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TREATMENTS for Vaginismus:
Pros & Cons



2. HYMENECTOMY


Before discussing hymenectomies, it’s essential you have a clear ideas of what hymens are and how they can tear and strech painlessly.

For most women, hymens are perfectly fine the way they are and will not be the cause of vaginismus nor the obstacle to having painfree i/c or to dilate.
It is very rare for hymens to be totally closed (imperforated hymen) and that is usually detected very early on in life, cause it leads to an inability to menstruate. Estimates of an imperforated hymen frequency vary from 1 case per 1000 population to 1 case per 10,000 population.

"Imperforate hymen is a rare vaginal anomaly in which a layer of epithelialized connective tissue that forms the hymen has no opening and completely obstructs the vaginal introitus. Familial occurrences of imperforate hymen have been reported, although most cases are isolated events" (From "Imperforate Hymen: Congenital or Acquired From Sexual Abuse?" , by Ann Botash et al.)

So if you menstruate or have managed to insert a tampon or finger or anything in your vagina at least once, it is very unlikely that your hymen will need to be surgically opened, as you clearly have some kind of space there, so it may just need a bit of stretching instead, rather than an operation.

We found in our experience that gynecologists seem too eager to cut every hymen that's even a little bit problematic and they may not tell you that by no means is the surgery an instant cure for vaginismus.

There are a lot of misunderstandings about hymens and these can have caused you a lot of anxiety and lead you to require or accept a hymenectomy without careful considerations.

For instance, you may be terrified of tearing the hymen yourself, you may fear that it could be so painful that you would not be able to stand it. So with the hymen gone, you may think you’ll be able to insert dilators and a penis without that extra fear. But remember that even with the hymen out of the way, you will still have the PC muscle to contend with. Unlike the hymen, these muscles are located inside the vagina, about an inch or two around the vaginal entrance. They can still clamp in anticipation of pain so you will still need to gently retrain them in most cases, by gradual dilating,.

So, before deciding whether or not to go through with a hymenectomy, just make sure you don’t have the wrong expectations. We suggest you get to check the section on the Vulvar Anatomy too, that's very important to get comfortable with the whole area, so you will get to know your hymen well first and then see if it can really just need a little help from you.

Clues that you may really benefit from a hymenectomy to solve vaginismus


Remember: in MOST cases, a hymenectomy does not really seem necessary and we heard from many women with vag. who after that operation still had problems inserting dilators or having sex. As we explained, that's because the muscles could still clamp. However:

*If you have no fear or anxiety regarding sex and penetration and you feel as relaxed as can be during foreplay, yet you or your partner can’t get past the hymen, maybe your hymen may indeed be more to blame than your muscles, so a hymenectomy could be a good idea.

**If you are an athlete, you may have a hymen ‘band’ , basically you will have a regular small hole in your hymen, but the rest of the hymeneal skin around it may have become inelastic and quite rigid and you may find it impossible to insert a tampon.

**If you or your gynaecologist could not insert a q-tip, during her/his attempts at examination, or if that hurt a lot, and if they diagnosed you with “introitus-stenosis”, then you may benefit from this operation.

***But the best deciding factor is probably the level of pain you feel. If your hymen is really tender, thick and painful when you try to insert the smallest dilator or finger in it, or when you try stretching it, then it wouldn't be so good to put yourself through a lot of agony.

So you may first give yourself some time to think about it and in the meantime you could try and see if your hymen will slowly pull apart with some gentle stretching..

If you still believe that the surgery would be helpful to you, and if you are aware of the expectations you may have about it, then go for it by all means but remember that it’s not an immediate treatment for vaginismus.

Also, since any surgery with anaesthesia is not to be taken lightly, we advise you to first get a second opinion.

The surgery:


There are basically two procedures done to correct problematic hymens.

1. Hymenectomy
2. Hymenotomy

1. A hymenectomy removes the whole hymen. Hymenectomies are usually carried out under general anaesthetics in a hospital. A hymenectomy is usually an outpatient procedure, meaning that you will be in and out of the hospital on the same day. The objective of a hymenotomy procedure is to open the hymenal membrane in such a way as to leave a normally vaginal orifice that does not scar.

2. A hymenotomy means cutting a few snips of the hymen. A hymenotomy is carried out under local anaesthesia and it is an office procedure. A hymenotomy can take as little as 5 minutes in your gynecologist’s office. The objective of a hymenotomy is to expand the opening of an incompletely ruptured hymen.

Except for the rare cases of complete obstruction of the hymen (imperforate hymen), most women will probably just need a hymenetomy, which is a simpler operation. Yet many women with vaginismus will end up having a hymenectomies under general anaesthesia instead for the following reasons:

- The local anaesthesia required for the hymenotomy is an injection…down there. You may not be comfortable with the idea of being injected anywhere your vagina or you may startle and move as the doctor injects you and you feel pain (like at a dentist’s) so there is a slight risk that you may get hurt

- After the anaesthesia you won’t feel a thing, but my doctor for instance believed that the view of a doctor cutting you in that area could have caused me to tense up, move, retract, startle etc. and this may be dangerous for you and risky for doctors too, so we had thankfully decided against it.

Hymenectomy: Pros


# For those rare women who have an “imperforate hymen”, then the surgery under general anaesthetics is the best solution.

#For those women who don’t have an imperforate hymen, hymenectomy (or an internal examination under general anaesthetic) will rule out any physical causes for your vaginismus and this can encourage you to then dilate as you'll know that something has been in there and that it’s definitely possible to do it.

#After a hymenectomy (sometimes a couple of weeks afterwards) you may be able to finally insert a tampon and medicine applicators successfully.

#After the surgery you may be able to undergo a painfree internal exam with your gyno or with relatively little pain.

#If you don’t have vaginismus (no muscle clamping in anticipation of penetration, no fear of penetration, no psychological issues re. sex etc..), then a hymenectomy may remove the only problem that was causing you painful penetration and you may then be able to have intercourse easily.

Hymenectomy: Cons

*You may be sore for a about a week and experience mild cramping, burning during urination for a few days following the procedure, spot bleeding, tenderness in the area.

* You may need stiches after a hymenectomy.

*The local injection in your vagina, for the hymenotomy, will be painful, though briefly.

* Your vaginismus will not be fixed by the surgery, you will still have to work with dilators. Your PS muscles can be just as tight as before and tensing up in anticipation to pain.

* You may still not be able to insert even the smallest dilator afterwards for several months.

* As with any surgery, there may be risks associated with general anaesthesia and scars.

Post-operative issues:

You may have some pain upon waking up, and you may be given painkillers.

You may need someone to drive you home after the operation cause you may feel too sore to sit.

You may experience soreness for a couple of days and you may be given some medicines ( estrogen or anesthetic creams for instance) to apply, to ease the pain or the formation of scar tissue.

You will have to abstain from sexual intercourse for a few weeks.

You will usually have a follow-up with your doctor about a couple of weeks or lessafterwards.


SOURCES OF MEDICAL INFORMATION:

For more information on imperforate hymens, you can read this scientific article on imperforate hymen online at: www.emedicine.com (WARNING: some graphic pictures at the end)

To see a video of a 5 minute hymenetomy operation, check store.brooksidepress.org
(WARNING: it's graphic and they charge a fee)


1. BOTOX 2. HYMENECTOMY 3. HYPNOSIS
4. PHYSICAL THERAPY 5. GRADUAL DESENSITIZATION
a.k.a. DILATING
6. PRIVATE CLINICS

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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 vaginismus-awareness-network.org carefully and confer with a health care professional specialized in vaginismus, as needed.