido en una respuesta corporal que no podía controlar conscientemente."

Evans acudió a su médico de cabecera, que le diagnosticó vaginismo y le sugirió un enfoque psicosexual para reducir el estrés. Sólo cuando eliminó el desencadenante inicial del vaginismo empezó a recuperarse, explica Evans.

"Utilizar un lubricante que no irritara fue lo que marcó la diferencia, porque dejé de contraer infecciones y, con el tiempo, mi cuerpo captó el mensaje de que ya no tenía que sujetarme y protegerme de las relaciones sexuales. Además, darme cuenta de que podíamos seguir disfrutando mediante la masturbación mutua me quitó la presión de tener relaciones sexuales con penetración cada vez".