I was intrigued to find out that the Showtime series, “Masters of Sex”, included vaginismus in the story line of their most recent episode (Season 2, Episode 9). Since I treat patients with vaginismus on a daily basis I felt compelled to watch the program. Although the show is steeped in melodrama, I felt the writers addressed this condition quite sensitively. Since this was the first episode of the series I had ever watched, I was a little confused by the backstory of each character but what came through clearly was the importance of treating both the physical and psychological symptoms of vaginismus. It was very interesting to see the “doctor” and his assistant arguing about what aspect of vaginismus is more important to treat first. The assistant stated that even if the patient was able to have sex she wasn’t psychologically ready to and the doctor argued that treating the physical problem first would allow the psychological wounds to heal. There is some truth to both of these statements but here at the center we address both the psychological and the physical at the same time and have an extraordinarily high success rate.
So, what is vaginismus? As the “doctor” quite accurately explained, vaginismus is a condition in which the muscles in the vagina spasm involuntarily preventing vaginal penetration. This involuntary spasm can prevent women from inserting a tampon, undergoing speculum exams and having intercourse. The cause of vaginismus is unknown, however fear, anxiety and pain can be contributing factors. I was a little disappointed that the writers felt the need to imply that perceived sexual abuse by the patient was the cause of her vaginismus. Although it is possible, the studies don’t support this and we do not see a strong correlation between vaginismus and sexual abuse.
As the episode showed, traditional treatment for vaginismus includes counseling and progressive dilation. I was disappointed they didn’t show the dilators in the episode, which to me made them seem a lot scarier than what they are. Dilators simply are plastic cylinders that come in several different sizes. Typically, I introduce the first dilator and the patient goes home to practice insertion daily and returns on weekly basis to increase in size. Also at these weekly visits, the patient meets with a counselor to discuss her fears. We have found that some patients benefit from more intensive psychotherapy which we offer at our center too. We have great success with these treatment modalities with most patients completing treatment in 2-4 months. However, in a case where the patient does not respond to conservative treatment, either due to severe pain or intense fear, we offer botulinum toxin injections under sedation.
I’m definitely interested in how this story line progresses and I do hope they continue to address this condition sensitively and show that it can be successfully treated. As illustrated in the show, some patients feel a lot of shame around this condition and the most important message I hope people walk away with is that vaginismus is a very real and treatable condition.