Vaginismus not only affects a woman’s ability to have sexual intercourse, but also makes gynaecological and pelvic examinations difficult or impossible. Dr Maria McEvoy is trying to bring awareness to the misunderstood and painful condition and reveals what can be done to help sufferers
Vaginismus is an involuntary tightening of a woman’s pelvic floor muscles, making penetration impossible or very painful. It is thought to be one of the most common female psychosexual problems and is associated with high levels of distress.
“When I started my PhD, there was nowhere for people with vaginismus to turn. If their GP couldn’t help, it was a dead end,” says Dr Maria McEvoy from DCU’s School of Nursing, Psychotherapy and Community Health.
Dr McEvoy decided to conduct the first-ever study in Ireland to interview couples together and include the perspectives of both women and couples, as well as a variety of healthcare professionals.
After an extensive literature review and a large number of interviews, she was struck by the fact that some common myths are stopping women from seeking help for their vaginismus — most notably that of sexual abuse as a trigger.
“A lot of GPs will tell women that, but there’s very little evidence of a link,” she says. “Then these women start wondering ‘did this happen and did I repress it?’ And they won’t go to counselling out of fear that all this will come out.”
More common among vaginismus sufferers, says Dr McEvoy, is an upbringing in a conservative household and culture, evidenced by the fact that the rates of vaginismus are far higher in countries with orthodox religious traditions. “It can relate to the way a family transmits messages to their daughters — like telling them that if they get pregnant, they needn’t come home, or that sex is dirty,” she explains.
“These women have to curb their sexual feelings to get their family’s approval. Naturally, some will be more sensitive to that than others — few have sisters with vaginismus. It could be that they’re the first-born and acting like a role model, or perhaps they have an almost intrusive relationship with their mother.”
Often times, medical practitioners tend to focus on the muscle spasm, aiming to help patients overcome a fear of penetration. “But there are deeper fears there — fear of shame, and of your own sexuality,” explains Dr McEvoy. “There’s this sense that you yourself are dirty. And that shame can prevent women from getting treatment.”
These messages can be very confusing. Vaginismus studies from Hong Kong, says Dr McEvoy, have highlighted the issue with strict control over pre-marital contact followed by immense pressure to start trying for a baby.
“Many women can’t make that mental switch from sex being something forbidden to something they’re suddenly required to do,” she explains, adding that many of the women she interviewed spoke of a particularly cruel effect of the combination of this pressure with the silence that results from feelings of shame.
“They don’t talk to their families and friends about this, so they think they’re the only one going through it. It feels like a personal failing. They watch all their friends have children and feel incredibly lonely.”
The experiences of Niamh Murphy*, 28, who lives with vaginismus, echo a lot of Dr McEvoy’s findings. She grew up the oldest sibling in a Catholic family in Leitrim and went to a Catholic primary school. “We would’ve never talked about sex at home,” she says.
“The sex education was very mechanical then, and in secondary school it was taught through the lens of biology. There was nothing to do with pleasure — not when it comes to women anyway.”
Active in GAA and Irish dancing, Niamh had what she describes as great mastery over her body, and the first signs of vaginismus came as a surprise to her. “I tried using a tampon once, very briefly, but I just knew it wasn’t going to work,” she recalls. Then she developed an eating disorder. “I was completely disconnected from my body, from the neck down,” she says.
“There’s a clear parallel between food and sex for me: I was denying my bodily cues, and my sexual needs as well. It was the same with dancing: mind over matter; no pain, no gain.”
But suppressing her sexuality didn’t feel like a sacrifice to her.
“Any talk about sex was about avoiding crisis pregnancies and STIs. There was a narrative of girls who are reckless when it comes to sex, and I wanted to distance myself from that,” she says.
While a conservative upbringing tends to leave a lasting impact, Dr McEvoy suggests that hearing different messages in school can offset conservative messages. “We need to improve sex education in this country,” she asserts. “I know moves are being made, but there’s still a strong focus on the mechanical aspects of sex, not the emotional — and certainly not sexual dysfunction.”
She’d like to see better information about what you can do if you’re struggling, and what support services are available — which is why she created the website vaginismusresearchireland.com with information, advice and links. “There shouldn’t be stigma around getting help. The current approach to sex education makes people feel bad when they can’t have sex, because they feel it’s meant to be natural,” she says.
In college, Niamh had some one-night-stands — always with strangers as she was too embarrassed to get together with anyone she knew — but she was never able for penetration. Men were often perplexed by the situation, some to the extent that they became coercive. But during a stint in America, things started to change for Niamh.
Her female colleagues would talk openly about sex, and she couldn’t join in. Slowly, she started to realise that something might be really wrong.
Returning to Ireland, she started googling — and she finally came across the term vaginismus.
A first university GP — whom she was only able to see because it was free — brushed her off. A second commended her for coming.
“She mentioned another GP recommending a glass of wine to loosen up, which is funny because if there’s one way for me to sober up, it’s trying to have penetrative sex,” Niamh laughs. “Then she said there’s a psychosexual therapist she could refer me to — but the wait could be months.”
Cost, says Dr McEvoy, was a barrier that came up a lot in her interviews.
“I interviewed couples who were broke because of vaginismus,” she says. “In Northern Ireland, many psychosexual services are free on the NHS, but in the Republic, there are limited specialist services on the public system. It’s very hit and miss, people take time off work and travel for all these appointments, and they’re missing out on so much time in their relationship.”
In addition, there’s still a lot of misinformation out there, and many of the women Dr McEvoy spoke to felt they had to educate their GPs about their condition. “Because GPs have a medical focus, their inclination is often to refer women to a gynaecologist. Whereas they should be working in a multidisciplinary way with physiotherapists and psychosexual therapists,” she says.
“Many GPs also think that vaginismus needs to be diagnosed by internal examination, but my view is that this can make things worse. If a woman has the experience of vaginismus, she can self-identify and go to get help with that.”
In some instances, dealing with the muscle spasm alone, as is sometimes done with Botox, can further complicate things.
“You might be able to achieve penetration but not pleasure, which can be very upsetting and lead to emotionally dissociating from sex,” Dr McEvoy explains, stressing that her study showed that most couples experiencing vaginismus have otherwise healthy relationships, sometimes both sexually and emotionally.
It can be helpful, Dr McEvoy suggests, to consider the condition as functional as opposed to dysfunctional.
“The physical experience is a symptom of vaginismus, not the cause — but where did that symptom come from? If you feel under threat and your body closes down, it’s doing a healthy thing to protect you. Once you no longer feel the need to be protected, gradually there won’t be a need for that spasm.”
Niamh scraped together the funds to see the recommended psychosexual therapist privately. Initially, the therapy seemed geared towards couples, which put her off — but she came away from the second session with some simple exercises.
“It was basically about learning to connect with my body again — just putting on body lotion, taking long, mindful showers.”
Then the first lockdown happened and she got an opportunity to fully disconnect from the outside world. She went for walks on her own, took up yoga and consciously worked on some pelvic tension, and slowly things improved for her.
She’s had ups and down since, including an eating disorder relapse, but overall the term vaginismus has helped her confidence.
“It’s helped me to assert myself, and when I meet someone I can say I have this condition and compare it to erectile dysfunction, which men can understand,” she says.
It’s been a journey of acceptance and self-discovery.
“I don’t feel under pressure anymore. I don’t feel like it’s a problem to be fixed — I feel like it’s an invitation to explore, and I’m enjoying what I discover about myself,” she says, echoing Dr McEvoy’s sentiment about flipping the notion of dysfunction on its head.
“With everything that women have been subjected to for decades and the news full of women being attacked, I’m not pressuring my vagina to open itself up to a world that just doesn’t care about women’s pain or pleasure.”
*Not her real name