Treatment for vaginismus: Where women can get help for painful sex
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Handling for vaginismus: Where women can go help for painful sexual activity
In the third and final story from its serial about painful sexual practice, CNA Women looks at how the different wellness disciplines work together to help women recover from vaginismus.
In Singapore, cases of vaginismus are increasing, which experts say could contribute to the country's already declining nativity charge per unit. (Photograph: iStock/Prompilove)
Contempo enquiry shows that female person sexual dysfunction is prevalent across the world, and that vaginismus – which is when a woman experiences hurting during vaginal penetration – is the well-nigh common condition. It is related to dyspareunia, which is when sex activity is possible but painful.
In Singapore, cases of vaginismus are increasing, which experts say could contribute to the state's already failing birth rate. A local study as well found that nearly threescore per cent of women endure from depression sexual part – an indicator they were at risk of developing such a condition.
If sex is consistently painful for you lot or if you are unable to tolerate fifty-fifty a Pap smear, residue assured aid is available.
WHERE TO BEGIN?
If you have no references and no idea where to start, y'all tin can get the ball rolling by showtime consulting a general practitioner (GP), who may interview you about various aspects of your medical history including your menstrual patterns, past pregnancies, your apply of contraception and medication, as well equally other medical conditions y'all might have.
During this visit, the dr. may suggest a pelvic test to make up one's mind the possibility of lower genital tract infection or skin atmospheric condition, but such a procedure at this stage of treatment is not for everyone, warned Dr Tan Tse Yeun, a senior consultant at the Department of Reproductive Medicine at KK Women's and Children's Infirmary (KKH).
"An internal examination should not be performed for patients with suspected vaginismus confronting their wishes, especially at first visit when she may be highly anxious and fearful," Dr Tan said.
"Information technology is of import to notation that many patients with vaginismus are nonetheless virgins and in the main intendance setting, internal vagina examinations should be avoided.
"A thorough explanation of what is involved in an internal pelvic exam and its possible implications, such as a torn hymen, should exist undertaken, and consent should exist documented," she added.
If a pelvic examination is conducted and information technology is found that the patient has an infection, the patient's condition will be diagnosed accordingly and medication is prescribed. For example, superficial dyspareunia could just be due to a yeast infection, which resolves once it is treated with antifungal medication, said Dr Tan.
If the medicine doesn't help, the medico may refer you to a dermatologist – to investigate the skin condition further – or a gynaecologist.
Your GP may too refer you to KKH, where y'all're likely to go through the infirmary'southward Sexual Wellness Clinic. This is where you and your partner will go through an assessment that includes not merely your medical history but also your "comprehensive sexological history", said Dr Tan.
This assessment records the patients' sexual behaviours or patterns (such equally if they currently have ane partner or more), masturbation habits and past incidents of sexual trauma.
The couple may likewise share if they take experienced symptoms of sexual dysfunction such as low sexual desire, disability to take an orgasm and pain, and if these symptoms are general or situational, and acquired or lifelong.
In one case these are all adamant, a "multisystemic and multidisciplinary" approach to managing dyspareunia and vaginismus is recommended, said Dr Tan.
This requires collaborating with other specialists, such equally physiotherapists and psychotherapists, to "co-manage" medical factors that contribute to sexual dysfunction.
TREATING VAGINISMUS WITH PHYSIOTHERAPY
"Pelvic floor cess by a physiotherapist experienced in pelvic floor dysfunction is important as women with chronic sexual hurting commonly have reduced pelvic floor function and increased tension," Dr Tan said.
In your sessions with a physiotherapist, you will learn more than well-nigh the female genitalia, specifically the muscular functions in your pelvic area, said Dr Tan.
Yous may as well be given exposure therapy, which in this context involves graduated penetration, she said. Patients receive footstep-past-step guidance at the clinic and volition exist taught transmission techniques for relaxing their pelvic floor muscles, which they are encouraged to practise at dwelling house.
Some patients may undergo electromyographic biofeedback, which incorporates the employ of an apparatus that feeds electrodes to a patient's muscles to aid them relax.
Patients at KKH'due south Sexual Health Clinic will be referred to in-house specialists, but those who aren't may likewise seek out contained physiotherapists – so long every bit they specialise in pelvic floor grooming.
Laura O'Byrne, a specialist senior physiotherapist at Health2U clinic, told CNA Women that treating individuals with vaginismus requires a special touch.
"Unfortunately, in Singapore, there is a lot of this and information technology but gets discovered later on they become married and endeavor to accept a baby.
"Considering the civilisation here is and so different, generally tampons are not used for menstrual health – information technology'due south all pads. And masturbation is something that tends to get looked down on.
"And so until you get married, you've not had anything inside your vagina," said O'Byrne.
"Then yous get married, y'all try to have sex for the outset time and it's .... horrible. It'southward atrocious, and so you see a gynaecologist, who tries to put a speculum inside yous and you're clamping down and they tell you to 'relax, relax, relax'.
"By the time they come to encounter me, they've had gynaecologists try to put a probe in in that location, their married man trying to put (his penis) in in that location and everyone request them, 'When are you going to have a baby?'."
And so, O'Byrne said she has to "spend a long time" with vaginismus patients.
"The first thing I tell them is that I'thou merely going to get every bit far as they desire me to – they are 100 per cent in control. And if that ways I only go to the archway of their vagina, that's fine. Sometimes just assuring them I'm not going to prod something into them is enough to promote relaxation," she said.
According to O'Byrne, one of the beginning steps to recovering from vaginismus is learning how to "correct your breathing" every bit this is continued to the pelvic floor.
While breathing sounds straightforward, instruction someone how to breathe to relax can be "difficult" and "a very slow procedure" because "I'm now having to undo everything that brought her to me", she said.
Aside from manual exercises, O'Byrne said she also sometimes recommends wearables that the couple can apply at habitation. An Ohnut, for example, is a circular silicone tube that fits on the base of a man's penis. Information technology has dissever parts that can be stacked co-ordinate to how deep the couple wants penetration to exist.
"He however has a kind of firm sensation around his penis just it stops him from going in as deep. So information technology'south just a question of managing what the symptoms are in the best mode nosotros can," said O'Byrne.
THE ROLE OF PSYCHOTHERAPY
In one case medical examination has excluded the possibility of infection, endometriosis and structural issues, the nigh common cause of vaginismus turns out to be psychological, said Associate Professor Tan Thiam Chye, an obstetrician and gynaecologist at Mount Elizabeth Novena Infirmary.
"This needs a give-and-take with the psychologist," Assoc Prof Tan said.
Incidentally, the recent KKH study on female sexual dysfunction found that the majority of the women who had low sexual part too reported depressive or anxiety symptoms.
Elaborating, KKH's Dr Tan said that "often, an individual's subjective sexual experience, thoughts, emotions and behaviour play a office in contributing to her difficulties". Psychological therapy tin be useful in helping them explore and manage these factors, she added.
"The goal is to help patients and their partners piece of work through their distress, acquire helpful coping strategies and modify negative beliefs about sexual functioning and sexuality," Dr Tan said.
"Not all patients require or are motivated to pursue psychotherapy, but a provision of cursory sexological counselling sessions are still helpful for most couples for education and back up," Dr Tan said.
Sex activity THERAPY AND Teaching
"Sex is frequently a taboo topic in our conservative Asian society," said Assoc Prof Tan. "We should be more open to discussion on this topic, rather than brush it under the rug."
According to Dr Tan, atmospheric condition such as dyspareunia are associated with "a lot of distress".
"Achieving pain-free intercourse oft becomes the primary focus of each sexual experience. This causes anxiety and prevents 1 from existence able to relax or fully engage with other aspects of the sexual feel," said Dr Tan, calculation that it would be helpful if women could "purposefully pay attending to arousing or pleasurable sensations" during sex.
Senior primary physiotherapist at KKH, Caroline Chua, said "educating women nearly sexual wellbeing and sexuality bug, destigmatising and normalising these topics as well every bit encouraging more discussions … will go a long way in encouraging a improve sexual experience in women".
There are workshops you can nourish and even online courses packed with data from those who report human sexual behaviour.
Popular sex toy brand Smilemakers, for instance, has what it calls a "pleasure-positive" sex education programme called Vulva Talks, which you can sign upwards for for complimentary.
Some topics addressed in the grade are how to have an orgasm, how to give and receive pleasure, and why pain during intercourse is then mutual. The curriculum is also delivered through Smilemakers' hour-long physical workshops, which allow participants to talk near what sex and pleasance mean to them.
"This helps people encounter sex very differently, more inclusively, more positively," said brand director Cecile Gasnault.
For those who prefer something more than personal and customised, sex therapy is another avenue.
Love and intimacy coach Andrea Tan, who typically meets with clients after they accept seen a GP or gynaecologist, said her work looks at how a person's emotional and mental health affects her sexual office and her drive or desire for intimacy.
Amid the things she has seen influence a person's level of anxiety during sex are "the belief that sex is shameful or something that is taboo based on how they were brought upward", prior bad experiences, and past relationship trauma.
It could likewise exist a combination of these things, said Tan.
Even a seemingly insignificant event, such as listening to someone else's painful experiences, can make the torso respond negatively to the idea of intimacy, relationships, sex or just penetration, she added.
To ascertain these atmospheric condition, Tan's clients are put through what she calls a "discovery process" that involves filling in a "pre-intake form", as well equally coaching tools like talk therapy.
"With experience, it's likewise most asking the right questions on the spot to uncover what the client is trying to achieve through the healing process. That ordinarily gives clues to what may exist blocking their ability to heal," she said.
Coaching is conducted one to two weeks autonomously, through video calls, said Tan, adding that sessions may involve only the customer or the client and her partner.
Afterwards every session, the client is given "homework" practices that Tan said helps to "re-wire sure mind-body conditions with respect to what nosotros are working with".
Typically, clients nourish up to several sessions across ane to three months before they are "confident plenty" to say they take resolved their condition.
"There are a scattering that take longer … Anybody heals in their own time," said Tan.
The coach said that the definition of recovery is "co-created" with the customer or the couple merely it typically revolves effectually being able to have sexual activity without pain.
"Being able to 'forcefulness through penetration' does not mean the vaginismus is healed," said Tan.
The of import thing to note, said Tan, is that women who successfully resolve this condition are those that "put in endeavour to work through the process and stick with it until they come out on the other side".
"Therapy doesn't piece of work if it'due south the counsellor or coach giving all the pointers but the client doesn't practise the piece of work (exercises). It has to be a co-created journey," she said.
CNA Women is a new section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, electronic mail CNAWomen [at] mediacorp.com.sg .
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Source: https://cnalifestyle.channelnewsasia.com/women/painful-sex-vaginismus-dyspareunia-treatment-gynaecologist-287546
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