Thank you both for your nice comments.
I don’t have any statistics to back this up, but in my own experience it seems that in about 1/3th of all women, vaginismus is primarily a physical problem. Penetration hurts, but those women have little to no issues with sex as a whole. They want to be intimate with their partner, they masturbate, they can/want to have orgasms, etc… a therapist and dilation exercises can usually help these patients.
In the second group the physical pain women have due to vaginismus, has an influence on the way they experience and think about sex. The pain causes them to be less interested in sex as a whole, they start avoiding intimacy, orgasms become unnecessary, sex drive declines, etc. This is usually where the work of a therapist is combined with a sexologist.
In the last group, vaginismus is caused by a combination of physical and psychological issues, either from the start or sometimes even before the first penetration has been attempted. Those women typically suffer from a low self esteem, they think something is wrong with their body, they are afraid to have sex, they had a bad experience in the past (rape, boyfriend that kept on insisting on sex despite pain, etc…).
I mainly work with the third group, a group which is typically impacted by the negative body image that many women have. Most of them are convinced that all the clients I see have the perfect body – except for THEM – while in reality I’ve never seen the perfect body in my entire career. Some women barely have boobs, others have large nipples, saggy breasts, pointy breasts, breasts with stretch marks… and while they all think they are “abnormal”, the opposite is true. Getting them to show me their breasts is a huge task that might take several sessions. When they finally dare to remove their bra, most of them begin to cry. It sounds ridiculous, but for most patients this is a very emotional moment – a first bridge they’ve crossed.
It’s even worse when it comes to showing their genitals. Almost none of these women know how a “real” vagina looks like. It still amazes me how many of them think having large inner labia is “ugly” or “abnormal”, while almost everyone has this. A large part of my work consists out of talking to them, convincing them nothing is wrong with their boobs or genitals and getting them to the point they are willing to show me their naked body. Once that hurdle has been taken, women seem to open up and trust is established. Some of them start asking questions about their body and insecurities themselves, like “look at this, what do you think about that, is this normal, etc…”. It’s a process that can take days to weeks in some, but it’s absolutely necessary. Also: it keeps amazing me how many women don’t know how real bodies look like. That’s definitely due to the picture perfect world on Instagram, but I also blame sex ed at school, where teachers often only talk about how to avoid a pregnancy, but never about different body types for instance.
The next step I take usually involves masturbation exercises. Some women know how to have an orgasm but can’t do it when someone else is present – which in most cases also means they can’t come during sex. The majority though, never masturbated before. For me it’s an essential part of love making, and I usually don’t continue before they are able to have an orgasm on their own. A small part needs a bit of guidance, in others there is a steep learning curve involving instructions on how to touch the clitoris. Some of them think it’s so weird to touch themselves they can only do it when they can put their hand on mine. Others are so overwhelmed by the feeling an orgasm is imminent they’ll stop touching themselves and never come. In my entire career I’ve seen over fifty women having their first orgasm, and even after all those years it moves me to tears when I see how those women are engulfed by emotions afterwards.
Next in line is… my own body. Many of my clients don’t have a clue on how the male body works. I show them how they can give me an erection, what feels nice and what doesn’t, how they can position and move their fingers, how they can make me ejaculate and how an ejaculation looks like. I’ve had clients who were afraid to look at my penis when I came. Others were afraid to get semen on their body. Some women have an aversion towards semen. They find it hard to watch an ejaculation, to smell or touch the semen. I even had a few patients who vomited when I came. I try to explain to them what I feel, what I like, why semen looks like that, etc… These are all issues we work on before going to the next stage, which is penetration itself.
Most therapists recommend the usage of lube to vaginismus patients, and I know this might sound controversial to some of you, but I’m not in favor of doing that. I think it’s too “easy” and you give your client the impression that you just put some lube in there and you’re okay to have sex. Enough foreplay is an important key factor to me, so I help women determining if they are wet enough – most of them don’t even know how to check that. When they aren’t wet enough, I forbid any kind of penetration. It always amazes me how many women tell me they were too dry to have sex but their partner insisted on sex so they did it anyway. What exactly turns women on is something very private and individual. I always tell them it’s okay to fantasize about other men, strange situations, unrealistic encounters, and I encourage them to touch themselves during foreplay. Anything they want, as long as they’re wet enough.
It might amaze you but once all these hurdles are taken, penetration itself often goes smoothly, mostly due to the preparations that have been done with the dilation set from the therapist. I always take things slow, which means that the first time I only penetrate for a few seconds and that’s it. The next time I start moving in and out a bit, and the amount of movement is build up over a few sessions. It’s weird to say this, most vaginismus patients I had, had little to no issues with penetration itself.
The very last step is usually penetration plus the client giving herself an orgasm during of after sex. Some of my colleges think penetration itself is enough as a goal, but I think learning women that their orgasm is an integral part of sex is actually a positive thing. You’d be amazed at how many (“normal”) women don’t come during sex with their partner and I’ve always found this a shame.
@recessivegenequeen asked if I was the only one doing this. I know I’m not. But it’s not like we have some kind of association, we all work individually and each of us has its own group of therapist he works with. It’s still controversial though, the fact we exist is never “advertised” to patients, but only offered as part of the therapy when needed. My official occupation is “massage therapist”, but that is mainly due to the lack of a VAT code for sex workers.
Feel free to ask if you’ve got other questions. I’m glad to help!