How Long Does Vaginismus Treatment Take?
It is a short and simple process. It is not a treatment that takes months, years, as people imagine. With 1, 3 or 5 sessions of therapies, the problem of vaginismus can be easily solved. The change in the number of sessions is due to the difference in the stages applied according to the personality structure and the size of the problem. It is given to people who do not have a therapist in the same city, with a more concentrated therapy for 1-3 days.
The aim is to reinforce a healthy sexuality, not only by ensuring that a person's sexual life is complete, but also to continue it with pleasure throughout life.
What is the First Approach in Vaginismus?
Each patient's story, reaction to intercourse experience, muscle control is different. Therefore, it is very important to take a history and establish a mutual trust relationship with the patient. The use of an understandable common language as a first step will ensure effective communication with the patient and their spouse.
Interviews should be as supportive as possible and aim to give the patient self-confidence. While obtaining information from the patient, an appropriate treatment plan is determined by understanding exactly what the sexual problem is.
In order to solve vaginismus, first of all, it is provided to be warm towards sexuality and nudity, to create intimacy, to inform about sexual anatomy and physiology, and to focus on sensations. Various trance techniques are applied to provide systematic desensitization.
Asking and answering questions in the sexual sphere is not easy, so the therapist should be more than passive and use a sexual problem-specific interview method until they fully understand the complaint. It should give the couple the feeling that they have come to a place where they can talk about their troubles, rather than feeling that they are being questioned.
Vaginismus treatment, should be planned considering all the details, since the person is unable to give sexual responses as expected or desired.
What Are Inappropriate Treatments and Approaches in Vaginismus?
1) Hymenectomy (Removal of the hymen): In most patients, there is no problem in the hymen. Therefore, hymenectomy has no benefit in resolving vaginismus. Rarely, a hymenectomy can be performed if a very thick hymen is observed in the examination.
2) Ensuring Sexual Coupling Under General or Epidural Anesthesia: As long as anesthesia is applied, the contractions disappear temporarily and sexual intercourse occurs mechanically, but after the effect wears off, the contractions recur in most patients.
3) Painkillers, Muscle Relaxants and Local Anesthetic Pomades: The use of these drugs before intercourse is not effective against contractions.
4) Use of Alcohol, Sedatives or Anxiolytics: These do not have any effect before sexual intercourse and adversely affect the sexual response to sexual stimulation.
5) Keeping Hot Steam in the to Vagina and Hot Water Bath: It is not effective for contractions before sexual intercourse.
6) Application of Botox to the Vagina: It is not useful since the problem is of unconscious origin and general body contraction. There are centers that use it to speed up treatment in mild cases, but it is not effective on its own.
7) Attempts of Sexual intercourse in the Practice Clinic: Having sexual intercourse in the presence of another person may cause trauma.
8) In Vitro Fertilization Centers: Treatments for pregnancy cause the problem to be postponed to a later period without being resolved. Only child-oriented behavior and cohabitation damage the institution of marriage and the relationship between spouses.
9) Drugs to Increase Sexual Desire: These drugs are not effective because vaginismus consists of fear and contractions.
How to Solve the Problem with Vaginismus Treatment?
One of the things that our patients fear the most is the processes we call finger exercises. Maybe this method, which is successful in simple vaginismus, does not give successful results in most cases. The feeling of failure exacerbates the problem and the patient cannot approach treatment or even quit.
The aim is to teach how the person perceives the event and the ability to manage and stop that emotion if there is an anxiety mechanism. The thing that patients with vaginismus problems most want is to be understood. Because they feel lonely in a very serious sense.
The treatment methods used can be in many different ways according to the personality structure. While some patients can clarify the problem with information and create a mental design, some need to go back to their parent relationships. Some of our patients are given behavioral exercises.
It is necessary to calm some patient's anxiety and fears with suggestion. On the other hand, a complex treatment system should be applied to some patients with hierarchical exercises, suggestion or cognitive treatments. After meeting with the patient, a treatment-therapy method is applied that is suitable for the patient's structure, does not force the personality limits, does not leave her alone with her fears, and can overcome her anxieties. The patient is given training in both emotion management and sexual stimulation.
For us, the beginning of therapy begins when the patient trusts a physician-therapist and comes to treatment. The process, which we call therapy, consists of a preliminary preparation of the patient emotionally and psychologically, then gradually clarification of anxieties-fears, examination of solutions together with the patient and the conclusion phase. The most important concept for him is not to delay, to decide on therapy.
What is the Purpose of Sexual Therapy?
When vaginismus is triggered by the stories about the difficulty of the first night that the person hears from the environment, and the fear of the first night is triggered, sometimes only cognitive therapies can be resolved if there is no serious subconscious problem.
While the hymen typically has few nerve endings and opens painlessly, most membranes are typically very thin, elastic, which open partially or completely at intercourse. With the dilator, only lateral flexion of the hymen or complete opening of the hymen may occur, but the opening of the hymen is usually not painful and there may be very little temporary bleeding. The remaining pieces of tissue remain adhered to the edge of the vaginal opening.
During the sessions, the aim is to provide body control by making imaginary and real desensitization. As a result of therapy in the patient; It is aimed to make people believe in what they will do, to provide the courage to start, to remove the contractions, to increase the diameter and to show that there is no problem with the membrane, to increase the trust towards the spouse and to transfer authority, as well as to provide breath, leg span and hip control.
Using only finger exercises or a dilator to treat vaginismus may not be sufficient for most patients. The use of finger exercises alone is often frustrating and ineffective, and leaving the treatment unfinished causes the process to take years. The goal is about learning to control and overcome contraction reflexes. Various trance techniques both increase the patient's self-confidence and shorten the working time. During the gradual sessions, the contractions in the body decrease and the self-touch and the increase in diameter take place in a short period of time.
Op. Dr. Sevinç BİLGİN
Gynecology and Obstetrics Specialist
