Vaginismus Symptoms: A Case Study
Vaginismus symptoms started during my 20’s. I was never able to insert a tampon and was never able to have any type of penetration despite trying during my 20s and while in college. With each try, it caused an excruciating and burning/stinging pain. Because of this, I never visited a gynecologist. I met my now husband at the age of 24. I tried to push him away before we had the chance to become intimate because I knew I would not be able to have him penetrate because of the pain. Instead of running for the door, he stuck by me and was there for me through everything. We were intimate in other ways but every single time he would even try to insert a finger, it caused horrific pain and all of my muscles including my thighs tensed up. We were married when I was 29.
Honeymoon. Vaginismus symptoms magnify
Our honeymoon was fun and memorable and, again, we were intimate in other ways but I was devastated and felt like a failure because we were not able to have intercourse. I felt like this quite a bit actually and the condition caused depression (a feeling of hopelessness that I would ever be cured and able to have intercourse) and considerable anxiety (fear of what the future would bring if I was never cured – i.e. divorce, continued or worsening depression, etc.).
Following our wedding, I made an appointment to see a gynecologist for the first time. I researched my vaginismus symptoms online, including excruciating and burning pain and feeling like “hitting a wall” of resistance that both my husband and I felt with attempted penetration and it led me to the diagnosis of vaginismus. I printed out my symptoms (1-page handout) and brought it to my first OB/GYN exam. I went to the appointment alone and did not tell anyone, including my husband. As soon as I got into the parking lot of the office, I felt sick to my stomach, dizzy, heart-racing, difficulty concentrating, and like I wanted to cry. I was also over an hour early for the appointment. Despite feeling like passing out, I went up to the office and checked in. I changed for the exam and got on the exam table and started to cry, shake uncontrollably, and feel all of the aforementioned parking lot symptoms to a heightened degree. I then met the doctor and she asked what was wrong. I handed her my 1-page handout on vaginismus that I had prepared and said I had this and that I was very uncomfortable being there. She put the paper to the side and did not read it. She asked me to lie down and try to be comfortable and this was impossible for me to do in any way. I was crying hysterically at this point and my entire body was tense and shaking. She became very frustrated and asked me to “just relax” and said she would just use the baby speculum (which never worked). Even when she attempted to just examine the outside area of my vagina, it was impossible because of my hysteria and she stopped the exam and asked me to get dressed and then meet her in her office. I was so embarrassed and humiliated at that moment and well-after. I met in her office and she said that she would never try to examine me again until I visited a sex therapist that she recommended. I never did this.
In early 2011, I developed significant abdominal pain and was unable to tolerate any form of exam or ultrasound because of my condition. I had an abdominal MRI which showed cysts and had laparoscopic surgery for their removal. The surgeon, perplexed by vaginismus and the fact that I was now in my early 30s and had never had a gynecological exam, asked me if he could do an exam while I was in surgery. I consented. Following surgery, he explained that he did the exam and there is nothing wrong with my anatomy or with me physically and, thus, I should be able to tolerate an exam fine. I refused and, again, felt humiliated, ashamed, and like a freak of nature.
Despite all of this, I continued searching for vaginismus treatment and in May of 2011, read a testimonial from a woman in an online vaginismus Forum who had received Botox and was now able to have intercourse. I immediately researched this which led me to Dr. Peter Pacik. I contacted the office and scheduled my procedure for June of 2011. On my procedure day, all of the same symptoms that I previously described came back and were very bad. On the ride to the office, I experienced the following symptoms: threw up in the car, extreme fear, crying hysterically, body shaking uncontrollably, feeling confused, difficulty concentrating, etc. . .
Upon arriving to the office, while I experienced all of these symptoms, I was able to go into the office with my husband’s support as well as changing and getting ready for the procedure with his support and that from Dr. Pacik and Ellen. I still, however, was beginning to have even greater anxiety symptoms and asked to receive IV Valium. After receiving this, I don’t recall anything until the time I woke up from the procedure with the largest dilator in place. Once I realized this and practiced dilating with my husband, my hysteria and level 10,000 anxiety was a zero. I completed the treatment program which addressed both the physical component of vaginismus (resistance, dilator training, etc.) as well as the emotional aspect of the condition (tips for transitioning to intercourse, relationship building, etc.).
I diligently practiced with the varying sized dilators for 2 hours per day and sleeping with one every other night and I made love to my husband 1 week following the procedure. We both were elated. Thereafter, I went to my first GYN exam 4-months post-procedure. I dilated in advance for 2 hours with the largest dilator and, while I was nervous because of my past experience with an exam, the anxiety level was around a 4 compared to a 10++++. The gynecologist was kind and caring and knew my history. She talked to me through the exam and removed the largest dilator. Immediately after doing this, she inserted the speculum and I felt no pain or resistance whatsoever. It was the best feeling in the world and completely opposite of what happened in the past. In fact, that evening, we celebrated my first successful GYN appointment with dinner at a nice restaurant in the city.
Today, now almost 3 years post-procedure, my husband and I continue to enjoy pain-free and enjoyable intercourse and I have tolerated many GYN exams, internal ultrasounds, and even having a catheter inserted for two full days entirely pain and resistance-free and VAGINISMUS FREE!!! It is one of the best feelings in the world and makes every day worth celebrating!!!
Commentary by Dr. Peter T. Pacik
This is the story of vaginismus. The vaginismus symptoms she experienced are typical of most of our vaginismus patients. This patient struggled for 15 years with severe Pacik grade 5 primary vaginismus. She had hypnotherapy which was of value in learning to relax but did not result in an ability to achieve intercourse. Lubricants and excess alcohol were also not helpful. She notes “I changed for the exam and got on the exam table and started to cry, shake uncontrollably, and feel all of the aforementioned parking lot symptoms to a heightened degree”. This is characteristic of a “fight or flight” visceral reaction over which the patient has no control and forms the basis of what is called severe vaginismus.
Doctors trying to treat a condition that they are not familiar with often make condescending remarks such as “just relax”, “Have a drink”, “First time jitters, you will get over this” and the list goes on.
She continues “Following surgery, he explained that he did the exam and there is nothing wrong with my anatomy.” Spasm of the entry muscle is an important component of vaginismus preventing penetration. Spasm disappears under anesthesia. The result is a “normal exam”. However vaginismus is far from a normal condition and this is why a detailed history is so important. Vaginismus cannot be diagnosed under anesthesia.
It has been a joy working with this patient. She achieved pain free intercourse seven days after treatment on July 4th, Independence Day, and continues to have pain free penetration including GYN exams now three years later. She continues to be an amazing advocate for many of our patients.