Overcoming vaginismus inspired me to become a sexual health educator
Grace Alice O’Shea was successfully treated for vaginismus — a fear of vaginal penetration — in her 20s. She talks about the myths and impediments that prevent women from overcoming this very treatable condition
‘I’ll never forget the first time I tried to use tampons. It really hurt and felt like hitting a brick wall,” says Grace Alice O’Shea, a 29-year-old Galway-based relationships and sexual health educator.
She first experienced that “brick wall” when she was around 14. “That’s the thing with vaginismus — there’s no give, so you get upset and distressed, which compounds the problem and makes you more tense,” she says. “Then you try to put in another one and the next thing you know you’ve gone through six tampons and they’ve all gone into the bin.”
Grace grew up in rural Kerry and recalls being very in tune with her body and sexuality, but there wasn’t a lot of understanding about her plight. Like the Tampax ad would go on to proclaim many years later, a friend of hers simply told her to “just stick it up there”, while others reassured her that it’s normal to get nervous and it would get easier over time.
“But it never did,” she says. “It was distressing — I’d keep trying to put it in and it would hurt. It just wasn’t happening.” Aine Ward, a psychosexual therapist (MIACP, COSRT), describes vaginismus as the muscles surrounding the vagina involuntarily tightening at any attempt to penetrate it.
“It can look like not being able to insert a tampon or having stinging, burning pain when you do,” Ward says. “Either a penis can’t enter or, if it does, there’s a lot of pain associated with it.
“Eventually, it leads to an intense fear of penetration, sometimes avoidance of sex and a loss of sexual desire.”
Vaginismus is classified as primary or secondary, the former meaning that the issues have always been present, and the latter arising when a woman has previously been able to experience penetration.
“This might happen as a result of trauma, after a difficult birth, an assault or similar,” Ward says. “For other women, vaginismus is linked to feelings of shame and guilt around sex, maybe from lack of sex education or as a result of cultural taboos around sex.”
Grace Alice O’Shea travelled to America in order to address her vaginismus
Maria McEvoy, the principal investigator for a DCU study of the experience of vaginismus in Ireland, says that surveys have found cultural influence to be very significant. “Ireland is unique in its level of conservatism,” McEvoy says. “It’s not Catholicism per se, but the level of religious orthodoxy. You see higher levels of vaginismus in ultra-conservative societies, whereas Denmark, for example, has really low rates of vaginismus.”
Unfortunately, she says, the stigma still pervades much of society. As a result, an unsuccessful smear test at the GP surgery doesn’t always lead to a diagnosis. “Male GPs will often say you’re tense, come back another time,” says McEvoy. “Women are told to go home and have a glass of wine and relax. It’s dismissed completely.”
It was when Grace wanted to have penetrative sex with boyfriends and it didn’t work that she realised something was really wrong.
“I was really turned on, really aroused — all the bits were in place, but it wasn’t happening,” she says. Eventually, she started talking to healthcare practitioners and her family GP mentioned that she might have what’s called vaginismus. That was the first time she had heard the term. “So I went home and Googled it, as you do, and there didn’t seem to be much support to be found at the time.”
Finding a sex therapist wasn’t easy, with barriers including both cost and geographical access. One therapist would only agree to see Grace if she came with her boyfriend, which she didn’t feel was appropriate considering she’d been experiencing problems long before any relationship.
When she finally saw a therapist, she was told that some women don’t overcome their vaginismus until they’re in their 60s. “I kept getting those kinds of messages, to just stick with it,” she says. “And as a 20-year-old, I felt like such a weirdo going to a sex therapist. That’s just the societal view of sex therapy — that there must be something really wrong with you.”
Around that time, Grace came out of a relationship. She managed to achieve some penetration at that point, but it was always painful and distressing. The day the relationship ended, Grace then returned to Googling vaginismus, “and on the first page, it came up and it said, ‘Botox treatment for vaginismus’.”
She knew as soon as she read about the vaginismus clinic in America that the treatment was for her and her mother took out a loan to pay for it and travelled with her. Grace was 21 at the time.
“I wasn’t one bit scared, not one bit worried,” she says. “I’d never had surgery and I hate needles, but I just felt it was exactly what I needed. I felt like I could be in therapy for years and the voice of that therapist was still in my head. I thought I could be 60 before this is over.”
But the shame meant she felt she had no choice but to keep the true purpose of the trip secret, so she lied and said she was travelling for dental treatment. “I lied to so many people,” she says.
In the clinic in America, Grace was put under anaesthetic and her vagina injected with Botox to prevent the muscles from tightening and when she woke up, there was a dilator inside her. “So you wake up and that psychological switch that you’ve unfortunately lost control of is flicked — there’s actually something inside you, there’s nothing wrong with you,” she says.
The procedure was followed by dilation treatment with dilators of different sizes, as well as group therapy alongside other women who had the same treatment. Since this, Grace has never looked back.
McEvoy worries that GPs who see vaginismus primarily as a physical problem have a tendency to refer patients to a gynaecologist when they should in fact be seeing a psychosexual therapist. “It’s not a great idea to engage in therapies that only deal with the physical aspect — then you’re just artificially getting rid of the problem, but, over the long-term, not actually dealing with what’s causing the vaginismus,” she says, adding that there’s unfortunately a cost barrier as a result of a shortage of therapists, which means many go private.
However, vaginismus is very treatable. “It’s very curable,” says Ward, who works with both individuals and couples. “It just takes patience and time. What I do is talk therapy with a cognitive behavioural piece alongside it — the reason being that the blocks are psychological,” she says, explaining the physical work around the vagina — which can involve touching and relaxation, pelvic floor exercises and the use of dilators — is all done at home. Then the women return and talk about what issues came up.
“Many women believe that they’re the only one, because they’ve never heard about vaginismus. But it’s very common among women of all ages,” Ward says. There’s a myth that vaginismus is always a result of sexual abuse, but McEvoy says that needs urgent debunking.
“Telling a woman that she must’ve been sexually abused is actually one of the worst things you can do, and we know from research that it’s a very low factor,” McEvoy says. “When women are told this, they go home and think they’ve repressed it. It’s actually a barrier to therapy as they know it hasn’t happened and yet they think people will make assumptions.”
Grace Alice O'Shea is glad vaginismus is now behind her
This was very much the case for Grace, who says she entertained a lot of narratives to try to explain her condition. “I believed that I had been abused. I believed that it was related to my disordered eating and body image. I believed that my body was simply broken or missing some vital piece. I felt that I had to explain away my condition, as men took it as a personal affront otherwise,” she says.
“It wasn’t until years later that I realised it was most likely triggered by an accident that caused physical trauma when I was a toddler, and compounded by other psychological and societal factors as I grew up.”
Looking back, she describes the years of suffering from vaginismus as “very dark times” and says that she wouldn’t wish what she went through on anyone. But the experience set her on the path of training to be a relationships and sexual health educator, and she’s convinced she’s more passionate, empathetic and patient as a result.
“For those years, I just felt so alone in it. But things are so different now, and there’s much more awareness and support.”
