Vaginismus FAQ

What causes Vaginismus? Is it caused by sexual abuse?

The exact cause of Vaginismus remains unknown and unclear. It is usually not the result of sexual abuse but occasionally we see vaginismus in patients who have suffered from abuse.

What is the best form of treatment? Is there a permanent cure?

The treatment we use at Maze involves determining the degree of vaginismus a patient has. We use a gradual vaginal dilation program with a series of dilators that increase in size weekly or every other week. We often prescribe vaginal valium to help with tight muscles in the vagina; we sometimes recommend Pelvic Floor Physical therapy to help massage tight vaginal muscles. In severe cases, we offer vaginal Botox which works wonders on patients.

Are there resources available for my spouse/partner?
 

At Maze, we try and include partners as deemed appropriate by our patients. Unfortunately most primary care providers do not really know or understand vaginismus. Hopefully this will soon change as more people are becoming educated about Vaginismus.

Can vaginismus miraculously disappear?
 

It’s unlikely that Vaginismus would go away on its own. Vaginismus is an involuntary tightness of muscles in the vagina. Since it is involuntary, Vaginismus can only be treated with dilation and Pelvic floor physical therapy. With the right treatment, it can nearly always be helped. It doesn’t just “fix itself”

What is the best way to incorporate your partner into your treatment?
 

The best way to incorporate your partner in treatment is to educate them on vaginismus. Many of our patients bring their partners to a few of their visits here at Maze so we can educate and answer any questions they may have. We find when the patients get comfortable dilating themselves they can then allow their partner to help them dilate. At first we tell patients to dilate in front of their partners. When they are comfortable with this, we advise allowing their partners to insert the dilators.

What are ways to conquer avoidance? / How can I get over my avoidance of sex?
 

It is so difficult to come face to face with Vaginismus. By educating yourself and knowing that you are not suffering alone you are better able to accept the diagnosis. I think it is vital to be kind to yourself and not judge. 

Once patients are aware of the many other patients who are managing Vaginismus, they then feel empowered to seek help. Questioning then accepting are the very first steps in overcoming Vaginismus.

One can easily avoid sex when they are suffering from Vaginismus. There are many other types of intimacy that do not involve intercourse. I think that becoming a sexual person starts with the self. Masturbating and using vibrators can be both pleasurable and help while going through the treatment of Vaginismus. Eventually you can transition from self to partnered sex when you feel comfortable doing so.

What are a woman's options when vaginismus is impeding her ability to get pregnant?
 

“Pregnancy and Vaginismus” is a topic we regularly receive questions about here at Maze. I think it is vital to overcome vaginismus before attempting pregnancy if this is an option for you. Pregnancy involves multiple trips to the obstetrician to assess both maternal and fetal well-being. Although some visits do not involve internal exams as the obstetrician is just listening to the baby’s heartbeat, measuring maternal vital signs, and measuring the size of the uterus to make sure the baby is growing well, many visits do.

In the beginning of pregnancy, an internal vaginal sonogram is standard in order to measure size and dates to confirm a due date and to check for fetal viability. If you have vaginismus, this internal sonogram can be difficult and potentially cause a good deal of pain and emotional trauma.

As patients head into the last few weeks of their pregnancy, weekly internal exams are sometimes necessary to check for cervical dilation and fetal position.

If Vaginismus is impeding your ability to get pregnant, you can opt for IVF or IUI but these are still difficult to do and very costly.

How does Vaginismus affect child birth and delivery?

When a patient has gone through the necessary steps to cure vaginismus we find that pregnancy and childbirth are not very difficult. We do think that patients should probably continue dilation throughout their pregnancy unless dilation is medically contraindicated.

Can vaginismus be hereditary?

We do not think that Vaginismus is hereditary, although we do sometimes see it occurring in mothers and daughters. However, this might be due to high levels of anxiety in the family. We just don’t know.

Is vaginismus a form of anxiety?

Vaginismus is not a form of anxiety. It is defined as the involuntary tightening of vaginal muscles. With that being said, many patients with Vaginismus do suffer from some form of anxiety. Whether the Vaginismus has caused the anxiety is often discussed.

At Maze our patients have a very thorough psychosocial intake before meeting with the medical providers. Patients can have a history of sexual and emotional abuse in conjunction with Vaginismus.

The majority of our patients present without any history of abuse and just have tight muscles which causes Vaginismus.

Any tips for having sex for the first time post-treatment?

Sex for the first time can be both exciting and scary. We suggest dilating before having intercourse.

We also recommend 2 positions for the first few attempts because they simulate the insertion of dilators. Lie on the bed with your legs apart and your feet propped up on chairs with your partner standing between your legs. Have your partner insert the largest dilator so that he can adequately gauge the appropriate angle. Then using his or your hands, slowly insert his penis into your vagina.

Another position is the missionary position. Have your partner kneel between your legs as you are lying on your back. Again have your partner insert the largest dilator so he can adequately gauge the appropriate angle. Then using his or your hands insert his penis.

Once your partner is fully inside and you are relaxed enough and you are not experiencing any pain, let him start to move slowly and gently.

Remember to use adequate lubricant to make insertion easier.

Are there any treatments for severe life-long Vaginismus?

At Maze, we treat every degree of vaginismus. We begin with a gentle dilation program. We often prescribe vaginal valium to help relax tight muscles and we offer a ton of encouragement every step of the way.

If we are not successful with dilation we do offer vaginal Botox. You are not alone and we can help you.

Are there birth control options for women with vaginismus that do not require pap smears how do other women handle this when it is traumatic to have a pap smear. How do you have that conversation with a doctor?

There are birth control that are available to you that do not involve a pap smear. Your age determines whether or not a pap smear is necessary.

The only form of birth control which could be difficult for a patient with uncured vaginismus is an IUD as it needs to be inserted into the uterus in your gynecologist’s office.

As far as birth control, there are many options. You can take birth control pills, get the depoprovera shot, use the orthoevra patch, or use male or female condoms. Condoms prevent Sexually transmitted diseases and do not require a prescription.

In terms of discussing Vaginismus with your Gynecologist, this can be tricky as many gynecologists do not know how to counsel women regarding Vaginismus.

I suggest finding a gynecologist who does treat female sexual dysfunction. These gynecologists are generally well versed in vaginismus and can see you through a pap smear. If you are already dilating, I suggest dilating before the gynecology visit and Pap smear.

Why do Doctors and Gyn's ignore vaginismus? Why is the medical community so insensitive to vaginismus sufferers?

Many gynecologists are not trained in vaginismus during both medical school and residency. This is a major problem in terms of the training that they receive.  We are hopeful that this will change in the near future as Vaginismus is no longer a condition that is not talked about by both the media and by patients themselves.

General FAQ

I’m not located in New York. Can Maze still help me?
 

Even if you live too far away to see us on a regular basis, there are many aspects of sexual health we can help you with. Although we cannot diagnose or treat medical conditions over the phone, our practice does have two helpful programs for people who contact us from out of our local area. Learn More.

What is Maze Women's Sexual Health?

Maze Women’s Sexual Health specializes in treating women who are having problems associated with sex. Many women’s problems have physiological roots and medical professionals are beginning to recognize more and more treatment possibilities for many of these problems.

How is Maze different from a sex therapy clinic?

In our view, sex therapy (whether is psychotherapy, behavioral treatment or education) is almost never the full answer to most sexual problems. It is one important tool to be used within a broader context that includes physiological conditions, psychological problems or relationship issues.

Our Center tries to get a full picture of all the contributing factors involved in a woman’s sexual health. If you need medical intervention we’ll treat you or coordinate the appropriate care. If you need education, ideas or behavioral techniques we will work with you on those as part of a treatment regimen. And if what you need is couple’s counseling or more in depth psychotherapy, we’ll help to coordinate that for you as well. Think of us a triage center, helping you figure out the most effective ways and means to get you help.

What differentiates Maze from other doctors or medical providers?

At Maze Women’s Sexual Health, we only treat female sexual dysfunction. In addition, Maze integrates a medical and psychological treatment modality to ensure treatment for all facets of female sexual dysfunction. Finally, the specialized training experienced by the Maze staff has provided them with a level of empathy and caring not often experienced from medical professionals. In these days of managed care, it is rare to find a medical professional who is able to take the time to really listen.

What types of problems do you see at Maze?

The professionals at Maze see women with a wide variety of sexual complaints. The facility treats women who are experiencing a lack of sexual desire, either as a recent development or those who feel they have never had a sex drive at all. Women who are unable to become sexually aroused are also treated, as are women who have pain or difficulty associated with intercourse as well as women who are having problems with orgasm. Most complaints will fall somewhere into one of these categories, but some will not. In some cases, a woman is unable to define the problem herself. In these cases, the professionals at Maze will help her do so.

What treatment methods are used at Maze?

The professionals at Maze use a variety of modalities including topical testosterone, progesterone, papaverine and L-Arginine. We also use a large range of oral medications including DHEA, Wellbutrin, and Viagra. The professionals work with the Eros device, dilators and vibrators as well as biofeedback. Some psychological treatments include behavior modification techniques, guided imagery, and relaxation exercises.

How long does treatment usually take?

That’s a pretty tough question to answer. It greatly depends on what the issue is you’re coming to see us about. In general, low desire patients start to see an improvement between six and eight months. Pain patients usually see significant improvement within thirty to sixty days.

What happens at an appointment?

The first appointment will take approximately 90 minutes. Patients first meet with Bat Sheva Marcus L.C.S.W., M.P.H., clinical director of Maze Women’s Sexual Health. She will take an extensive psychosexual history. Patients will then have a thorough physical exam. Most blood tests and other medical tests will be performed during this first appointment. Occasionally, patients will be asked to return to have blood drawn on a specific day.

Often, the Maze staff will be unable to provide a treatment plan until the results from all of the tests are completed. Patients will be asked to schedule a follow-up visit where the team will be able to present a treatment plan for the patient.

What’s your success rate?

It’s high. For the most part 90% of the patients who see us have significant improvement in their sexual health. But there is a caveat.

Progress is best measured by a patient herself. If she doesn’t return for follow up assessment or treatment, there is no way to know how our treatments are working. Patients who stop coming after the second visit because things feel better, or don’t return after a first level of treatment isn’t completely successful, have less opportunity to resolve their issues. When a patient takes responsibility for her own care, who explores the avenues to success as diligently as we do — she is our star patient who virtually always finds solutions that work for her.

Our testimonials reflect the voices of many women who talk about “sticking with it,” until we found the source of the problem or the right combination of treatments. Treating sexual dysfunction is still as much art as science. You need to be present, involved and committed to make things work. But then they usually do.

Maze seems expensive. Why is that?

We know there is a significant financial commitment involved when you come to see us. After over fifteen years of practice we are convinced that the only way we can provide the level of care necessary and appropriate is by setting aside a significant amount of time and resources for each patient. And that is an expensive proposition.

Your first appointment is 1½ hours. Follow up appointments generally run 20 minutes to a half hour. Compare that to the 6 minutes most physicians are able to allot for patients today.

We try hard not to make you wait, we coordinate care with your other physicians, we call you back in a timely manner and have convenient lab services on site. All these elements require a financial commitment on the part of the Center so we can fulfill our mission.

We want to help you have a satisfying sexual life and we want to do it well. If we accepted insurance plans we would not be able to achieve these goals as well as we do. Charging our patients directly, and working with them to understand which services may qualify for out of network coverage, is the model we use to help our work be accessible to more and more women.

We have made arrangements with CareCredit.com, an interest free loan company, to assist patients. This is a payment plan that allows a patient to pay over time without penalty or interest. Please talk to our billing department before deciding we’re too expensive. We never want someone to go without help because they can’t afford to see us.

Is treatment covered by insurance?

Since Maze is a medical facility, treatments are covered by many insurance companies. The organization is not in-plan with any insurance companies, so patients are required to contact their insurance company directly for reimbursement. Our office will assist with this process.

Do I really need professional help, or can I work this out on my own?

Only you can really answer that question. If your problem is bothering you, has lasted more than a few weeks or months and the solution is not easily apparent to you, you probably need professional help. In general we believe that if women were able to resolve problems related to their sexual health, they would have done so a long time ago if you were able to.

If you’re not sure, you might want to come in for a consultation anyway. The professionals at Maze are very good at helping you clarify issues and untangle problems. Unfortunately women often wait until the problem has become almost unbearable before they are willing to take the time to deal with it. Then sometimes it’s harder to fix.

Why was Maze Women's Sexual Health started?

For over a decade,the topic of sexual function has been on the table; not to mention on TV, in magazines, in stand-up comedy routines and, yes, in doctors’ offices. With one caveat — we could talk about it as long as we were talking about men.

Medications that treat erectile dysfunction in men successfully resolved many (but not all) of the problems men were having with their erections as they age, or because of a medical condition, or due to depression after a job loss. Sexual dysfunction, though upsetting, was now an issue a man could address with his doctor quickly and get “back to business.”

Over the course of his 25-year practice, Michael A. Werner, MD, a board-certified urologist specializing in male sexual dysfunction and infertility, learned a lot about the lives of the men he treated, and he could not ignore the plain fact: women were suffering from different types of sexual dysfunction, and there was very little help.

Maze Women’s Sexual Health

Founded in 2000 under the original name “The Medical Center for Female Sexuality,” Maze is dedicated to helping women treat female sexual dysfunction in each of our offices in the New York area. Every patient is greeted with warmth and support, participates in a psychosexual intake process, and has a physical exam. Depending upon the condition presented, follow up appointments are made to explain a diagnosis and recommend treatment.

Women who come to Maze vary in age, from newly weds in their 20s, young mothers in their 30s, and pre- or post-menopausal women in their 40s, 50s and older. They come with dramatic stories of marriages not consummated, withering sex lives with life partners, years of pain while trying to love their partners, and vanishing — or nonexistent — orgasms.

A variety of medical and psychotherapeutic tools are used to treat women in our offices, and the success rate is high. The practitioners at Maze work closely with patients in an intimate but comfortable environment. Sometimes women try out different vibrators to help with orgasm; we assess hormone levels to understand decreases in libido; different exercises or medications are combined with the most effective lubricants to reduce pain and anxiety during sex. Visit our testimonials page to hear women’s stories in more detail.

Each month, thousands of women come to our site to learn that they are not alone; that their pain or loss of desire is not “in their head,” that there are treatments for the complex arena of women’s sexual health. Some travel from afar to see our practitioners because there are very few practices like this in the country. Some call for a non-diagnostic consult so they can make general suggestions to their own local doctors.

Whatever your situation, you are reading this because you have questions about your sexual health. We hope we can be of help.


Painful Sex Glossary

Our Painful Sex Glossary provides a list of terms associated with sexual health disorders that cause pain during intercourse.

 

Sex Therapy Glossary

Our Sex Therapy Glossary lists medical and other terms commonly associated with sex therapy.

Sexual Health Glossary

Our Sexual Health Glossary provides a list of general terms associated with sexual health and wellness.