Vaginism and dyspareunia are sexual dysfunctions where pain is the main element. The scarce sexual education and the lack of knowledge about the body seriously hinder the detection and expression of both problems.
The result is a continuous warning that distances the affected person from intimate relationships, which translates into silent suffering. This week, Yolanda Segovia, a psychologist who collaborates with the Instituto de Asistencia Psicológica Mensalus , talks to us about these two dysfunctions and opens a reflection on the importance of their treatment.
What is the difference between Vaginism and Dyspareunia?
Vaginismus is the inability to achieve vaginal penetration due to the contraction of the muscles surrounding the entrance of the vagina. When a woman becomes sexually aroused, she experiences a relaxation of the vaginal muscles. However, in Vaginism, the muscle contraction is such that it prevents penetration.
Dyspareunia, on the other hand, is the pain that both men and women can suffer in the pelvic area during or shortly after sexual intercourse. The pain occurs at the time of penetration, erection, or ejaculation.
Focusing on the female sex, the pain factor is central to both problems. Still, the difference is important. In the case of women with Vaginism, the reflex response of the muscles makes penetrative sex impossible (or extremely difficult). In the case of women with Dyspareunia, pain seriously hinders pleasure during penetration but does not prevent intercourse.
In the case of Vaginism, what aspects prevent the relaxation of the muscles?
Women with Vaginism relate penetration to the feeling of danger . This creates a fully automatic tension response that materializes in the vaginal musculature. This reaction generates a high level of discomfort because there is a desire to have a sexual relationship with penetration, but the physical reality is very different. A contradiction between mind-body appears, which is inexplicable for the person.
The result is an overwhelming sense of lack of control and an explosive increase in anxiety. Among the factors that can cause Vaginism are beliefs and values of a sexual nature that create confusion, insecurity and inevitably generate a maladaptive response. On the other hand, this dysfunction usually has an onset in the past.
Some women report difficulties during the first stage of menstruation when they want to introduce a tampon, irrational ideas about penetration or the possibility of becoming pregnant, and even distorted ideas about the perception of their own genitals.
And in the case of Dyspareunia, why does it appear?
Among the aspects that can influence the appearance of pain are insufficient lubrication due to lack of erotic stimulation, vaginal dryness, premature sexual relations after surgery or childbirth, genital irritation from soaps, allergies to latex from diaphragms or condoms, and those aspects specifically of a medical nature (phimosis, frenulum, prostatitis, hemorrhoids, genital herpes, etc.).
We want to emphasize that, in the case of this dysfunction, the pain must be constant and repeated during sexual relations ; occasional pain does not mean that there is a problem. Be that as it may, there is no doubt that discomfort greatly affects sexuality and can lead to avoidance of relations.
For this reason, in case of doubt, it is advisable to consult a professional.
Do people who suffer from Vaginism or Dyspareunia talk about their problem?
Most don’t, they make it a taboo subject. In the case of women with Vaginism, educational work is especially important. The lack of awareness about one’s own body (usually there is no exploration) and social censorship, make it even more difficult to express and normalize aspects of a sexual nature .
This reality distances the affected person from different contexts (friends, colleagues, family, etc.) for fear of being misunderstood and branded as “weird”. Fear increases day by day and alertness becomes an intrinsic element of the personality.
From Psychotherapy, what work is done in both cases?
In addition to the psycho-educational work and the detection of negative and destructive thoughts that is carried out from an individual therapy context, the work carried out from the couple’s therapy is important. To solve the problem it is essential to establish open communication in order to express the discomfort and find mutual understanding.
Likewise, the therapeutic work that facilitates the change will be aimed at addressing, progressively, deep aspects . The work of introspection, insight and emotional self-expression will accompany us throughout the process. Guilt, internal conflicts and, in some cases, unresolved feelings resulting from past traumatic experiences (e.g., history of sexual abuse, mistreatment, or rape) will be some of the issues that, from a systemic and integrative perspective, we will repair.
What advice would you give to people suffering from one of these two dysfunctions?
Especially, in the case of Vaginism, the feeling related to the lack of control contaminates the rest of personal contexts. The discomfort goes beyond the purely sexual border and translates into a fear that goes much further.
The impossibility of having penetrative sex even when one feels the desire , gradually diminishes the ability to seek pleasure and satisfy one’s needs. Neglecting this problem can have a serious impact on a woman’s self-esteem.Fear translates into more fear; this is why it is difficult to talk about the problem and consult a professional.
Our recommendation is always to approach the problem from a holistic viewpoint and, above all, to consider the possible organic causes. Once they are ruled out, the work from individual and couple psychotherapy is the one that will facilitate the person to regain self-confidence and, above all, not to live in a continuous struggle, thus managing to have control of the situation and stop “escaping”.
In this sense, couple’s communication is essential to reaffirm the right to express and empty all those cumulative feelings that, in an unconscious way, one day were reflected in an essential organ.