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CASE STORY
ROBIN: Fear of Vaginal Penetration (Vaginismus)
Robin, a 30-year old woman, came to see me because she had been plagued by fears of penetration of her vagina since adolescence. When her girlfriends were graduating from sanitary pads to tampons, Robin couldn’t bring herself to insert a tampon. When she was old enough for gynecological examinations, she avoided them out of fear of the doctor inserting fingers or instruments in her vagina. When she started dating, she would engage in petting, she allowed breast touching and she would give blow jobs, but she would guard her vagina from being explored, from being touched or from being entered.
Robin was suffering from vaginismus, a sexual disorder in which the vagina “closes up.” Involuntary spasms of the vaginal muscles make the entrance to the vagina so tight that penetration is impossible or very painful. Some have called it the body’s way of saying “no.” Robin is one of the estimated 2 to 9 percent of women who experience vaginismus.
After years of ignoring her problem, Robin was now pressured into looking for help in overcoming her penetration fears. She had been dating a thirty-two-year old man, Richard, with whom she fell in love. He had been dangling the promise of an engagement ring if she got help for her vaginismus.
The gynecologist Robin consulted for her problem referred her to me. After a thorough examination showed no physical problems related to her inability to be penetrated, the doctor felt emotional reasons were causing Robin’s penetration fears.
Though there are a variety of emotional factors which contribute to vaginismus, as Robin told me about herself, it became apparent that her very restrictive sexual upbringing had contributed to her fears of penetration.
Robin’s parents were in their forties when Robin was born. She was their second and last child. Her brother was twenty years old when she was born so she was basically raised as an only child. Her parents were older, Eastern Europeans with very old-fashioned ideas about sex. There was virtually no affection expressed in the house. Though they got along, Robin never saw her parents kissing, hugging, or showing any affection toward each other.
Robin learned the “facts of life” from friends. Her mother seemed embarrassed at discussing sex and Robin in turn avoided asking questions she felt would embarrass her mom. Sex wasn’t discussed but the message Robin got at home was that sex was dangerous and disgusting. Her dad’s message was: “Don’t trust men.” Her mother’s message was “Sex is dirty and the consequence, childbirth, is painful.” Robin would often grimace and say “yuck” when talking to me about sex. For a responsible, hard-working young woman who had been taking care of herself for years, Robin was naïve and childlike when speaking about her relationship with her parents and her boyfriend.
Robin had dated since she was 14-years old but her relationships usually lasted about three months. She confided that she had become very good at giving blow jobs to make-up for not allowing any exploration or penetration of her vagina. But her fear of penetration, even with fingers, would cause her boyfriends to lose interest in dating her after a few months. Her longest relationship, before dating Richard, lasted about 6 months. She was twenty-one years old at the time. She broke up with him because he was “cheating” on her. She had continued to date, but hadn’t had a long term relationship until Richard.
She met Richard at work. They had been dating for 8 months when she first visited me. They were in love and were talking about engagement and marriage. Robin wanted very much to get married and have a family and there was also a lot of family pressure for her to do so. Her brother and all her cousins were married and the family would constantly ask her when she was going to take the “leap.” She feared that her sexual problem would keep her from living up to her family’s expectations and from realizing her dreams of being a wife and a mother.
Her sexual relationship with Richard was very satisfying for Robin. Mutual oral sex would excite her and bring her to orgasm. He enjoyed it also, but wanted to be able to go on to intercourse. He had tried many times to penetrate, but the moment he would have his penis near her vagina, Robin would tense up, her vaginal muscles would contract, and penetration would be impossible. She said Richard was patient and understanding, but was firm in letting her know that he would not marry her if he could not penetrate her. His warning was the motivation for her seeking help at this time.
Treatment for vaginismus, I reassured Robin, has a very high rate of success. But she had to be committed to doing the exercises I would assign her and accept that it would take time to overcome her anxiety and fear of penetration. She agreed to follow my instructions.
Initially, there was to be no attempt at penetration. They could continue oral sex and climaxing that way, but NO PENETRATION ATTEMPTS.
The first step was for Robin to practice breathing relaxation exercises at least once a day to help her learn to relax her muscles. These were her instructions:
- Sit with your back straight to open the chest area; feet flat on the ground; hands palm down on your knees.
- Breathe in slowly through your nostrils to a count of four. Take the breath in all the way down to your stomach.
- Exhale slowly through your nostrils again to a count of four.
- Repeat at least four times, each time saying to yourself on each exhalation, RELAX.
Robin successfully practiced the relaxation exercises and we proceeded to the next step: Kegel exercises to help her gain voluntary control of the muscles in her vagina. When she was urinating, I asked her to contract her pelvic muscles to start and stop the stream of urine. She was to stop and start several times each time she urinated. The goal of Kegel exercises is not to tense the muscles, but to learn to relax them. When she contracts the pelvic muscles, she’s tensing them. When she stops contracting, she’s relaxing the pelvic muscles. I asked her to notice the difference and pay particular attention to the relaxation part. She was to practice these exercises several times a day.
As Robin practiced relaxation breathing and Kegel exercises, we began to discuss the next step in her treatment: the use of vaginal dilators. Vaginal dilators are smooth, plastic cylinders in graduated sizes, rounded at the end. There are usually about four dilators in a set. The smallest dilator is about the size of a tampon and then they increase in size. Robin agreed to purchase the dilators. The dilators may be ordered from medical supply houses or from companies which advertise them on the Internet.
After Robin received the dilators she ordered, I instructed her to select when and where she could start practicing inserting the dilators in complete privacy. Robin lived alone and this was simple for her. She chose to do her dilator therapy in her bedroom in the evenings. I suggested that she take a warm bath, listen to relaxing music while bathing, and practice her relaxation breathing. Then she was to lie down. Choosing the smallest dilator first, she was ready to start. These were her instructions:
- Use a mirror to see the opening to the vagina.
- Use lubrication on the entrance to the vagina and on the tip of the smallest dilator.
- Lie on your back with your knees bent.
- Insert the dilator slowly and gently about two inches or so into the vagina.
- Leave the dilator inside for 10 minutes or so.
- Breathe, relax, read, watch television, or talk on the phone while the dilator is inside.
- When the time is up, remove the dilator. Clean it and store it.
Robin was asked to do this four to five times a week until she became comfortable with having the dilator inside. Then she was to move to the next size and follow the same steps until she had graduated to the largest dilator. If at any time she experienced pain, she was to STOP and discuss the problem at our next session.
Progress was slow. It took several weeks for Robin to graduate to the largest dilator. In the meantime, Richard, aware of her efforts at overcoming her fears of penetration, had given her an engagement ring and they had set the date for their wedding. They had continued to enjoy sex play without attempts at penetration.
When Robin had been able to tolerate the largest dilator, it was time to ask Richard to come with her. Richard proved to be a personable, down to earth, no nonsense guy. He was ready to do whatever was necessary to proceed to penetration. He was instructed to start penetrating Robin with his fingers, gently, slowly, letting Robin guide him. Once this was comfortable for her, penetration with his penis could be attempted.
For the first penetration with his penis, I asked Richard to lie down with Robin straddling him. Using lubrication, Richard was to penetrate her with Robin guiding his penis so she could feel control over his entrance. He was to penetrate only a couple of inches with no thrusting. He was to remain quietly inside Robin for a few minutes and then come out. They could sex play to orgasm outside the vagina if they wanted to. They were to repeat these steps on following nights until complete penetration was achieved. After initial penetration, Richard could thrust gently until he climaxed.
It took many attempts before their goal of complete penetration was accomplished. When it did happen, Robin was so excited she called next day to tell me. At our next session, Robin admitted to feeling inadequate and deficient as a woman until now. Finally, she felt like a “real” woman. But she confessed that intercourse was not particularly pleasurable. She preferred oral stimulation and continued to have orgasm with Richard going down on her. Richard’s reaction was one of pure pride. He felt his manhood validated now that he could penetrate his fiancée like a “normal man.”
Robin moved in with Richard and they continued to plan their wedding. They came in for two more sessions at one-month intervals to make sure they continued to engage in intercourse without backsliding into their old love-making habits. At the end of the last two sessions, they were consistently having satisfying intercourse so we terminated counseling.
SEXPERT’S COMMENTS
In Robin’s case, as is important for anyone experiencing problems with vaginal penetration, a thorough examination by a gynecologist is important to rule out any physical problems which might interfere with penetration. Once physical factors are ruled out, emotional factors need to be considered.
Some emotional factors which contribute to vaginismus are:
- History of sexual abuse
- Traumatic experience with gynecological examinations
- Extremely restricted sexual upbringing
- Religious taboos that invest sex with shame and guilt
- Fear of intimacy and loss of control
- Negative maternal attitudes concerning vaginal penetration
- Poor self-esteem
- Sexual ignorance and misinformation
The treatment for vaginismus is usually similar to the treatment described in Robin’s case regardless of the particular emotional factor involved. And though progress is often slow, treatment for vaginismus has a very high rate of success.
SUMMARY
Vaginismus, a woman’s fear of having her vagina entered, is often caused by psychological factors.
Physical factors should be ruled out by a thorough gynecological examination before sex therapy is initiated.
It is possible for women suffering from vaginismus to have a satisfactory sex life enjoying oral sex and other love play which does not involve penetration of the vagina. But this may prove unsatisfactory to her partner.
Treatment for vaginismus requires practicing exercises that relax and expand the muscles of the vagina so that penetration becomes possible.
Treatment for vaginismus is highly successful.
If you feel that you need more counseling for your difficulties than was offered
in the case story, you may contact me
about your specific problem via email
counseling or telephone counseling.
THANK YOU FOR YOUR INTEREST IN SEXPERT COUNSELOR.
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