Fear of Dilators ! Was-----> How do I tell my PT)

May 20, 2008

(Info on Vaginismus here)

awwh

You poor thing Beth. *sigh* What a shame and I'm so sorry you're feeling so browbeaten hon and I sure don't blame you... arghhhhhh but you are NOT a wussy failure, not at all.. Nature makes us flinch or get anxious if we know pain is going to be involved, sounds normal to me. *smile*

Hon I hate to probe but have you had penetrative sex yet? If so does that hurt you? (forget about the dilators) I'm trying to understand hon if you have pain with reg. sex and if it's actual tissue damage OR if it's more muscular like vaginismus. Makes a big difference and I'm sorry if you've told us I don't remember.

It seems to me that someone pushing a dilator on you like that (no pun intended *smile) sure isn't the way to go if it were me if it were either case. Hon with that anxiety level alone for now I'd forget about the dilators, (but I'm speaking if it were me)... If it's a tissue problem that's causing that pain you need to get the skin healthy again and I'd definitely do that 'before' 'I'd' even try a dilator. If it's V tissue that's ripping or tearing or splitting that must be conditioned first (fed & nourished) so that it has that elasticity to stretch and not tear.... if it's vaginismus that's different and there are various things you can do hon, but keep in mind vaginismus can be a secondary issue because of tissue pain... that's common too (and understandable). And then I'd work on tissue healing 'first' and then the vaginismus if it were 'me'...

I'm going to just make a supposition that it's vaginismus (and could be completely wrong) but I have an article, the link is dead or I'd send that, and I'll add it below hon for what it's worth. Again I am so so sorry you have to go thru that and perhaps an antianxiety med like the Atavan or Xanax or Valium etc., is something to consider right now. I would. You need to relax not for the dilator issue so much but for your own nerves hon. Just to not think about it and break that loop or chain of thought with people pulling you every which way.

Anyway here's that article... and it's from Dr. Allan Gordons pain management center at Mt. Sinai in Toronto, Canada. He used to be with us here at the group but the link like I said isn't effective any longer. Note within here he even mentions our group. *smile* You can tell this is old as he says we're at 'e groups' They owned us before Yahoo bought us out.. that's how long we've been in existence. *grin* (whew* talk about time flying) but when you click it, it does take you to our Yahoo group..

What is vaginismus?

Vaginismus is a spasm in the musculature of the outer third of the vagina which makes insertion difficult or impossible. For some women, this muscle spasm is painful; for others, it is not. Most women experience pain if they try to insert something in spite of this spasm.

Is vaginismus always caused by abuse?

No. Some research suggests a correlation between vaginismus and abuse, and other studies show no relationship at all. Many women with vaginismus have been abused, and many have not. Just because you've never been abused doesn't mean you can't have vaginismus, any more than being abused would guarantee vaginismus.

What causes vaginismus?

It is widely believed that in most cases of vaginismus, the spasm is triggered either by pain or the anticipation of pain (emotional or physical pain). Much like the way an eyelid closes when something comes to close to the eye or a muscle flinches in response to an imminent punch, vaginismus is like a vaginal flinch. It is in some sense protecting the area, even though the woman doesn't want it to. Some women have fears or guilt regarding intercourse, others have physical pain problems, and still others have no obvious cause for their condition. One perplexing aspect of vaginismus is that often the spasm remains long after the woman has dealt with any anxieties or physical problems. So learning to control and eliminate this spasm is how one cures vaginismus.

If I have pain with intercourse, then do I necessarily have vaginismus?

Not necessarily. Painful intercourse can be caused by any number of factors, and vaginismus isn't even the most common. Often, painful sex due to other conditions may lead to vaginismus, so even if you do have vaginismus, you may have another underlying primary cause of pain.

The most common cause of chronic painful sex (or painful attempts at sex, depending on the severity) is vulvar vestibulitis syndrome (VVS), which is one of a number of vulvar pain disorder. VVS can occur at any age, and often with no obvious cause and often with no visible symptoms. It is simply an enhanced sensitivity in, on, or near the vaginal opening. It should not hurt to touch any part of your vulva. If it does, you should look into the possibility that you may have a vulvar pain condition. They are extremely common, and only seldom diagnosed. Most women suffer in silence. Most doctors do not routinely test for VVS, but the test simply involves poking certain areas (corresponding to your vestibular glands) with a Q-tip and seeing if you have pain. There are other problems which can cause painful intercourse as well, including lichen sclerosis (a skin condition), interstitial cystitis (involves the bladder), essential vulvodynia (which causes nearly constant pain), and others.

These conditions are not widely understood or even recognized by many doctors, so most women with these disorders (especially young women) are likely to be misdiagnosed initially with vaginismus. If you suspect you have one of these disorders, treatment by a specialist is recommended. A few resources to help you find out more about these conditions are the VulvarDisorders list on egroups, <---(NOTE* this is us *smile*) Vulvodynia.com, which has a very useful FAQ, The Vulvar Pain Foundation, and WellWeb.

In short, if you have pain that is not the result of a muscle spasm, then you have something besides (or, possibly, in addition to) vaginismus.

How can I cure this?

Many women, though not all, find it necessary to treat the underlying causes of their vaginismus. For some this will involve therapy if emotional issues are involved, and for others they will have to treat vulvar pain conditions, while still others may not need to focus on what initially caused their problem (some may not even know their cause), and just focus on controlling the muscle.

Learning to control the muscle can be done in many different ways. The most common way is to gently insert progressively larger objects (called "dilators") into the vagina so that the muscle spasm is unlearned. Two excellent sources on the web for instructions on how to use dilators are http://www.med.umich.edu/obgyn/vulva/sandp.html(you have to scroll down a bit to find the right section), and http://www.marriagebuilders.com/graphic/mbi5049a_qa.html (scroll here too).

Other techniques our members have found helpful include relaxation exercises, stretches, biofeedback-assisted muscle rehabilitation, and focused exercises such as in Pilates.

What are dilators and where can I get them?

"Dilators," in this context, don't actually dilate, so it's kind of unfortunate terminology. The word refers to any objects inserted vaginally to slowly condition the vaginal muscles to not tense up during penetration attempts. These can be candles, fingers, tampons, vegetables, dildoes, vibrators, or so-called "medical dilators." The medical ones aren't significantly any different from dildoes, except that often a prescription is required, they are not available in festive colors, and in some cases, your insurance may cover them.

All of the different options listed here have been tried with some success. Depending on your financial situation, whether you are being treated by a doctor or self-treating, and your personal preference, any of these may help you. Some women prefer vibrators because they find the vibration tends to relax the muscles, while others prefer non-vibrating dilators.

Medical dilators are typically provided by physicians or therapists, and dildoes and vibrators may be purchased at sex shops. Two shops that have online ordering and discreet delivery are A Woman's Touch and Good Vibrations, but nearly every sex shop will carry products of this sort.

Should I use lubricant? If so, what kind?

Yes! Especially if you are just practicing with dilators, you may not be aroused enough to provide adequate lubricant. Many drugstores carry personal lubricants. The most common ones available are KY (liquid is more highly recommended than the jelly) and Astroglide (also recommended). Many women prefer lubricants that are available at sex shops, for various reasons. Visit any online sex store and you will see many possibilities to choose from, and often the stores have good descriptions to help you choose. One popular lubricant is called Liquid Silk, and is only available from sex shops.

Are there any good vaginismus resources on the web? In Print?

Yes. But they are few and far between. If you join the Vaginismus internet list (see below), you will have access to links their members have found useful at: <http://www.egroups.com/links/vaginismus>

One resource that many women have found incredibly useful is support groups. There are three main support groups for vaginismus. One group (the group for whom this FAQ was originally written) is just for women with vaginismus, and is on egroups.com under the name Vaginismus. Another is just for partners of women with vaginismus, and is called VaginismusPartners. A third is for women with vaginismus, their partners, and medical professionals. It is called 1Vaginismus.

There is only one book about vaginismus, and it is out of print, though you may be able to find it at a used book store or a library. It is by Valins, and is called: "When a Woman's Body says 'No' to Sex: Understanding and Overcoming Vaginismus." This book deals with vaginismus that is due to emotional issues, so many women with emotional issues around sex find it very useful, while women with pain are less likely to relate to this book. It contains personal stories about dealing with vaginismus, as well as detailed treatment options.

Another highly recommended book, which is in print, is called "A Woman's Guide to Overcoming Sexual Fear and Pain," by Aurelie Goodwin and Marc E. Agronin, MD. This book is in workbook form, with exercises and questions to work through.

Where can I find a therapist in my area?

Whether your vaginismus is due to emotional issues or not, many develop sexual issues as a result of having vaginismus. For many, support groups such as ours help a lot, and for some, professional therapy is useful. One option is to write our list and see if other women in your area have found good therapists who are knowledgeable in this area. A resource for Americans is the American Association of Sex Educators, Counselors, and Therapists, which has a searchable list of sex therapists throughout the country.

Maybe that'll help a little bit? Take care hon and hang in there. HugsDee

May 21, 2008

--- Sounds like you need a new PT!

My first PT was like that and would say things like, " How do you know

if this is working if you never try? "

My current PT, who actually helps, told me NOT to try sex or dilators

for a long time, until she could comfortably insert a finger for

internal work. Once she could do that, I knew I could do that smallest

dilator, at least, and I would apply my lidocaine and lubricant and do

my deep breathing and just put it in slowly and let it sit - no moving

it around or anything. It's a very slow process. And if you are doing

it and it hurts, you are only contributing to the pain cycle and it

won't get better. Have you consider trying estrace to make the opening

stretchier and more elastic?

Get a new PT if you can! =)

Melinda

May 21, 2008

Hi, I told my PT today about you, and she was just horrified on

how your PT was treating you. Her practice is only for “when sex hurts”. She

see’s nine patients a day and said she would never tell a patient to do

something that was uncomfortable or they were afraid to do. Some patients never

have to use dilators and they still get well. As Melinda said it is a very long

process and if possible, see if you can find a more compassionate PT.

nne

From:

VulvarDisorders [mailto:VulvarDisorders ] On

Behalf Of spanishmiss430

Sent: Wednesday, May 21, 2008 6:50 PM

To: VulvarDisorders

Subject: Re: Fear of Dilators ! Was-----> How do I tell my PT)