When Everybody Isn't Doing It
How three women have coped with painful intercourse
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There are two types of vaginismus – primary and secondary. Primary refers to women who have never experienced penetration without pain. Secondary refers to women who have experienced pain-free penetration but develop vaginismus – usually due to childbirth or a hysterectomy. From this categorization some women experience ‘total’ vaginismus, meaning that they cannot accept penetration from the smallest items or ‘partial’ vaginismus.
Although there are many variations on the definition, vaginismus is generally thought to develop as a hyper-defensive measure to protect the vagina from pain—perceived or real—similar the way an eye blinks. Tension in the pubococcygeus (PC) muscles, the same muscle group that surrounds the vagina and controls the flow of urine, blocks the entry of the penis. The disorder can also be referred to as a hyper-tonic or non-relaxing pelvic floor.
What sets off the protective measure may be different for every woman, but the majority of theories relating to the causes of vaginismus are emotionally based. The Diagnostic Manual of Mental Disorders links the condition to victims of rape and sexual abuse, strict religious upbringings and women with control issues. Another generally accepted theory is that women whose first attempts at penetration were very painful have retained that muscle memory.
A review of the research reveals a wide range of speculation, including a stern or sadistic father, an overbearing mother, a history of difficulty expressing needs, unresolved feelings of vulnerability or dependence, childhood feeding difficulties and extreme passive aggressiveness. However, these are just theories; none of them have proven to be definitely true. And if you ask most women what the root of their condition is, they do not always know.
A group of Swedish researchers have speculated that there are combinations of predisposing, precipitating and maintaining factors—all of which potentially contribute to a woman’s ability to resolve her vaginismus problem. This theory could very well explain why, in two women with similar backgrounds, one develops vaginismus and the other does not.
The idea that muscle tension alone could be the sole cause of vaginismus is a less popular theory, but some medical experts do subscribe to it. “I think that there certainly are women whose anatomy and physiology is such that her muscles are tighter or more reactive,” says Dr. Shirley Baron, a Chicago-based sex therapist. “I don’t think that it’s necessarily caused by some deep emotional problem or psychological trauma by sexual abuse. I think what basically causes it is some pain experience, even trying to put in tampons. It’s a protective physical response for the muscle to clamp down, and once that occurs it’s even more painful, it’s a conditioning cycle.”
She points out that women with vaginismus also are more likely to have other disorders generated by muscular tension.
Dr. Sheila Dugan, co-director of the Rush University Medical Center’s Program for Abdominal and Pelvic Health, says that the reason for the ambiguity in diagnosing vaginismus is that the term is descriptive rather than anatomical. “I think that any term that is a descriptive term is going to be fraught with this broad array of ‘who gets put into that basket.’ So if vaginismus means ‘muscle contraction or lack of relaxation,’ there is probably more than one thing that can cause that.”
For her part, Elise believes that her condition is the result of extreme muscular tension, which she says has always been problematic for her. “I’ve always been tremendously high-strung and it’s always manifest itself in muscular tension,” she explains. She says the education she received about sex was “not puritanical at all.” She recalls with amusement how, when she was three years old, her older brother prodded her to ask their parents where babies come from: “So I asked them. And they told me. They never tried to hide information from me. Sometimes they felt awkward talking to me, so they got me books. But from an early age, I knew what intercourse was, and I never had a problem with that.”
