Doctor Says Relax

[Merida]

Hi everyone, I would like to share my story here and I would be very grateful to anyone who gave this a read and shared their thoughts.

Some background: I’m about to turn 24, I’ve been in a long-term hetero relationship for 4 years, I have never successfully achieved penetrative sex without pain, and I was diagnosed with vaginismus approximately 3 years ago. I think I have always had vaginismus, as I remember the first time I tried to put a tampon in when I was around 13 years old I failed completely and cried as I couldn’t go swimming at the water park! I can now insert tampons successfully with some discomfort but no pain, but anything bigger than that is extremely painful.

When I was diagnosed 3 years ago (age 21) my doctor was very understanding, one of the first things she said to me was “Society now is so geared towards sex, and I get that it can be so difficult when you feel like you’re the only person you can’t do that”. She started me on a course of dilators, trying to use them every day for 5-10 minutes, and gradually stepping up the sizing. I went to a few follow ups, and had some initial success, going from a size 1 to a size 2 dilator and being able to find that quite comfortable, but I was never able to make it up to the size 3 without pain, and to be honest I really struggled with avoidance of treatment. Eventually I stopped going to the follow ups, and my compliance with the treatment regime was very sporadic. I would do use the dilators for a week or two, then either I would get busy and forget or I would get my period and stop using them and then normally it would take me a couple of months to get around to trying again, so no real progress was being made. I stopped attempting penetrative sex with my boyfriend around the time I started using the dilators, and although at the start we were still doing other forms of sexual contact, to be honest that has now reduced to almost nothing too (we tried penetrative sex once last year rather hopefully after I’d had a better stint with the dilators, but it was just as painful as before and it sort of set me back). I seem to have lost a lot of my sex drive, and I just seem to always be surrounding by negative feelings about sex now. I think that’s why I’ve been avoiding the treatment so much – if I don’t try to have sex and I don’t do the treatment then I don’t have to think about vaginismus and then it doesn’t exist, right?

I realise this frame of mind isn’t the best strategy, and is particularly unfair on my boyfriend since I am currently in a long-term relationship (although he has always been incredibly understanding). I’ve got to the point now where even thinking about sex just makes me feel terrible about myself, even a mention of sex on the TV makes me tense at times. I think this is both because I feel like I’m a failure sometimes because I can’t do this basic human thing that everyone else can do as naturally as breathing, but also because I haven’t want to have much sexual contact in the past couple of years and that is really unfair on my boyfriend too.

I finally decided to go back to my doctor after watching an episode of Jane The Virgin (if you don’t watch it you should, it’s amazing), where Jane finally loses her virginity and it’s not quite what she expected. Another character says to her “you’ve not lost anything, you’ve gained a whole new exciting aspect of your life and your relationship” (I’m paraphrasing here) and really that comment just reasonated with me as I thought maybe I am missing out, you know?

So today was my appointment, getting back on the wagon. My previous doctor had retired (it’s been a couple of years since I’ve been there) so I had a new doctor today, who I didn’t realise and wasn’t mentioned to me at the time of booking, is a man. Now I know men can be doctors too! But it sort of threw me off as I feel like I would prefer someone with a vagina to treat the problem with my vagina (I realise that may be my preconceptions getting in the way but I can’t help it).

I had a few main goals to go through with my doctor today:
– Dealing with my avoidance of using the dilators and of sex in general (I was expecting perhaps to visit therapy or a counsellor?)
– Ask about kegel exercises, as I recently read that dilators alone aren’t much use without exercises too, but I have never been advised by a professional about them

I talked a lot with my new doctor, which in itself helped, and I cried a whole bunch which I was sort of expecting but really I cried A LOT. He commented part the way through that I looked very tense and he asked if that’s how I got when I tried to have sex and I said yes, I know that I should try not to be tense as that isn’t helping anything but it’s also my body expecting pain and I can’t really help it! I went through the whole story as above and my questions and he asked some questions too.

Near the end he said “so you’ve never had a sexual assault, not had negative sexual messages from home growing up, and you’ve not had any major body image disorders. It looks like you really need to just relax. Have you tried…you know…relaxing?”

I thought maybe he was going to suggest yoga or medidation or something! Have I tried relaxing?

In the end he told me to massage the inside of my vaginal wall (kind of like a back massage to get any knots out of tensed up muscles), and said that I didn’t have to bother with the dilators since I’d tried them before and they’d not really worked (even though I said that I felt like I hadn’t really tried them properly due to my avoidance issues). He also said nothing about kegel exercises.

I don’t know but it just felt like maybe he didn’t think I actually have vagnismus? I think he maybe just thinks I’m uptight? Although I have been diagnosed with vaginismus by medical exam by two separate practitioners in the past.

I’m sorry about the long post but I would really appreciate any thoughts from you, about any part of my journey but in particular where to go from here? (Don’t say switch practitioners, I live in the UK and in the NHS you don’t get to pick and choose these things a lot of the time). I feel like I want to try and do the dilators properly with kegel exercises, and just add in this vaginal wall massage he has suggested.

Thank you

[Aimee Goldman, RWHNP]

Hi Merida
I am so happy that you reached out to us on the forum. At Maze we treat women with all different degrees of Vaginismus.
From the most severe cases to mild ones.
We believe that consistent dilation is the key to success. Like you were doing-dilate 10-15 minutes a day. When you are comfortable with the smaller dilators then we suggest you move up to the next size. We also suggest that you dilate on your period too! If you ever feel overwhelmed with dilation it is important to use the smaller dilators rather than not dilating at all.
Make sure that you use enough lubricant during dilation. We love coconut oil as the lubricant. After you have been consistently dilating if you still feel stuck then we often suggest Pelvic Floor Physical Therapy. Most of the pelvic floor physical therapists do dilation along with massaging tight vaginal muscles.
Another thing, we often give our patients vaginal diazepam to further help to relax tight muscles.
I think it is great that you are seeking help. Stay strong and positive!!!

[Helen Leff, LCSW]

Thanks for sharing your struggle Merida. Aimee has given you some valuable info. Sounds like you are feeling motivated and the forum is all about support. We are here for you through the ups and downs of vaginismus treatment. Vaginismus can be successfully treated. You can do this!

[recessivegenequeen]

Hi Merida! First, I have to say, what a journey! I am frustrated on your behalf about this doctor who told you to just relax – I think most of us have been told that at one point (and obviously it’s occurred to most of us to try to relax – you wouldn’t be here if it’s that simple!)

Aimee has made some great points above, but I want to emphasize a couple as a patient who has successfully undergone vaginismus treatment and has a sense of what worked for her. Most importantly, for dilating to really work its magic, you have to do it every day. Even the period days. Even the busy days. Even the I’m-so-tired-I-just-want-to-go-straight-to-bed days. Your vagina is a muscle, and just like when you exercise other parts of your body, you need to train it regularly to keep it in shape. The same is actually true if you’re a runner or a swimmer or do any other kind of exercise. Stop working out for even a few days and you’ll start to notice your body adjusting to the lack of activity and losing its tone and stamina. The vagina is just the same – if you skip dilating for awhile, your vagina will forget what it’s learned and you’ll be back to square one on the dilation train.

The fact that you’ve said you’re able to dilate and move up a size is enormously encouraging. You mention that at the third size you always experienced pain – one thing I want to mention just because it was my experience was that it’s important to distinguish between pain and discomfort. Because when dilating is working correctly, there’s a lot of discomfort. This is because you are stretching the muscles of your vagina in ways they have never had to stretch before. I have recently taken up running and am having the same exact experience again, except with my legs. They aren’t used to moving this way and after a hard run, they’ll burn and ache uncomfortably because the muscles are tearing and rebuilding stronger. This is good pain and it means internal change is happening. Now, if you’re feeling irritation or stabbing pain, that may not be what I’m talking about and is worth discussing with a doctor, but if it’s just that tight, squirmy, this-is-unfamiliar-and-I-don’t-like-it ache, then that is the good pain telling you you’re on the right track.

Finally, I also see you’ve identified one of the huge difficulties of treatment: the spiral of self-doubt that begets failure that begets more self-doubt. This is the hard part that the doctors often can’t address, but I can tell by what you said that you have a lot of determination. If you can, you might want to see a therapist for these feelings, as they can often hold up treatment (vaginismus is, at the end of the day, a problem of the brain and body being in disagreement with each other about what’s possible). And if you decide to continue dilating at home, start small and celebrate your successes, even if progress is slow. There is a whole new exciting aspect of your life and your relationship waiting at the other end.

(Also, I love Jane the Virgin, and that moment on the show really resonated with me! As much as sex seems like the most natural thing in the world, it’s a skill we have to learn to do well and culture doesn’t do a good job of accurately portraying that. We’re not born experts in cooking either, but we can be taught to make beautiful, complicated meals!)

[Nicole Tammelleo, MA, LCSW]

Thanks for all the posts. Thanks recessivegenequeen for also making the analogy about running and tight muscles. This is so true, muscles get sore, and need to be stretched. It would be so nice if our bodies could just take care of themselves, wouldn’t it? But we need to brush our teeth, comb our hair, and yes some of us do need to stretch our vaginas, but it is worth it.

[Gatoxistem]

This is frustrating..so sad for this situation.

[Merida]

I want to thank everyone for their comments, you really helped prevent me from taking a step backwards after that horrendous doctors appointment.

I have been dilating consistently every day for the past 2.5 months. The longest I’ve ever dilated consistently before that is about 9 days (which sounds ridiculous when I actually think about it since it’s three years since I got my dilators) so this is the longest I’ve ever dilated for by a long shot.

Yesterday I also managed to move up to the size 3 dilator for the first time, which has always been way too much for me in the past. It’s uncomfortable but not painful, and feels like a real step forward.

I’m still struggling dealing with negative feelings around sex, and I think I will probably get some therapy sessions in the future to help with this. But it feels like I’m making actual progress in my vaginismus treatment for the first time.

[Helen Leff, LCSW]

So glad for your feedback. You are certainly making progress! Scheduling some therapy sessions sounds beneficial to deal with your feelings. Keep it up and know we are all here to support you.

[recessivegenequeen]

Merida, this is incredible news! I know how hard it is to stick with it, so a huge congratulations to you for your unwavering resolve. I feel so happy knowing that you’ve seen real progress in moving up a dilator size and in keeping with a schedule. Part of why it’s so hard to stick with the dilation every day is because it forces you to think about this problem that you have, when in the short term it feels easier to try and push it under the rug and forget about it, which only makes it worse when the problem comes rushing back. But facing the problem head-on like you’ve been doing is the way to fix it so that you’ll get to a point where vaginismus isn’t holding you back anymore.

Huge congratulations on this big milestone so far, and keep us updated with how it goes! We’re cheering you on all the way!

[Heather34]

Hi Merida. I am so sorry for what you went through with this new doctor and feel like he was so insensitive in saying to “just relax”. I had doctors say this to me as well when having vaginismus. I even had a surgery for an ovarian cyst and the male doctor told me at a follow-up appt. that everything was normal down there and wanted to know if I wanted to try again to have the ob/gyn exam and just relax more. Uhhhh. If only it were that easy. I commend you and think it is so, so, so awesome that you are doing very good dilating and were able to move up to #3. This is so excellent.