Its not “all in your head”

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    mmHeather34
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    Hi ladies. I read an interesting article concerning the differing views of vaginismus from surgeons, gynecologists, and psychiatrists.

    http://www.thedailybeast.com/articles/2010/03/27/the-female-sex-pain-mystery.html

    Excerpts from the article include:

    “Pain during sex affects millions of women, and the medical community’s explanations for why it happens seem nearly as numerous. Gynecologists have treated sufferers with everything from vaginal insertions to Botox. Surgeons want to solve the problem with a scalpel. Psychologists prescribe anti-anxiety meds for it. Despite centuries of study, it’s an area that remains in dispute.Stacie, a stay-at-home mom in Nova Scotia, Canada, struggled with sex-related pain for years. She says that she’s seen a shrink who convinced her that her problem was simply a symptom of anxiety. “Doctors automatically think it’s stress,” says Stacie. “They say, ‘You’re too stressed out, just relax.’ I’ve seen a psychiatrist and all he really wanted to do was to prescribe pills.” She’s tried a handful of different antidepressants to no avail and is skeptical of the idea that she has a psychiatric condition. “I have no doubt that there’s something physically wrong with me,” she insists. “I know it’s not in my head.” Binik doesn’t think the idea that pain during sex might have psychological roots should serve as license for providers to write it off. “I don’t have much sympathy for doctors who say, ‘It’s all in your head.’ If it’s used in a dismissive sense, that the pain doesn’t really exist, that’s very unfortunate.” But he still believes that some type of pain/penetration disorder is worthy of inclusion in the DSM, an assessment bolstered by the fact that cognitive-behavioral pain management, a form of psychotherapy that focuses on relaxation and mental control techniques, has been shown to reduce pain during sex significantly. But since talk therapy doesn’t work for every sufferer, a range of other treatments of varying effectiveness have been tried. One of the most controversial is Botox. In a 2004 study by Shirin Ghazizadeh at the University of Tehran, 18 of 24 vaginismus sufferers were able to have relatively pain-free intercourse after a single series of Botox injections to the pelvic region.”

    I think this is an interesting article for so many reasons. First, I never knew that vaginismus dates back to 1880 (Sims article). Second, it is interesting how the doctors and clinicians treating this condition have such a different opinion as to what they believe works and what doesn’t work. I have read so many of your stories and testimonials and have experienced myself both a doctor and clinician saying “why don’t you just relax” and “it’s all in your head” when I described my physical symptoms of vaginismus (i.e. every time I went to insert anything, the feeling like I was hitting a wall). I appreciated what Binik wrote “I don’t have much sympathy for doctors who say ‘it’s all in your head if used in a dismissive sense, that the pain doesn’t really exist, that’s very unfortunate.” I believe that vaginismus does have a significant physical component that should be recognized and acknowledged. In the final sentence, the 2010 article discusses Botox as being a controversial treatment yet goes on to note it’s effectiveness.

    In a prior post, the husband of one of Dr. Pacik’s treated patients who is a psychiatric nurse, discusses both the psychological and physical aspects of the condition and their post-procedure success:

    “A very long story short: we went for treatment, and I saw everything. It is amazing how someone can display muscular spasms and attempt to avoid treatment even under anaesthetic. This underlines the “involuntary” nature of this debilitating condition. Rachel did not feel a thing; she was not aware of anything whatsoever. Yet, she was attempting to resist treatment during the procedure. This is not a problem that is attributable to mere psychological constructs or defense mechanisms. There are psychological components to vaginismus, most definitely. However, this is an essentially physiological condition which is reinforced by the following: lack of education, distorted perceptions and beliefs, rumination, catastrophising. The initial memory and pain of intercourse triggers and maintains these psychological constructs, which simply reinforce the problem. So there is a cognitive element to this condition. However, the root of the problem is not psychological. Rachel had the treatment. She dilated in no time at all. She had inserted the dilators without problem. I had even inserted the dilators without problem – into Rachel that is!!! Where was the impossibility now? Rachel thought that she was too small. Rachel thought that nothing could “get in there”. Now, she had the biggest dilator inside her. The problem is no longer a problem, and Rachel was walking around Portland like a duck with the evidence inside her vagina. So, when the psychological conflicts arose, there was no evidence to substantiate or validate their claims. Rachel and I knew it. We went home, back to Canada. We followed the golden rule of “tip only intercourse”. No problems. Why? The botox has temporarily paralysed Rachel’s vaginal muscles so that she cannot spasm. This has given Rachel time to get over the so-called physical impossibilities and her unsupported psychological constructs. Rachel now knows that she is not too small; she now knows that she does not need a hymenectomy; she now knows that she has a normal vagina; she now knows that she can insert a dilator that is the size of an erect penis. The “arguments” in her head have been levelled to the ground. We have now even had full intercourse.”

    In the past, I, too, was told to “just relax” and “it’s all in your head”. Despite hearing this, I persevered and had Dr. Pacik’s Botox treatment program and was able to have pain-free intercourse within 7 days. Has anyone else been told by a doctor or clinician to “just relax” or “it’s all in your head”? What is your advice to other women currently suffering with vaginismus who have also been told this???

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