GUEST POST: Explaining More About Psychosexual Therapy for Vaginismus

Explaining More About Psychosexual Therapy for Vaginismus.

By Kate Moyle, Psychosexual & Relationship Therapist & Partner at Pillow Intimacy App for Couples.

The first thing I would like to comment on, as a Psychosexual Therapist who works with a variety of dysfunctions and presentations, is that as therapists we never underestimate the nerve and strength that it takes to reach out for help for the first time. It’s not uncommon for people to be very nervous about a first appointment, and that’s also compounded by the fact that ultimately the conversation is to do with a part of our bodies that we don’t openly discuss, and that a lot of this relates to sex, a topic that despite being all around us is still pretty taboo.

This also may not be the first time that you, as a woman, have asked someone for help.  There may have been an appointment with a doctor or medical professional, which ultimately would have gone one of two ways, well or badly. Many that come through my door have positively been referred by doctors who have recognised and suspected vaginismus as a diagnosis, and encouraged the sufferer to get further help. ( in whatever form that may be, psychosexual therapy is not the only answer ) But sadly, many leave medical appointments without a signpost or answer, apart from that ‘everything looks normal’, or ‘ you just need to learn to relax’. This is not always the fault of the professional either, more a general lack of training and understanding of conditions such as this, that are what we describe as psychosomatic; which relates to the interaction of mind and body or the understanding that a condition or symptoms are caused by, or aggravated, by psychological factors.

Psychosexual Therapists are specially trained in dealing with conditions and psychosexual dysfunctions such as this, with an understanding of the workings of the mind, and body and how they are in context of an individual- their experiences, background and personal history. Ultimately if you are seeking psychosexual therapy the approach that your therapist will take is a talking and explorative approach in sessions; with setting exercises to be done at home and then fed back and reflected to the therapist, in order that you can then work out how best for you to move forward with a treatment plan.

Each therapist will have their own way and style of working, and it’s important that you feel comfortable with the person that you are working with, it’s your process and you want to feel able to be open and honest with them, not that you are holding back. When you think about the feeling associated with vaginismus itself, it is one of tension, holding back, discomfort and being closed; and although therapy may feel difficult at first this isn’t a feeling that should continue, and you should be able to trust that your therapist can hold the space for you. Feelings of resistance are normal, it is a process of accessing help for a problem, but you should feel able to discuss these and how you are feeling openly in sessions.

In therapy, it will be important for your therapist to have an idea about you, what factors you think are influencing or have caused vaginismus, your background, sexual history and things like your ideas about how you feel about your body, any medications or procedures you have had, and what you have tried to improve your symptoms so far. This early part of the process may involve your therapist taking notes or going through a thorough personal history or what your therapist may call a ‘history take’. This isn’t about them being nosy. One of the best ways I know how to describe it is that it’s like putting the pieces of a jigsaw puzzle in place – it gives us a clearer picture. It’s also worth noting that, although you may be convinced that you know what is going on, this is a fresh set of eyes looking at your difficulty and we may see things that you haven’t connected with your situation that could be influencing it. For example, I have worked with a number of women who have experienced high levels of stress around their periods, which has created negative feelings about their vaginas and vulvas contributing to vaginismus, but prior to therapy they may not have connected it to their symptoms. 

Your therapist will be helping you to make links, and connect ideas such as negative messages that you may have received about your body, being a woman or about sex. For many women who experience vaginismus there are strong feelings of guilt and shame and there are a lot of myths around sex, sexuality and women’s pleasure, so a therapist’s job is to also challenge myths, and educate. Many women don’t have much sex education or knowledge about their own bodies including which bits do what e.g. the clitoris vs the vulva vs the vagina and it’s important to make sure that women have the correct information so that they can make informed decisions about their bodies and have a more complete understanding of what is going on.

It is also helpful to identify your goals for therapy. We all know that vaginismus is about so much more than just sex. It’s about pleasure, enjoyment, intimacy, self esteem and confidence, using tampons, health ( e.g. smear tests ) , relationships and much more. Your goals are unique to you, but don’t feel afraid to tell your therapist what you would like to achieve, as they will work their best with you to try and get you there. A concern for many women is that they would like to have children one day, and if that is the sole focus of your goal then don’t be ashamed to say that, but also think about including pleasure and enjoyment as a part of it. The more your are able to feel good and positively experience what you are doing with anything in life, the more you are going to want to do it, and this can help many women move from a place of sexual functioning to having a more fulfilling and relaxing sexual and intimate life.

Like any process, what you put into therapy you will get back.  Of course you will be tackling difficult and personal material, and exercises such as starting to use dilators, explore your body and discover different types of touch and what feels good for you, but the challenge itself is so often in the doing of these exercises and overcoming those boundaries as much as it is what you get from them. Your therapist will help you to tackle these steps one stage at a time, it’s not like jumping in at the deep end. The aim of every step of therapy, for example starting to use a set of dilators is that you start small and build up. This way of working aims to help you to become desensitised to the strong aversion or anxious reaction that you may currently be experiencing, and you will be focusing on mastering one stage before moving onto the next. What this also offers you is more sustainable progress as you build up to having a different foundation e.g. your comfortable minimum becomes using the first size of dilator or one finger and you then have the knowledge and experience that it is possible for you. For many women with vaginismus this first step can feel like the hardest but also one of the most rewarding. It’s not uncommon to hear sufferers say, ‘ I just don’t think anything can fit’ or ‘I’m not normal’ or ‘it’s too tight to get anything in there’ and at the time this may not be true for that person, it may not have ever been a possibility for them, but they have also not been taught, or helped or shown how it could be possible. When you think about how we do almost anything else in life, we learn but when it comes to sex, we just expect or feel that we are expected to instinctually know what we are doing, and although a psychosexual therapist will not physically be hands on showing you as it is a talking only practice, therapy is a process of education.

 Therapy is also about understanding the cycle of vaginismus and how you react in the moment when vaginismus happens. If we can break this down and start creating changes for you, then you will start to learn more about yourself. Sex for example shouldn’t cause you pain unless there is a reason for it, but many women tighten their muscles in the anticipation of pain which ironically is more likely to cause it as it creates tension.  If you are expecting something to hurt you aren’t going to be lying there relaxed just waiting for the pain, it is natural for your brain and body to want to prepare you for it. This again will be challenged in therapy. Exercises and the more you do them and more you progress will help you to challenge the assumption that penetration = pain and will aim for you to change your messages around the act of penetration so that you can relax more. Learning to control the pelvic floor muscles is an important part of this, but also breathing techniques and exercises to communicate to your brain that you feel calm.

So, to finally focus on what I name as exercises in this piece, each Psychosexual Therapist will work differently with each client, but dilators, ( my preference is for this set from Sh! As they are soft silicone and less medical and you have an optional vibrator if you would like to use it ) dilators will very likely be a part of the physical exercises. You may decide to start or prefer to start by using your fingers, again the preference is personal. Others would like to start with a smaller, and I would recommend as simple as possible which is why dilators can be easier, but it’s your choice) sex toy and then once they feel comfortable with that, then purchase a slightly bigger size. But exercises will not just be limited to dilators, and may also include touch exercises which are also about learning about your vulva and parts of your anatomy like the clitoris so that you can feel less uncertain of the sensations and more sure of what to expect, which can also help you to calm that instant panic / pull back feeling or reaction. 

It’s also important that you know what feels good for you. Not for your current or future partner, but for you. The best way to do this without feeling under pressure is on your own. This may start by paying more attention to yourself in the bath or shower, exploring your body in a way that feels safe for you, or it may be starting by holding your hands on yourself outside your clothes or underwear and then moving them inside when you feel more familiar. Again, these exercises are all determined on a case by case basis and what may feel right or comfortable for one person may not for another, working through something like vaginismus is a process, there isn’t a clear start and a clear end, for many it’s about how and what they are feeling. Those presenting for therapy will also be at different stages of vaginismus, already using dilators and finding themselves stuck at a certain point, or having only just discovered that they are not the only person in the world that is feeling this way and that there is a name for this condition. It is also worth noting that some women are able to have a non-penetrative sex life with their partner just without penetration, again it’s personal but some women feel comfortable with oral sex or clitoral stimulation and are able to be orgasmic but experience vaginismus when it comes to trying penetrative sex , inserting fingers or tampon use; others feel uncomfortable with any form of sexual touch or activity. I am also a partner at Pillow App for Couples ( ) which provides audio-guided follow along intimacy ( not sex ) episodes for couples that can help couples to connect and feel close in a non-sexual way. If sex is something that is not currently possible for you don’t be afraid to be creative in ways that you can be intimate if you are in a relationship.

The important thing to think about is where you are, and where you would like to be. Don’t compare yourself to others, do read other people’s stories and blogs and gather information but remember that we are all unique and how this condition impacts you will be personal to you, although many women describe a huge sense of relief when hearing the stories of others as there is a sense of ‘that’s how I feel’ the path through is different for everyone. Treatment for vaginismus is there and although it may be one of the scariest things you have ever done, don’t let the fear of trying stop you.

Kate is a member of the College of Sex & Relationship Therapists (COSRT). To find a sex & relationship therapist in your area, click here.