Vaginismus and the politics of penetration
Vaginismus is a diagnosis usually given to heterosexual women whose vaginas go into an involuntary spasm causing the vagina to close so tightly that intercourse becomes impossible or extremely painful. It is easily reversible depending on the treatment sought and the willingness of the woman to engage with a supportive psychosexual therapist into an exploration of her feelings about intercourse. A diagnosis is not always helpful as it medicalises what is often an emotional issue. When I work with a woman with this problem, I start from a stance of curiosity. Why do you want to have sexual intercourse? This question alone often startles and liberates them because they have been hitherto operating from a stance of 'I should want this', 'everyone else enjoys this', 'I am failing at something', 'I am letting myself, my partner and my parents down'; 'it is shameful and my vagina is inadequate and flawed'.
Some doctors and therapists will go to straight to vaginal trainers as the first line of treatment. They are also called dilators but this is misleading as we are not trying to ‘dilate’ anything. The vagina is fit for purpose and is normally flexible and accommodating when aroused. The use of trainers is an invasive graded exposure treatment program involving the use of dildo shaped insertable devises ranging from a little finger size to that of a large erect penis. Now this works well for some women especially with ongoing support but, and it is a big but unless they are motivated, understand why they are using them, know that it is their choice to use them then I suggest it can worsen their feelings about themselves and cause unnecessary trauma.
Sometimes vaginismus is serving a woman well. She might be in an abusive relationship and avoiding intercourse is her last stand, the last frontier over which she has control. She may have a fear of pregnancy and not trust her contraception. She may have experienced pain in the past due to infection, or other physiological problems and it is the anticipation of pain that causes the spasm. She might be anxious that if she ‘gives in’ to intercourse her partner is going to be insatiable or even that if she enjoys it she herself may become insatiable sex mad and unsafe in the world. A diagnosis like that of asthma, for example, saves explanation or elaboration. We don’t insist that someone with asthma who is allergic to cats spends time in our multiple cat household. For some women, stating a diagnosis can halt further enquiry or pressure from partners.
Looking at ‘the politics of penetration’ is a positive way to explore the topic. It makes no assumptions about how a woman should feel and places no expectations on her as to what she wants or hopes for. The use of the word penetration is an interesting one too. We talk about penetrative wounds but we don’t penetrate a building when we enter it. Food doesn’t penetrate our mouths. I suggest the word itself can be intimidating.
There are self-help books available on this subject but nothing can replace the support of a qualified therapist who can guide the client through the an exploration of their understanding of sexual intercourse and its significance for them as an individual, who can be open to listening to client fears without judgment and explore the multi-relational, physiological and biological factors involved in vaginal sexual intercourse and help transform the ‘should's’ into choice-driven ‘could's’.
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