Gynaecologists and Vaginismus

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Hurtful things gynaecologists did and said...

S/He didn't mention the word vaginismus

Yes, surprise, surprise, complaint number one is simply that of not having been diagnosed with vaginismus. In a poll in one of the biggest yahoo support-groups for vaginismus, only 28% of 358 respondents said they found out about vaginismus through a doctor. Most women still seem to find out about this condition while surfing on the Internet about their symptoms. It's easy to imagine that for the millions of women without Internet access, realizing that they are not alone with this condition in the world, will be pretty much impossible, causing all sorts of strains.

Women deserve to have doctors and people around them able to inform them about their symptoms, and to have a non-judgemental atmosphere where they could talk openly about the symptoms. There seems to be a concering ignorance of this condition especially among older and male gynaecologists, probably due to the fact that vaginismus was never treated in-depth in gynecology textbooks and University medical curricula and that other vulvar conditions related to vaginismus, such as vulvodynia and vulvar vestibulitis in particular, have only been recently recognized scientifically and still do not appear in most textbooks.

As an example, in my text-analysis of a dozen gynaecological schooltexts published after the year 2000, and found in the library of the University of Melbourne, Faculty of Medicine, (with a reputation and ranking of being the best of Australia and one of the best in the world), I found that only 2 texts! included the terms vulvodynia and V. Vestibulitis, and even if the term Vaginismus instead was present in all the textbooks, often no more than a few short lines or paragraphs were dedicated to it. These textbooks need to be improved for sure.
This data certainly shows a need for women to INFORM their doctors Some doctors seem under the false impression that vaginismus is simply an emotional problem that will go away on its own or with a gentle partner or they seem to think that a single girl may not need to solve it until she's in some relationship with a man, so they may not diagnose a single or young woman in order not to scare her unnecessarily since they assume with the right partner or some experience, all things will settle.

These mistaken gynaecologists cause women without a partner, or without a gentle partner, or women who may simply need to insert a tampons and may not even be interested in pursuing a sexual relationship, to be left completely in the dark about what they have and how they could deal with it.

How can the problem be addressed?

• by diagnosing clearly the patient and explaining vaginismus to them
• by dedicating more space on vulvar problems and sexual pain disorders in University textbooks
• by preparing free pamphlets that doctors can give their patients to read at home
• by referring these patients to support groups or websites or any kind of information which is deemed useful
• by showing patients that vaginismus is something physical, but treatable and that they are not alone

He/She hurt me during the exam

Unfortunately still too many professionals do not seem to recognize the pain of a vaginismic woman during a pap-test examination and will insist that she’ll just have to relax or put up with it and ‘be a woman’, instead of stopping immediately and reassure her about her condition and not causing her any extra pain.

It is unacceptable that so many women everyday are traumatized this way because of sheer ignorance or insensitivity on the doctor’s side.

The pain a woman with vaginismus can feel during an internal exam is excruciating and certainly very upsetting. It would be like forcing sex to a young girl with a closed hymen. Yet doctors seem under the impression that women should put up with it or that they are exaggerating.

A recent Melbourne pilot-study done on women who had been sexually abused, reveals that gyn. exams are extremely traumatizing for some and since few women disclose their past abuse or trauma to doctors, (unless they are asked and feel safe revealing), then it is of paramount importance for doctors to be as gentle as possible and to stop as soon as a lot of distress and avoidance is noticed.

How can the problem be addressed ?

Whenever pain is experienced, the exam should be stopped.
Most of all, a woman's complaint that she's in pain have to be taken seriously!
Some may say that health concerns, such as finding out if the person may have cervical cancer etc, are worth the woman putting up with some pain, but since vaginismus is treatable and often in less than a year's time, and since cervical cancers grow very slowly, it does not seem necessary to put women with vaginismus through a lot of pain when instead they could be first helped to treat vaginismus and then helped to train with a speculum until they are comfortable trying a Pap test.

Just relax/Have a glass of wine at home tonight/Just keep practicing sex/Just use more lube

These are unfortunately very common advice which many gynecologists are reported to give women with vaginismus.
You can just join any support group or our forum to read some of this advice being given and the effect it has..
Giving this kind of advice to a woman complaining of painful first time intercourse or of pain and tension during an internal exam, is not only patronizing, but can be extremely harmful since it completely fails to acknowledge:

1. the real pain caused by vaginismus or vulvar disorders, and by the muscles clamping, which won't go away just by relaxing or drinking
2. the presence of any severe anxiety, panic attacks, phobias at having anything inserted
3. a past trauma or sexual abuse
4. an abusive or ignorant partner, who may be lacking important skills or feelings when attempting intercourse
5. that the mixture of alcohol and sex for women is associated with unwanted pregnancies, date rape, decreased use of birth control and higher risks of contracting an STI.
6. that relaxing is not something you just DO, one needs the right environment and some helpful techniques too

How can the problem be addressed ?

Women's specific problems CAUSING the inability to relax should be acknowledged clearly, in a non-blaming way, so that women can feel validated for feeling as tense as they do.

Women with vaginismus or previous abuse and other sexual or vulvar problems should be offered specific advice on how they could best relax, instead of being told to just relax.
There could be a brochure available for women to learn relaxation techniques.

Without examining me, He/She suggested the use oftranquilizers, a hymenectomy or numbing creams

We noticed that some doctors are a bit too eager to fix the most apparent problems without caring much for the root causing them.

Shutting women up, in this case by shutting up their vaginas, is a very easy and commonly used technique. In some cases it can be helpful to be given some drugs or have an operation (see more on hymenectomies), but in some cases they are overrated and offered as the first option without even discussing where vaginismus could stem from and what would be the best course of action for not only focusing on the vagina but on the whole woman.

Women feel that sometimes they are just sent off back into their world (with unloving partner, or with past sexual abuse, or with lack of knowledge about their vaginas) and given suggestions which will make their vaginas open fast, by cutting a hole in her or numbing her, but that they have not at all been considered as human beings with something to say and to explore.

How can the problem be addressed ?

Before suggesting women such remedies, it'd be worth to first take a full sexual history and talk to them about their vaginismus and to then show them the pros and cons for each treatment, and give them time to consider those options.

His attitude/words/gestures made the whole experience traumatic

It would be quite interesting to find out how often women with vaginismus leave the gynecologists’ office having self-harming thoughts, feeling suicidal, acting recklessly or having a break-down. From the women we talked to, it's not so few unfortunately..

Internal exams can be a VERY emotional moment for a woman with vaginismus:
she is in a very vulnerable position, she is often afraid of anything entering her vagina, she may have issues releasing control (understandably!), she’ll often be a virgin even if married, she may have had some form of sexual abuse, she will anticipate pain and yet there she is, half-naked, about to have an invasive procedure, usually by a man, and often there is anxiety and also some pain associated with it.

If the doctor isn’t sensitive enough or the woman doesn’t feel safe or understood, it can certainly be a VERY disempowering experience.

A pilot study in Melbourne, Australia, showed that most women who have been sexually abused then find internal exams to be quite traumatizing.

How can the problem be addressed ?

It is not necessary to put women through such emotional heartache and pain again, so any gynaecologist really caring for his/her patients may want to read our guide to smooth gynecological exams, which lists many tips and also W.H.O. recommendations which can make women exams much more comfortable and not traumatizing for the sexually abused.

He/she said they felt sorry for my partner or made some jokes on me

Some gynaecologists and gynecology textbooks have been reported to have chauvinist attitudes where the doctor shows more concern for the male partner of a woman with a sexual problem and takes his side, rather than the woman's.<

It's important to stress that vaginismus can be a couple's problem but it's the woman who will bear the greatest burden.
Men do NOT need sex and do NOT suffer physically and emotionally because of their wives' vaginismus, and if they do, it's NOT because of vaginismus in itself but because of their conditioned views on sex as essential to happiness or sex as the wife's duty etc. Those views cause the suffering but their bodies won't hurt nor are they the ones who will have to go through the dilating process, or who will risk sexual abuse or being divorced because of it etc...

Even if it was a woman's partner who went to a doctor for advice on the woman's vaginismus, it would still be ethically very questionable to offer your sympathy to them as if they were the poor victims here.

The ones who do suffer because they lack intercourse will need to be reminded of outercourse, of love and respect for their partner, of how overrated sex is, how intercourse is not necessary for good health, how pleasure should always come second when someone pays with pain to provide you with it, etc.

So, showing sympathy to a woman's partner and taking his side, in front of her, is like telling the woman that she is indeed a bad wife/lover/partner/woman and that her vaginismus is making her partner's life more miserable, therefore shifting the focus on him when it should be on her.

Women already blame themselves enough for not being able to sexually fulfil their partner’s desire, if anything they should be helped not to feel guilty for having something that they did not choose to have nor did they have much chance of preventing.

Some gynecologists even go as far as saying that the male partner has been ‘too patient’ or ‘too delicate’ and they irresponsibly suggest partners to be a bit more aggressive instead.
Such advice can only lead to men believing that vaginismus was indeed all in the partner’s head, since even the doctor is taking their side, and will easily convince themselves that an extra push/thrust won’t harm anyone…

How can the problem be addressed ?

Maybe we all really need to remind ourselves and these doctors too, that in developing countries, where rates of sexual abuse between spouses are extremely high and women don’t have many options, such careless advice and showing apprehension for the male partner falls short of a justification for marital rape…

Comment on this Article in the Forum, Add your experience with your gyno.

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DISCLAIMER: This site is not designed to provide medical advice. All material is gathered from the experience of hundreds of women who experienced vaginismus but it is for information only and is not intended to be a substitute for professional or medical advice, diagnosis, and treatment. Please review the information contained on carefully and confer with a health care professional specialized in vaginismus, as needed.