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I’m sorry it took a while before I was able to answer here, I had some issues with my internet connection. Thank you all for you nice comments. Some of you have asked me to give details about the personal experiences I’ve had with clients, but I’m not a good writer, and certainly not in English. So I’ll try to do my best.

I honestly can’t remember every single woman I’ve worked with, but there is one 33 year old patient I can talk about if you want to learn something more about the way I work. She was my client right before the dreadful Covid virus entered our world. Her story is similar to what I’ve heard from other women, so you’ll get an idea of how things usually go.

First a warning, I don’t think the patients I have are “typical” vaginismus patients. Most of them do not only suffer from vaginismus, but also have several issues with accepting the way they look, they are afraid to establish intimate relationships, have had bad sexual experiences in the past, etc… so it’s a whole package in which vaginismus is the result of the sum of all the issues they have, or in which vaginismus is the cause, or one of the side effects. Vaginismus is part of the package, so to speak, and I’m not sure in how many patients this is the case. That’s something other people here on the forum probably know much better.

The same goes for Anna (I’m calling her Anna here but that’s not her real name). Vaginismus was just a part of the issues she had. Anna had a bad sexual experience when she was 14. She wasn’t raped but a male family member made her undress in front of him while he was touching himself, and he also touched her breasts. Technically she wasn’t raped, but the entire event did have a huge impact on her intimate live. Especially because her parents refused to believe what happened. Plus she wasn’t raped, there was no “proof” and it was her word against his.

When Anna got to know her first boyfriend at the university, they tried to have sex and found out penetration was impossible. Her boyfriend ended their relationship as soon as he realized he couldn’t have sex with her, and he said some pretty nasty things about the way she looked. This is a pattern I often see: when (male) partners are facing vaginismus, their initial reactions are usually *very* important and can worsen the vaginismus. In a LOT of women I’ve worked with, partners left them because of the vaginismus, which put even more pressure on them the next time they met another partner. It’s an endless circle. In Anna’s case, she completely lost faith in men and became a (not so) happy single.

When one of her best friends committed suicide, one of the last things her friend told her was that she had to learn to enjoy life again. This is something I often see: an unexpected “event” stimulates women to start working on their problems. Things like meeting the love of their life, finding an understanding partner, or an external event like the sudden death of a loved one… these can all trigger the idea “something should be done about it”. And this is where gyns and docs should be more understanding and willing to help their patients out, because I’ve heard some of them try to minimize the issues and even don’t recognize vaginismus at all. In Anna’s case, she was lucky and her doc send her to a pelvic floor therapist who worked with a sexologist and a psychologist during almost two years on her recovery.

As usually, my role was limited to the very last part of the therapy, and at that moment she could already use the largest dilator. In the mean time Anna turned 33, had almost no kissing experience and never had sex. Her libido was still very low, and while she technically got rid of her vaginismus, she had 0 interest in having sex. Usually I’ve read the file of my patient before, but despite that, the first few times we meet I usually take lots of time to listen to their story.

I’ve told it before here on this board, but I always ask my patients explicitly not to shave, not to wear special underwear, not to wear make-up… they CAN do that of course, but only if they really WANT to do it, not because they think it’s NEEDED. In fact, all those things are of 0 importance in the entire treatment. I explicitly tell them this, and to some this comes as a complete surprise. I know guys probably don’t read this board, but if there was one thing I could tell them it is: accept the body of your partner the way it is. Most of them have no idea how much indirect pressure males put on them. For instance, I’ve heard men say that a hairy vagina is “dirty”. No! EVERY vagina is hairy, so how could this be dirty? I find it really important to take that pressure away from the start. When a client wants to open the door wearing a jogging suit, without wearing her contact lenses and while still eating her sandwich, that’s perfectly fine.

I also tell them we’re not going to have sex immediately but that we’re going to take very, very small steps and discover each others body. Some of my patients already have sexual experience and clearly have seen a penis before, and/or know how to masturbate and have an orgasm, others have never touched or seen a real penis in their life and don’t know how an orgasm feels like. I also say to them they will have to get nude at a certain point, and at that moment I can already feel the “temperature” so to speak. Some say “okay, fine” and have not issues with that, others become very hesitant and without them knowing, therapy already starts at that moment. Anna was like that, she told me she found her breasts ugly, so I spent an hour talking about that. Why did she think that? Is that her opinion, or the opinion of her ex boyfriend? Has she ever seen other breasts? What makes her breasts ugly? It’s an informal – but super interesting – talk.

In Anna’s case, I used my “book of boobs”, which is a book I bought once in a bookstore. It contains thousands of pictures of breasts, and when she took a look inside the book and I told her EVERY single one of those breasts are normal, she started to cry. I don’t know how it works in the States but here girls are never shown real nudity during sex education, only pictures. So they really have NO clue on how normal, average breasts look like. The only material they can compare them to, are the pictures in woman’s magazines, Instagram and Facebook. In her own words, Anna had “large hanging breasts with big, ugly aureola”, and all I could see when she removed her bra were standard looking boobs. Yes, they were hanging. Yes she had big aureola. But that’s perfectly NORMAL.

Next time I saw her, I asked her if she would feel comfortable removing her bra again for me. She didn’t hesitate one second. Those are the moments I know we’re getting somewhere. Usually the first intimate contact we have – me putting my hands on their breasts – follows shortly after. At the end of Anna’s session, I removed my shirt and Anna was able to give me a hug while her breasts were touching my chest. I still remember her words that day: she called that “a triumph”, which indicates how hard some of these women are struggling with their body image.

In lots of other patients the second part – being comfortable showing their vulva – takes at least two or three consults, but Anna went a lot quicker. During our next session she told me she enjoyed my cuddle last time and wanted to do it again, so she was actually already showing initiative on her own, which is positive! When I asked her if she was ready to remove her pants as well, she said something I’ve heard a thousand times before. It basically comes to this: ok, I’ll do it, but I’m warning you, it looks terribly ugly down there. That “terribly ugly” usually means they have large inner labia sticking out. Again, something that over 80% of all women have, but you never see this on pictures, so there is usually some convincing needed to make them see this is entirely normal. I’m probably repeating myself, but more “exposure” to nude bodies would help these women a lot, if you ask me.

One thing I also like to stress is that I always assure them I won’t penetrate them with my fingers at this stage. I do touch their inner and outer labia, clitoris, the vulva in general, but I promise my patients I’ll never put my finger inside. I found out over the years this is crucial to them to be able to relax and enjoy the feeling of someone touching their vulva. There shouldn’t be a “danger” involved at this moment of me unexpectedly putting something inside.

The next part can vary a lot between my clients – this mainly depends on how much they know about the male sexual organs, how they feel about them, and how many experience they already have with sex. Some women are “experts” cause they masturbated their partner as a kind of surrogate sex in their relationship. Others don’t even dare to touch a penis. Anna told me when she tried to have sex with her boyfriend, he ended up masturbating and ejaculated all over her body, which she found immensely humiliating. She told me that was her “punishment” cause she couldn’t give her boyfriend “what he wanted”. Anna reveled to me she stumbled upon porn on the internet a few years ago and seeing how a guy ejaculated actually made her literally sick. So as I’ve said this part differs among patients, but in Anna’s case we worked on learning her how to GIVE me pleasure, so basically shifting the idea of a guy doing it on his own towards HER giving the pleasure to the guy. In her case she already touched a penis so she knew more or less how things worked, but there are women who need a biology course and a detailed explanation on every single part of the male genitals. To get things clear: I’ve written down this text in a few minutes but in reality these sessions can take weeks and weeks, it all depends on the client.

The next step – learning them how to masturbate – is very important to me and I dare to say it’s even more important than getting rid of vaginismus. Anna had no experience with masturbation and orgasms, and she’s not an exception. I have seen lots of statistics on this in my career, and it always surprises me how little women masturbate. So what I usually do is sit down on the bed with my back against the wall, and ask them to sit between my legs with their back on my chest. This enables me to reach towards their vulva, and/or put their hand on mine to guide them. This is also a key moment in which they need to open up and tell me what they like. A bit more to the left, a bit more to the right, harder, faster… SAYING what they want is already a big step to some. After a while I put my hand on theirs, and they become in charge. During the last step I touch their body but they need to do the work themselves. I learn them to interpret the signals their body gives them: when is their orgasm imminent, when do they need more time? We go SLOW, it’s not a race, there should be plenty of time to get sexually excited. The goal is not an orgasm, the goal is to get so excited you WANT to feel something inside of you. But how can they feel they are ready to have sex? How can they know they are wet enough? Plenty of questions women never ask themselves, but which are ultra important to women with vaginismus.

I think it’s my favorite part of the therapy, because this is such an intense experience for most of my clients and I tend to get emotional myself from time to time. When Anna had her first orgasm, we both cried afterwards while she was lying in my arms (I know men aren’t supposed to say this, but I’m not ashamed to admit this).

(I also want to add a personal note here for parents reading this. I’ve got American friends with kids and they already told me once their teenage daughter isn’t allowed to have sex “under their roof”. As far as I understand, this is something a lot of American parents say, and this causes most teenagers to have sex in the backseat of their car. Correct me if I’m wrong here, but I have the impression they go from kissing to sex in the most uncomfortable circumstances, with lots of stress and the idea they might be caught. Personally, I’m convinced you can offer your kids a “safe haven” to experiment with nudity and sex, and let them discover each others bodies STEP BY STEP. I’m convinced this can even prevent some cases of vaginismus!)

During the two or three last sessions, I usually work with the dilation set again. Not that it’s needed, but I found out that inserting them in my presence “convinces” them for one reason or another “it still works” and this makes the final step – the penetration – a lot less invasive. It’s also the one time on which everything falls in place we’ve “practiced” before. And I have to be honest here as well, in Anna’s case everything went smooth, but a lot of vaginismus patients are still in pain at this stage, which means I can penetrate them, but it still hurts them. Those things are reported back to the pelvic floor therapist and in reality, things don’t work out fine from the start in some cases.

Sometimes people ask me if I get sexually excited when working with clients, and the answer to that is: no. For me there needs to be some attraction to a female before that happens, and honestly, that has never been the case. I am usually able to get an erection and ejaculation, but under some circumstances, I need Viagra in order to have sex with clients. I also need a day or two days in between two sessions to “recover” after I ejaculated. And one other thing: I never kiss with my clients. It’s hard to explain why, but I find that to be a limit I can’t cross.

There you go, that’s what I wanted to tell you. I hope I don’t regret I’ve been too open to you guys… Remember that in almost all cases something can be done about vaginismus, but that when you decide you don’t want to get treatment, that’s a good decision too. It’s your body and there are plenty of other ways to have sex, without incorporating penetration.

I’m always prepared to answer your questions!