When Everybody Isn't Doing It
How three women have coped with painful intercourse
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However, for Jill, a 20-year-old woman living with vaginismus, neither physical nor emotional therapy provided much help. She speculates that the origins of her condition come from her first sexual experience when she was a teenager, which she describes was “like having sex with a butcher knife.”
With a case so severe that even attempting to insert a cotton swab is painful, Jill’s physical therapy consisted mostly of external work, massaging muscles and ligaments. Eventually the physical therapist wanted to start working with the skin in the labia region and start inserting things. Jill says that she knew it wasn’t going to happen, so she stopped.
“It was just too painful,” Jill says. “I think that much of this is about muscle memories. So I’m not sure what the point is in paying someone to create make more bad memories to further impress the problem. If I pinch you 800 times will it stop hurting? Probably not.”
She says she doesn’t resent the fact that intercourse is considered the natural progression of a romantic relationship. “I resent that I can’t do it. Of course that’ll be the defining factor, if not nature has a problem. Because it can’t get anybody to reproduce if we’re all just giving each other blow jobs.”
Jill is curious about Botox. A 2004 paper in Obstetrics and Gynecology outlined a study, where a group of Iranian doctors injected the Botulinum toxin into 24 women on three areas on each side of their vaginas. Upon being examined one week later, all but one showed “little or no vaginismus.” Eighteen reported achieving “satisfactory intercourse” after the first injection.
The only thing keeping Jill from trying Botox is the fact that insurance companies consider the neuro-toxin’s use cosmetic and generally do not cover the cost. “I’m kind of at the point where the situation is very simple for me: It hurts, it sucks, fix it. I don’t wanna go through the counseling and talking about it and retraining my vagina. I don’t want to do any of that. If there’s a shot or a pill that’ll fix it, bring it on. I’m all about expediency.”
Medical experts are split on the use of a chemical like Botox. “It’s one possible helpful tool,” Dugan says cautiously. Although she has been trained to use the Botulinum toxin on patients after stroke and brain injury, she doesn’t inject Botox for her patients with vaginismus. However, at times she has used Lidocaine, a local anesthetic. The patient sees the therapist immediately afterward for manual therapy to see if they can get that persistently tense muscle to loosen. The injections are meant to help create new muscle memories over time. Dugan is conservative about the use of Botox for vaginismus because paralyzing muscles could potentially make the patient incontinent.
Sex therapist Dr. Shirley Baron sees both sides of the issue. “I think it’s important not to over medicalize it. I don’t think that the answer’s going to be a quick fix, a pill. I think that the answer is and is going to continue to be an integrated approach. If there is going to be more help on the medical side, that’s just part of the answer. We also need to address what’s going on psychologically, what’s going on in the relationship, rather than putting on a Band-Aid.”
The problem with mining for better statistics by doing a comprehensive study is that the elusive nature of a condition like vaginismus makes it that much more difficult to do a study on it. “How do you write your inclusion criteria?” asks Dr. Dugan “And if you don’t read every study and say, well this study included women with these characteristics but this study included women with these characteristics, suddenly you get a huge range in the literature of how common is it because it depends on how the author decided to define it because it’s a prescriptive diagnosis, not an objective diagnosis.”
