What happens in sex therapy? Treating vaginismus

While most people won’t think twice before inserting a tampon, or having penetrative sex with their partner, for people with vaginismus this isn’t physically possible. In fact, the condition can make penetration agonising, and can have a serious detrimental affect on both their life, and their sex life.

The condition causes an involuntary spasm of the vaginal muscle upon penetration, and is completely out of someone’s control. It can arise even if you previously enjoyed painless penetrative sex, or could previously insert a tampon, and it doesn’t affect your ability to get aroused, or enjoy non-penetrative sex.

It can often be hard to pinpoint a cause, but many causes are often related to emotional aspects of sex or gynaecology, such as a previous unpleasant experience.

Once diagnosis is confirmed one of the first points of action your GP may take is to refer you to a sex therapist, who will focus on managing feelings around penetration, and teach you exercises to help you gradually get used to penetration.

Corinne Worsley, a 37-year-old life transformation coach, had always experienced pain when trying to have sex, to the point that she wasn’t able to have penetrative sex until her late twenties. She presumed that that’s just what sex was like but by the time she was 32 it occurred to her that perhaps what she was experiencing wasn’t normal. She went to a sexual health clinic where she was diagnosed with both vaginismus and vulvodynia, a skin condition affecting the tissue at the entrance to the vagina.

For Corinne, her counselling sessions specifically involved discussing her relationship towards sex and what might be contributing to her vaginismus. “I had a religious upbringing and religious guilt often contributes to women developing vaginismus,” she says.

She was referred to a treatment programme at a hospital, which comprised of three elements: seeing a skin specialist, seeing a physio to help relax the vagina muscles, and psychosexual counselling to focus on the emotional aspects of vaginismus. For Corinne, the treatment programme was hugely beneficial.

So what actually happens in sex therapy, and does it work for everyone when it comes to treating vaginismus?

What happens in counselling sessions for vaginismus?

Sarah Berry, a psychosexual and relationship therapist, says that generally what will happen in sessions to treat vaginismus depends on the client and she doesn’t use a one size fits all approach.

“For some clients, an understand of what vaginismus is and dilator work is all they need,” she says. This might involve, then, discussing exercises the client can do at home to encourage their vagina to relax, for example using dilators or dildos.

Often, though, Sarah works with people who are stuck in this process, that is, they cannot contemplate inserting anything, let alone get enjoyment from penetration. In this case, working through what might have caused the vaginismus can help.

For Corinne, her counselling sessions specifically involved discussing her relationship towards sex and what might be contributing to her vaginismus. “I had a religious upbringing and religious guilt often contributes to women developing vaginismus,” she says. “By the time I had started treatment I had stopped going to Church, and so the vaginismus was lessening and the counselling certainly helped.”

“There are many other possible causes of vaginismus,” continues Sarah. “It could be trauma, bad relationships, a difficult medical examination, a change in body due to menopause, a traumatic birth, lessons from a young age that sex is wrong, fear of disease, or pregnancy. Sometimes the client may not know.”

Sarah also tries to work out what maintains the vaginismus. “Vaginismus is a defence mechanism which helps the client to protect themselves,” she says. “So reasons it persists could be there because the client has a difficult relationship with their body, sex, relationships, trust, or lack of control.”

Another part of therapy involves looking at what a client’s goal might be. For example, maybe someone is looking to get to the point where they are able to have penetrative sex, maybe they want to be able to have children, maybe they want to be able to have a smear test, or maybe they just want to feel more in control of their body.

“There are many other possible causes of vaginismus. It could be trauma, bad relationships, a difficult medical examination, a change in body due to menopause, a traumatic birth, lessons from a young age that sex is wrong, fear of disease, or pregnancy.”

“If it is sex, there can be work around managing and overcoming the condition while with a partner, and looking at what a healthy sex life, based on teamwork and communication could look like,” adds Sarah.

Part of what Corinne found useful from the counselling was having the opportunity to speak openly about sex to someone who wasn’t shocked by anything she said, and for whom it wasn’t a taboo subject. This helped her normalise her attitude towards sex, and her six sessions were a great catalyst for her to figure out what part she wanted sex to play in her life, and to release the guilt.

Can sex therapy cure vaginismus?

Sarah is wary of vaginismus treatment services that concentrate solely on opening the vagina as opposed to dealing with any emotional aspects of vaginismus, especially if the client’s goal is to get pleasure from their vagina, or to have sex. “These are quick fixes that don’t address the root of the problem, or can either provide further trauma to the patient,” she says.

Instead, she advises seeking out someone who is trained in psychosexual therapy so that the client gets a chance to work on both their physical difficulties and what is going on emotionally. As someone who has experienced vaginismus herself, she is a strong believer that sex therapy can really help those with the condition.

“There are people out there who can help, it’s just that other people don’t talk about this kind of thing. We all deserve to have pleasurable sex as a part of our lives, painful sex is not something that you should just put up with, especially as there is a solution.”

If therapy is done properly, many people may even be able to get rid of their vaginismus altogether. “I am very open with my clients and create a space where they are able to say if they are frustrated with me, or the process,” says Sarah. “Through working with me I have had clients who are then able to enjoy sex, have babies, and endure difficult medical examinations.”

Corinne benefitted hugely from her therapy. “It’s taken a long time, but I no longer feel any guilt about having sex, and I’m much clearer on what works for me,” she says. “My vaginismus is almost gone, and I have physio exercises that enable me to manage the vulvodynia, which I hope I will one day be free of.”

How should you go about getting help?

The first step towards getting help is going to speak to your GP, or, like Corinne, going to your local sexual health clinic, so they can diagnose you. Unfortunately, due to cuts to NHS funding, not everyone will have access to such a programme that Corinne was able to attend, but sex therapy can be offered on the NHS.

Alternatively, those who are able to go private may wish to seek out a gynaecology physio who will be able to help with this sort of thing, and Corinne also recommends finding a psychosexual counsellor. Her own counsellor was registered at the College of Sexual Relationship Therapists.

“There are people out there who can help,” says Corinne. “It’s just that other people don’t talk about this kind of thing. We all deserve to have pleasurable sex as a part of our lives, painful sex is not something that you should just put up with, especially as there is a solution.”

Featured image shows two middle-aged women sitting opposite each other. One is talking, and the other is taking notes on a notepad.

Page last updated June 2018