Let me again reassure you that problems with anxiety are among the most readily treatable psychological issues. The sexual healing program will work for your sex-related anxieties. But the cure is behavioral in nature. That means you must change your behavior. To change anything you must be willing to at least try. I encourage you to give the program presented in this book a try. I believe you’ll feel pleased and empowered with the results of your efforts.
chapter 30
Healing Vaginismus
Although vaginismus feels very scary and hopeless to the woman who experiences it, it is the sexual dysfunction with the highest cure rate: over 95 percent, especially in the case of acquired vaginismus. Essentially, once you have experienced one instance of successful penetration with a penis, you are cured. Read Chapter 29, “Healing Sexual Aversion Disorder,” very carefully. Since vaginismus is a phobia (the fear of penetration), many of the concepts outlined in that chapter will apply here also.
The traditional treatment for vaginismus involves the use of dilators, which are rods of graduated width starting with one about the size of a Q-tip. The largest dilator is about the size of an average penis. The woman learns to insert the dilators, beginning with the smallest and moving to the largest. She also learns to breathe and relax her PC muscle as she inserts each dilator and allows it to remain in her vagina for a few minutes.
To cure vaginismus, I could just advise you to go out and buy a set of dilators and learn to use them. But I have a few objections to the use of dilators. One is that they are a prescription item and are therefore expensive. Also, inserting something the size of a Q-tip into your vagina is actually more difficult than inserting a small dildo. When inserting a Q-tip, it’s easy to miss the vaginal opening and hit a vaginal lip or your urethra by mistake, which could be painful. Plus, using dilators is neither fun nor sensual. Dilators do not help you get comfortable with the five penetrations described in Chapter 12. You already possess an alternative to dilators that is fun, free, and easy to use: your own fingers.
Progression of Exercises for Vaginismus
If you are trying to heal vaginismus, you should do the breathing and relaxation exercises in Chapter 16 on a daily basis. You should also do the sexual fitness exercises in Chapter 17. Pay special attention to the PC muscle exercises, since this is the muscle group you have a problem with. Make sure that you have located the muscle and are exercising it correctly. Focus on the part of the exercise in which you relax your PC muscle after tightening it. None of the exercises in Chapters 16 and 17 should cause you a problem, as none of them involve penetration. You should also be able to do the basic partner sensate-focus exercises in Chapters 19 (face caress), 20 (back caress), and 21 (front caress). When you get to the genital caress (Chapter 22), have your partner caress just the outside of your genitals. Don’t attempt finger penetration if you are still afraid of it. At this point, use the exercises in this chapter instead of the genital caress.
In addition, start the self-touch exercises in Chapter 18. When you get to the vaginal self-caress, if you can’t do it as described, that’s fine. Break it down into two different exercises, an external vaginal caress (the clitoris, inner and outer lips, and pubic mound), and an internal caress (the inside of the vagina). If you can only do the outer vaginal caress because you can’t yet insert a finger into your vagina, that’s okay. You can break the genital caress down into baby steps. I’ll describe how to do this soon. First, there are a couple of other specific exercises I want you to do that involve the PC muscle.
Exercise 80. PC MUSCLE FOR VAGINISMUS
Lie on your back. Relax and breathe. Put some baby oil on your hand and do a genital caress on your external genitals. Now rest one hand lightly over your vaginal opening. Do your PC muscle exercises with your hand resting on your vaginal opening. Squeeze your PC muscle, hold it for two or three seconds, then relax it. Do twenty-five repetitions, all with your hand resting lightly over your vaginal opening. If this exercise causes you to be so tense that your hand isn’t relaxed, instead of using your whole hand, just lightly rest one or two fingers on your vaginal opening. As you do the exercise, you will be able to feel your vagina slightly opening and closing each time you tense and relax your PC muscle.
Exercise 81. ADVANCED PC MUSCLE FOR VAGINISMUS
Do this exercise as described in the exercise above. Rest your hand or a couple of your fingers lightly against your vaginal opening. Instead of squeezing your PC muscle and holding it for only two seconds, slowly squeeze it to a count of five, hold it for a count of five, and then relax it for a count of five. This is similar to the regular PC muscle exercise, but you are drawing it out so that one entire repetition lasts about fifteen seconds. Work your way up to ten of these advanced squeezes per session.
Shaping for Vaginismus
Once you are able to caress the outside of your vagina and do the above PC muscle exercises, you are ready to set up a shaping program similar to those I described in Chapter 29 for sexual aversion disorder. Always remember that your eventual goal is to be able to have sexual intercourse with your partner inserting his penis into your vagina. Accomplishing this will require the following steps:1. Insert each of your fingers, one by one, into your own vagina and hold each one there for a couple of minutes, starting with your pinky finger and ending with your thumb.
2. Insert each of your partner’s fingers into your vagina and hold each one there for a couple of minutes, beginning with his pinky finger and ending with his thumb.
3. Insert a small (three- to four-inch-long) dildo into your vagina and hold it there.
4. Insert your partner’s flaccid penis into your vagina in the side-to-side scissors position and leave it there without moving for ten minutes.
5. Insert your partner’s erect penis into your vagina in the female-superior position and hold it there for five minutes without moving.
6. Insert your partner’s erect penis into your vagina in the butterfly position and hold it there without moving for five minutes.
7. Insert your partner’s erect penis into your vagina in the side-to-side position, the female-superior position, and the butterfly position. You thrust, but your partner doesn’t.
8. Insert your partner’s penis into your vagina in any position and have your partner move.
9. Your partner inserts his erect penis into your vagina in any position and you both thrust.
Do each of the above steps as a full sensate-focus exercise. Start with spoon breathing and shared focusing caresses, and give your partner a genital caress either before or after your part of the exercise. Finish with spoon breathing and partner feedback. Use plenty of lubrication for each of these steps. For these exercises, you really can’t use too much lubrication.
If you are able to work through the above progression, do two versions of each step. Do one version in which you keep your vagina relaxed, and do another version in which you do your PC muscle exercises around whatever is inside your vagina—a finger or a penis.
If you are too anxious to be able to work through the above progression of steps, you can break each of the steps into smaller steps. Here is an example showing how you could break Step 1 into a series of smaller steps. You could do all of these baby steps in one session, you could do all of them in one day, or you could do just one baby step per day.
Step 1 is to insert each of your fingers into your vagina and hold each one there for a couple of minutes. First, lightly rest your pinky finger along your vaginal opening for two minutes. Then insert the first joint of your pinky finger into your vaginal opening and hold it there for two minutes (or one minute, or thirty seconds—whatever works for you). Breathe normally and relax all of your muscles, especially your PC muscle. Insert your pinkie finger into your vagina up to the second joint and hold it there for two minutes. Breathe and relax. Insert your pinkie finger all the way into your vagina and hold it there for two minutes. Breathe and relax.
You can see that you can break all nine steps in
to a series of smaller steps. You could insert each of your fingers one joint at a time, and each of your partner’s fingers one joint at a time. When it comes time to use a dildo, buy a soft rubber one, mark divisions on it in ink, and insert it a little farther each time you do an exercise. When it comes time to insert your partner’s penis, you don’t have to mark divisions on it. Just take your time and insert half an inch or so at a time and hold it there.
Proceed at your own pace. You could do several finger joints a day or only one. It doesn’t matter, as long as you are always either reinforcing a previously successful step or trying a new one. That way you are always moving in the direction of your goal.
If you choose to do this shaping approach, you should make a series of charts to review your progress, and you should set up a reward system for yourself. I described how to do that in Chapter 29.
There is another way to structure an experience to heal vaginismus, based on the five penetrations I talked about in Chapter 12. Remember that those five penetrations are a tampon, a medication applicator, a speculum, a finger, and your partner’s penis.
To heal vaginismus based on the five penetrations, buy a box of small-size tampons (I think the size is called “Junior”) and a package of yeast-infection medication that includes an applicator. Buy the type of tampons that have a plastic applicator. They’re much easier to insert than the cardboard kind. Ask your gynecologist to give you a speculum, or call a women’s health center and see if the center can provide you with one.
Work through each of these penetrations in the way I describe for finger and penis penetration; that is, break everything down into baby steps. For example, take a small tampon and make ink marks every half inch along it. For the first exercise, just rest the tampon against your vaginal opening. Remember to relax your PC muscle and breathe. Next, using plenty of lubrication, insert the tampon into your vagina up to the first mark, then the second mark, etc. Hold the tampon in place at each mark for two minutes (start with smaller increments of time, if necessary, and work your way up to two minutes). Remember to breathe and relax your PC muscle. Then actually push the applicator in and insert the cotton part of the tampon. Leave it in for a couple hours. When you remove the tampon, be sure to relax your PC muscle. If you have never done it before, removing a tampon is an unusual sensation that takes a few times to get used to. Once you are able to insert a small tampon comfortably, work your way up through the other sizes until you can comfortably insert the size labeled “Super Plus.”
Do the same progression for the medication applicator. When it’s time to use the speculum, make ink marks on it, insert it sideways, and hold it. Then insert it sideways and turn it so that it’s pointing the same way it would during a pelvic exam. Have your gynecologist or someone at a women’s health center show you how this works if you’re unsure. Then get to the stage where you can open the speculum inside you. You don’t have to open it all the way the first time. It has ratchets so that it can be partially opened. Once you are able to open the speculum inside of yourself, it would be a really good idea to take a flashlight and a mirror and look at the inside of your vagina. This will help demystify things for you.
The other two penetrations are finger and penis. Work through them in the way I described above, using the shaping approach.
Exercise 82. ALTERNATING INSIDE AND OUTSIDE STIMULATION
You can do this exercise after you have completed a shaping program using either your fingers and your partner’s penis or the five penetrations. You can do the exercise either by yourself or with your partner. If you want to do the exercise by yourself, lie down, relax, and give yourself a genital caress using plenty of lubrication. Caress your clitoris for a minute. Remember to breathe and relax. Now relax your PC muscle, slide one of your fingers into your vagina, and caress the inside of your vagina for a minute. Continue the caress for ten to fifteen minutes, alternating a caress on the outside of your vagina with one on the inside.
If you want to do this exercise with your partner, use the side-to-side position. Put plenty of lubrication on your vagina and on your partner’s penis. Hold his penis and use it to caress your clitoris for a minute. Then relax your PC muscle and insert all or part of your partner’s penis into your vagina. Keep your hand on his penis and use it to caress the inside of your vagina for a minute. Alternate caressing the inside and outside of your vagina with his penis. It doesn’t matter whether he has an erection or not for this exercise. You can do it either way. You could also repeat this exercise in different positions.
A Possible Medical Solution?
Many physicians and psychologists have recommended drugs such as tranquilizers to help women relax enough to allow penetration. Alcohol has also been recommended. I don’t believe these strategies work, because you can develop a tolerance to tranquilizers and alcohol, meaning that you will gradually need more and more of the drug to achieve the same level of relaxation.
I was talking with my gynecologist recently about vaginismus and sexual pain. He has seen many cases of these conditions and has been frustrated because many of his patients have been very difficult to treat. He believes that both vaginismus and sexual pain are due to lifelong chronic tension in the PC muscle. He told me that he and his colleagues are considering the use of Botox injections to relax the PC muscle, the same way it relaxes the facial muscles that cause frown lines between the eyebrows. As of this writing, I have not read anything about this line of treatment for vaginismus, but it will be interesting to see whether Botox is approved for this use at some point in the future.
Additional Suggestions for Comfort with Penetration
Here are some additional facts about the vagina and tips that may help you get more comfortable with penetration. One of the most common mistakes made by women with vaginismus is trying to insert something (whether it’s a penis or a tampon) at the wrong angle. The vagina doesn’t point straight up. When inserting a tampon while standing up, aim it toward the small of your back. Even the most experienced tampon users occasionally experience vaginal dryness and miss the opening or don’t insert the tampon far enough and have to take it out and use another one.
If you want to practice inserting a dildo, the best position to use is the butterfly position—on your back with your pelvis tilted and your legs spread. Point the dildo toward the small of your back. It’s not going to hit anything. Use plenty of lubrication.
The best way to learn how to insert a finger is to smear plenty of lubrication all over your vaginal lips and then just rub a finger all over the whole area. You will discover a place where your finger slides in. That’s your vaginal opening.
If you are working through the progression of exercises using your fingers and your partner’s penis, you may make an unexpected breakthrough. When you attempt to insert a half inch of your partner’s penis, the whole thing might slide in. What should you do? Enjoy it! If you are able to experience penetration and it feels okay, go for it! Women are often spontaneously cured of vaginismus in situations like the one I have just described. Remember, once you successfully experience comfortable penetration, you’re cured.
When you are able to experience penetration with your partner’s penis in all the different intercourse positions, continue your sexual education by doing advanced sensate-focus exercises like the peaking and plateauing processes. These are described from the woman’s point of view in Chapter 26. Or you could go through any of the other exercises in the female arousal and orgasm chapters to learn more about your arousal and orgasm triggers.
The difficulty with inserting a penis is that there’s a person attached to it. You don’t just aim the head of the penis toward where you think the vaginal opening is and push. There’s kind of an art to it. Use plenty of lubrication, and start by gently inserting your fingers into your vagina to open it up and to make sure there’s lubrication all along the vaginal canal, not just at the opening. Rub your partner’s penis up and down, over your clitoris and vaginal lips, until it f
eels some give and slides in.
One of the biggest psychological issues with women who have difficulty with penetration is their feeling that penetration is not under their control. They view a man’s penis as a kind of weapon that is forced into them. Healing yourself of vaginismus will ultimately require you to realize that you have a choice about whether or not to have sexual intercourse. The exercises presented in this chapter should help you to tap into your sense of empowerment about your sexuality.
chapter 31
Healing Sexual Pain
This chapter deals exclusively with treating female sexual pain. I know of no treatment options for men who experience psychologically based sexual pain. When men experience pain during sexual intercourse, in the majority of cases a physical cause can be found for the pain.
If you have sexual pain, you should first do the breathing and relaxation exercises in Chapter 16. Then start the sexual fitness exercises in Chapter 17. When you do the self-touch exercises in Chapter 18, leave out any exercises in which you explore the inside of your vagina if they cause you pain. For the basic partner exercises in Chapters 19 through 22, do all of them except the internal genital caress if it causes you pain.
If you have both vaginismus and dyspareunia, or if you have superficial dyspareunia (pain at the vaginal opening), do the progression of exercises in Chapter 30 instead of the exercises in this chapter. I think they will work better for you. The progression of exercises in this chapter is really intended for women who have deep dyspareunia (psychologically based pain inside the vagina during intercourse).
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