What happens during therapy?

[sarah232]

Can one of you guys tell me something more about the therapy itself?

I know you have to work with dilator sets at home, but what happens when you’re with the therapist? I’ve heard so many different stories about this. Do you have to get naked? Will you be touched down there? Will the therapist insert fingers, objects or instruments? Do YOU have to touch yourself? Are there relaxation exercises involved? Do you have to sit or lie down on a table? Will there be another person inside the same room? Like an assistant or so? Are there male therapists?

I think having an answer to these questions would take away part of the uncertainties I have right now (I know I have vaginismus but I didn’t contact a therapist yet).

[recessivegenequeen]

Hi sarah232! Thanks for your question, it can definitely be confusing if you don’t actually know what will happen at a therapist’s office.

Speaking specifically to what happens at the Maze Clinic (which I think is similar to lots of other treatment protocols), when you meet with a therapist at first it won’t involve getting naked or being touched – it’s more about the therapist learning about your history with sex and your body and understanding better what your priorities are and what kinds of help you’ll need. A good therapist will NEVER push you into something that could violate your comfort without a lot of warning and discussion first.

At Maze, once you speak with a therapist, you will usually meet with one of the clinicians who will do things like try to examine you to assess the extent of your vaginismus and what kind of treatment options might work best for you, but they will be sure to communicate what they’re doing in advance.

If you’re working with some kind of sex therapist locally where you live, it will likely go much the same way – the therapist will get to know you and then start helping you work with dilators or some other treatment method, but they should never push you into something too quickly. You can also call therapists and ask them what their process is before meeting with them so you’ll feel more at ease. I highly recommend doing this!

[hellenmia]

That’s kind of an evasive answer, no? 🙂 Of course you will be asked if it is okay the therapist will touch you, but he/she WILL have to insert dilators, fingers or instruments to help you out. Part of therapy is talking and giving instructions and training, the other part is purely medical and involves being nude and touched.

[recessivegenequeen]

I don’t agree 🙂 Treatment protocols for vaginal pain are highly individual – some clinicians may help you insert the dilator directly but other patients may not feel comfortable with that and will do it themselves with guidance and supervision, for example. The important point here is that what specifically happens will depend on the severity of your vaginismus and will be something that you and your therapist/clinical team come up with together.

[rabbit]

I think I had 2 or 3 sessions with my therapist during which she only asked questions and gave me some basic relaxation exercises I could do at home. From the 4th session on I had to get nude and fingers/dilators/instruments were inserted either for me or by me. All WITH consent, and step by step. You don’t have to worry, (most?) therapists will respect your limits. But I honestly can’t see how you can get rid of vaginismus without this part. If only talking was involved, therapy could be given by a sexologist or psychologist as well.

[recessivegenequeen]

Yes definitely, I haven’t heard from anyone who hasn’t done some form of dilation, whether it’s after botox, with a physical therapist, or whatever else. But it definitely wouldn’t make sense to push this in a way that was distressing to the patient since vaginismus is so much a byproduct of a disconnect between the body and the brain – that would just compound the negative emotions that keep vaginismus so rooted!

[Jennifer Dembo, LMSW]

Hello Sarah 233 – thanks for your great question! I think the dialogue between you and recessivegenequeen is very important, and it illustrates just how unique every woman’s experience with vaginismus, their treatment and their approach to it is.

The most important thing we know about vaginismus diagnosis and treatment is that it MUST be customized for each and every woman. Someone might require more physical support with dilation, others need additional psycho/emotional guidance. And there is a wide spectrum all along the way.

Also, after re-reading your initial question – I’m curious as to whether you’re taking about a behavioral therapist or a pelvic floor physical therapist? The former – unless otherwise qualified to provide medical care – will not ever examine nor treat your physical body. A PFPT, on the other hand, often does internal work (with consent only, of course) as part of treatment.

Either way – all of this must be tailored to each patient, and everyone on the team should ideally be working in concert in order to provide collective support and effective treatment modalities that compliment one another. If for any reason you’re not getting what you need, please speak up and tell your providers! Most of us aren’t taught to self-advocate in a medical setting, but we MUST in order to secure the highest standard and most respectful of care.