Vaginismus is an involuntary contraction, or reflex muscle tightening, of the pelvic floor muscles that generally occurs when an attempt is made to insert an object, tampon, penis, speculum used for a Pap test, into the vagina. This muscle tightening causes pain. which can range from mild discomfort to severe burning and aching.
Vaginismus may be Primary, i.e. lifelong, or Secondary, occurring after a period of normal sexual function. It may also be Global, occurs in all situations and with any object, or Situational, may only occur in certain situations, such as with one partner but not others, or with sexual intercourse but not with tampons or pelvic exams or vice versa.
Women with vaginismus often think that they’re “Too Small” and that their vagina needs to be stretched. Just imagining this is painful! The truth is that women with vaginismus don’t need to “Stretch” anything; they need to learn to control the muscles around the vagina. This can be done with exercises.
- How do I know if the pain I have with intercourse is vaginismus?
Your doctor should be able to answer that after he or she has asked you a few questions and examined you. The pain with vaginismus occurs only with penetration. It starts as soon as the partner attempts to insert his penis and usually, but not always, goes away after he withdraws. The pain is often burning or tearing.
Women may describe it as
- It feels like he’s hitting a wall
- It feels like he’s too big for me
- I feel like I’m being torn
The pain may or may not improve as sexual intercourse progresses, and there may be times when the pain is not as bad. Women with vaginismus often, but not always, also have discomfort when inserting tampons or having an internal exam.
- Is the pain all in my head?
Vaginismus is a learned reflex. A useful way to look at it is to compare it to getting a finger in our eye. We’ve all been poked in the eye at some time in our life and if we see a finger or other object approaching our eyes, we shut them automatically. In the same way, a woman with vaginismus has had an experience of painful intercourse, or other object in the vagina. Later on when she or someone else tries to insert an object in the vagina, the vagina “Shuts” to protect itself from pain without the woman even being conscious of it. The muscle spasm is what causes the pain and that is definitely real.
- How common is vaginismus?
Vaginismus is a much more common problem than you may realize. Women with vaginismus tend to be very embarrassed about it and not mention it to anyone. That is too bad because it is a lot easier to treat vaginismus if it has only been going on for a few months than it is if it has been going on for several years.
Many women have mild degrees of it at some point in their lives. Vaginismus can vary from mild discomfort with intercourse to the man being unable to enter because of pain and spasm. There are many couples who have been together for years but have never had intercourse because of vaginismus. They may even have had children by means of a “Splash Pregnancy”, the man ejaculates near the vaginal opening and sperm make their way up the vagina. Many women with vaginismus have very active sex lives; they just don’t have intercourse. Sometimes a couple is happy with the way things are and would rather not try to change things; if you and your partner both agree - that is perfectly fine.
- What can I do if I have vaginismus?
The good news is that there is a cure for vaginismus; it simply involves learning how to control and relax the muscles that are tightening involuntarily. The bad news is that this does not happen overnight and requires you to do “Exercises” for several weeks to several months. How long it takes for the exercises to work depends on how faithful you are in doing them and also on how long the vaginismus has been a problem.
During the time period that you are doing the exercises, you should avoid intercourse. It may be hard to explain to your partner that you won’t be having intercourse for several weeks and possibly several months. However, every time you have painful intercourse, you are reinforcing the reflex and it will take that much longer to get rid of it. You can still do all the other things that give you and your partner pleasure including touching each other, oral sex, etc., just not intercourse.
- How exactly do I do these exercises?
Start by doing Kegel exercises. If you have had a baby, you probably learned to do Kegels in prenatal class. These involve tightening the muscles of the pelvic floor - the same muscles you would contract if you were on the toilet urinating and wanted to stop the flow of urine. You should contract your muscles, hold for a couple of seconds, then relax. Initially, you can do the exercises on the toilet to make sure that you are contracting your pelvic floor muscles and not your abdominal muscles instead; however, as soon as you are certain that you are doing them correctly, you should no longer do them on the toilet but whenever you think about it during the day. Each time you do them, do about 20 contractions. You can do these while talking on the phone, watching television, etc. Don’t forget to relax the muscles for a few seconds after each contraction.
After a few days you should try doing the exercises with fingers in your vagina, starting with one finger and working your way up to three. It is a good idea to cut your fingernails and to use a lubricant. The fingers must be inserted to a depth of at least 5 to 6 cm or to the level of the first joint after your knuckle. We ask you to do this for several reasons: you can feel your pelvic floor muscles contract and relax around your fingers so that you can be sure you are contracting and relaxing the right muscle. It also helps you get used to having something in your vagina.
- Why fingers?
They are the easiest object to remove if it starts to hurt and they don’t cost anything. Women will sometimes wonder if they can use their partner’s fingers instead; this is generally not a good idea since you have less control if you use your partner’s fingers than if you use your own.
You also want to avoid associating your partner with pain. Many women like to do the exercises in the bathtub where water acts as a natural lubricant. You should do the exercises daily if possible. Don’t get discouraged if some days you can’t insert as many fingers as others; this is normal. If you find that you can’t get your fingers in far enough, try doing the Kegels; as you relax the muscles you should be able to get the fingers in a little bit further.
- How long do I have to do the exercises before I can try to have sexual intercourse again?
The time it takes to get to three fingers varies from weeks to months, depending on the duration of the problem and on how faithfully you do the exercises. When you can insert three fingers without pain a few times, then it is time to try intercourse. The first few times you try intercourse you should be on top so that you have total control and lubricants should be used. You can try pushing out as if you were having a bowel movement as you insert your partner’s penis. This is because you can’t push out and contract your muscles at the same time. If it hurts, you should stop, contract your pelvic floor muscles, then relax.
It is not a bad idea to just lie still with your partner’s penis in your vagina the first few times, with no movement. When that is successful, the next couple of times you only should move, so that you have total control over the situation. It’s a good idea to discuss this with your partner beforehand. If that doesn’t hurt, then the next time you can do whatever you wish. If you find you just can’t have intercourse the first time you try, don’t panic. Just go back to the fingers for a few days, then try again.
- What are the chances that these exercises will work for me?
These exercises, though they may seem very simple, are successful more than 90% of the time, as long as there is no history of sexual trauma. Obviously, if you are suffering from flashbacks or nightmares as a result of sexual assault or abuse, these issues also have to be dealt with. The exercises also won’t work if you have physical problems causing pain such as an infection or inflammation of the vulvar glands. Usually, though, when the exercises “don’t work” the problem is that the woman hasn’t done them for some reason or other. If you just can’t seem to make yourself do these exercises, you should discuss it with your Sexologist. He or she may have some suggestions or may be able to refer you to someone who can help.
Sexual desire disorder is a psychiatric condition marked by a lack of desire for sexual activity over a prolonged period.
Inhibited sexual desire (ISD) refers to a low level of sexual interest resulting in a failure to initiate or respond to sexual intimacy. ISD may be a primary condition (where an individual has never felt much sexual desire), or secondary (where lack of interest is something new).
ISD may also be specific to the partner, or it may be a general attitude toward any potential partner.
A diagnosis of hypoactive sexual desire disorder refers to a persistent or recurring lack of desire or an absence of sexual fantasies. However, sexual performance may be adequate once activity has been initiated. This disorder occurs in approximately 20 percent of the population and is more common in women, though it does affect both sexes.
Sexual aversion disorder refers to a condition in which the concept of genital sexual contact seems repulsive. This disorder probably occurs less frequently than hypoactive sexual desire.
- Lack of sexual interest
- Communication problems
- Lack of affection
- Power struggles
- Lack of one-on-one time for partners to be alone together
- A very restrictive upbringing concerning sex, or negative or traumatic sexual experiences
- Physical illnesses and some medications
- Psychological conditions such as depression or excessive stress may inhibit sexual interest
- Individuals who were victims of childhood sexual abuse and persons whose marriages are lacking in emotional intimacy are particularly at risk.
In most cases, medical evaluation and lab tests will not reveal a physical cause. However, because testosterone is the hormone responsible for creating sexual desire in both men and women, it may be useful to check testosterone levels. For men taking this test, blood should be drawn before 10 a.m., when male hormone levels are at their highest. Interviews with a specialist in sex therapy are more likely to reveal possible causes.
Treatment must be individualized—some couples will need relationship or marital therapy prior to focusing directly on enhancing sexual activity.
Of course, many couples may need to focus on the sexual relationship itself, and through education and assignments they can expand the variety and time devoted to sexual activity.
When problems with sexual arousal or performance are factors, these sexual dysfunctions will need to be addressed.
One helpful way to prevent ISD is setting aside time for nonsexual intimacy. Couples who reserve time for one-on-one talking are more likely to experience sexual desire. Also, reserving time before exhaustion sets in will encourage closeness and sexual desire. Couples might mentally separate sex and affection, so that neither one is afraid to be affectionate daily.
Reading books or taking courses in couples communication or massage may also encourage feelings of closeness. For some couples, reading novels or viewing movies with romantic or sexual content may also serve to encourage sexual desire.
Low sexual desire may be a barometer of the emotional health of the relationship. In the case of a loving relationship, low sexual desire may cause a partner to repeatedly feel hurt and rejected, leading to eventual feelings of resentment and promoting eventual emotional distance.
Sex is something that, for most couples, either bonds their relationship or creates a wedge that gradually drives them apart. When one partner is significantly less interested in sex than their companion, professional help is recommended before the relationship becomes strained.
Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it's not cause for concern.
However, you may meet the diagnostic criteria for premature ejaculation if you:
Always or nearly always ejaculate within one minute of penetration
Are unable to delay ejaculation during intercourse all or nearly all of the time
Feel distressed and frustrated, and tend to avoid sexual intimacy as a result
Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation - or a combination of these - can help improve sex for you and your partner.
The primary symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem may occur in all sexual situations, even during masturbation.
Premature ejaculation can be classified as lifelong – primary - or acquired – secondary-.
Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters. Acquired premature ejaculation has the same symptoms but develops after you've had previous sexual experiences without ejaculatory problems.
Many men feel that they have symptoms of premature ejaculation, but the symptoms do not meet the diagnostic criteria for premature ejaculation. Instead these may have natural variable premature ejaculation, which is characterized by periods of rapid ejaculation as well as periods of normal ejaculation.
When to see a doctor
Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It's common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.
For some men, a conversation with their doctor may help alleviate concerns about premature ejaculation. For example, it may be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.
The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of psychological and biological factors.
Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:
Situations in which you may have hurried to reach climax in order to avoid being discovered. Guilty feelings that increase your tendency to rush through sexual encounters. Other factors that can play a role in causing premature ejaculation include:
Erectile dysfunction.Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change.
Anxiety.Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
Relationship problems.If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem.
A number of biological factors may contribute to premature ejaculation, including:
Abnormal hormone levels
Abnormal levels of brain chemicals called neurotransmitters
Abnormal reflex activity of the ejaculatory system
Certain thyroid problems
Inflammation and infection of the prostate or urethra
Nerve damage from surgery or trauma (rare)
Various factors can increase your risk of premature ejaculation, including:
Erectile dysfunction.You may be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection may cause you to consciously or unconsciously hurry through sexual encounters.
Health problems.If you have a serious or chronic medical condition, such as heart disease, you may feel anxious during sex and may unknowingly rush to ejaculate.
Stress.Emotional or mental strain in any area of your life can play a role in premature ejaculation, often limiting your ability to relax and focus during sexual encounters.
While premature ejaculation alone doesn't increase your risk of health problems, it can cause significant problems in your personal life, including:
Stress and relationship problems.A common complication of premature ejaculation is relationship stress.
Fertility problems.Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to have a baby.
The truth ? -Everyone’s experienced performance anxiety at some point - including women. At the end of the day, sex - since it involves being naked, physical and very, very vulnerable in front of another person, especially a person you’re attracted to - can be a bit intimidating, and more people than not sometimes stress about how they stack up in bed.
Sex is supposed to be fun, but it’s hard to relax and enjoy it when you’re too busy worrying about how you look or what she thinks about you to just be in the moment. And unfortunately, worrying about your sexual performance can create a nasty cycle: Stress can block blood flow to the penis, marking it harder to get and stay hard, which in turn increases anxiety about performance…
If you find yourself freaking out when you’re about to get freaky, your best bet is to switch to a little foreplay. Go down on her or finger her for until you feel more relaxed, ands let her audible pleasure give you the confidence you need to get back in the saddle.
Ease your anxieties by arming yourself with the best information to improve your sex life.
Sexis supposed to be a pleasurable experience, but it's hard to feel sexy or intimate with your partner when you havesexual performance anxiety. When you're constantly wondering,
- Am I doing this right?
- Is my partner enjoying this?
- Do I look fat?
- you become too preoccupied to enjoy
Constant worry over your appearance or ability in bed can make sex stressful and nerve-wracking. It can even make you want to avoid having sex.
Sex is more than just a physical response. Arousal is tied into your emotions, too. When your mind is too stressed out to focus on sex, your body can't get excited either.
In this article, you'll learn what causes sexual performance anxiety and discover treatments that will help reignite your sex life.
Causes of Sexual Performance Anxiety
Many different kinds of worries can lead to sexual performance anxiety, including:
- Fear that you won't perform well in bed and satisfy your partner sexually
- Poorbody image, including concern over yourweight
- Difficulties in your relationship
- A man’s worry that hispeniswon't 'measure up'
- A man’s concern about ejaculating prematurely or taking too long to reach orgasm
- A woman’sanxietyabout not being able to have an orgasm or enjoy the sexual experience.
These anxieties cause your body to launch a response called “fight or flight.” Stress hormones likeepinephrineand norepinephrine are released in a series of reactions that were actually designed to prepare your body to run or confront a threat. Of course, your partner isn't a threat, which is why this response is so counterproductive to intimacy.
Symptoms of Sexual Performance Anxiety
Your state of mind can have a big impact on your ability to get aroused. Even if you're with someone who you find sexually appealing,worrying about whether you'll be able to please your partner can make it impossible for you to do just that.
In men, one of the effects of the stress hormones is to constrictblood vessels. Lessbloodflowing into thepenismakes it more difficult to have an erection. Even men who normally don't have any trouble getting excited can become unable to get an erection when they're overcome by sexual performance anxiety.
Overcoming Sexual Performance Anxiety
If you've got sexual performance anxiety, see a doctor -- someone with whom you feel comfortable discussing your sex life. The doctor can examine you and do some tests to make sure a health condition or medication isn't causing your sexual performance issues. During the exam the doctor will ask about your sexual history to find out how long you've had sexual performance anxiety and what kinds of thoughts are interfering with your sex life.
Medications and other therapies can help treat erectile dysfunction and other sexual problems that are due to physical causes. If a medical issue isn't to blame, your doctor might suggest trying one of these approaches:
Talk to a therapist. Make an appointment with a counselor or therapist who is experienced in treating sexual problems. Therapy can teach you to become more comfortable with your own sexuality, and it can help you understand -- and then reduce or eliminate -- the issues that are causing your sexual performance anxiety. Men who are worried about premature ejaculation, for example, can try some techniques that help them gain more control over ejaculation.
Be open with your partner. Talking with your partner about your anxiety can help ease some of your worries. Trying to reach a solution together might actually bring you closer as a couple and improve your sexual relationship.
Get intimate in other ways.There are many ways to be intimate without actually having sex. Give your partner a sensualmassageor take a warm bath together. Take turns pleasing each other with masturbationso you don't always have to feel pressured to perform sexually.
Exercise.Not only willworking outmake you feel better about your body, but it will also improve your stamina in bed.
Distract yourself.Try putting on some romantic music or a sexy movie while you make love. Think about something that turns you on. Taking your mind off of your sexual performance can remove the worries that are stopping you from getting excited.
Finally, take it easy on yourself. Don't beat yourself up about your appearance or ability in bed. Get help for sexual performance anxiety so you can get back to having a healthy and enjoyable sex life.