GUEST POST: Pregnancy with Vaginismus

Network Member Nickey has written this really interesting piece, describing her experience of pregnancy and birth, with vaginismus:

 

Hi everyone!
My name is Nickey, I have primary vaginismus, and I’m currently pregnant for a second time. When my husband and I decided that we were ready to start a family, I had an extremely difficult time finding any personal stories about being pregnant and giving birth with vaginismus. I happy to share with you some of my experiences, from discovering I had vaginismus to the after effects of giving birth vaginally.
 

Part 1 – Discovering Vaginismus:

I was diagnosed with primary vaginismus in 2012.

The first time I tried inserting tampons my mother found me in the bathroom crying because it hurt to the point where I could not get it in. She reassured me that I didn't have to use tampons, that pads would be just fine.  I didn't think anything was out of the ordinary for not being able to use tampons (even the smallest ones).   I also wasn't ready for any kind of sexual experience involving penetration when I was in high school or the first half of college. I preferred engaging in other types of sexual activity. I loved my "sex" life. Penetration was never really brought up with the partners I was with at the time. We never ventured to try fingering, intercourse, etc. We just enjoyed doing what we did.

During the latter half of college, I was officially ready to try intercourse. I still had no idea that I had vaginismus at this point. I had been with my boyfriend for many years, we had a wonderful "sex" life, and both him and I were ready to be with each other fully in every sense. We had never tried any kind of penetration before. It wasn't because we didn't want to, it just didn't matter because we loved our sex life how it was.   

Upon trying intercourse for the first time, it just didn't work. It was excruciating and he barley even made it inside of me. It felt like he hit a wall right at the opening of my vagina. We stopped, and he was an amazing gentleman, comforting me as I cried. I was angry, frustrated, confused, sad, and disappointed. I felt like a total freak. I felt broken.

I asked my mother to accompany me to an OBGYN appointment.  I attempted to undergo my first pap smear...it didn't go well. They couldn't even insert the child sized speculum in my vagina because I was so distraught and in so much pain. I was officially diagnosed with primary vaginismus and recommended that I start physical therapy. 

Although I was bummed that I had a sexual disorder, I felt so much relief that I finally had an answer. 

After a few months of physical therapy, I decided to stop going. I wanted to see if I was ready to use some of the muscle relaxation techniques I learned in physical therapy with the dilators at home. I used my dilators for about 5 - 8 weeks on a regular basis.  I would use them 3 - 4 times a week because my vagina felt too sore to use them every single day.   I only ever got to size 1 in those few months. It is smaller than a tampon. My regular use of them came to a halt. It wasn't intentional, other things in my life took priority. A year later I went back to physical therapy. After a few months of going, I stopped again. This time though, I really was ready to use the dilators on my own. I kept up with them for a while. As you may guess, I once again failed to use them on a regular basis.  They were pushed aside because I became preoccupied with planning for my wedding. Remember that boyfriend I tried having intercourse with for the first time? He is now my husband.

 

Part 2 – Making a Baby with Vaginismus:

Shortly after getting married my husband and I decided that we indeed wanted to start a family. Since vaginal penetration is extremely painful I wondered how we are going to go about it. I knew the first step was going off birth control for a few months, but I wasn't sure if I could handle having intercourse or if we should just aim for a splash pregnancy.

For those wondering, it is possible to become pregnant with vaginismus.  

A splash pregnancy is when the male ejaculates semen as close as possible to the vaginal opening without any actual penetration. This can happen both intentionally as well as accidentally. If the semen makes it to the vaginal areas there is a chance of getting pregnant. If penetration is at all possible and ejaculation happens within the first or second layers of the vagina, the chances of getting pregnant are even higher. 

I became pregnant, not by a splash pregnancy, but by tolerating an amount of penetration and having my husband ejaculate inside of me.

I won't lie, the penetration part was painful. I've never had pain-free intercourse.

When I want to attempt intercourse it is a painful and slow process. Even with lube and lidocaine gel (numbing gel) it takes about 20 minutes for him just to make it through the first and second layers of my vagina. The only position that works for us is him being on top while I'm laying on my back. This allows for my body to have the best chance at relaxation techniques as well as optimum vaginal opening with my vaginismus. My vaginal and pelvic floor muscles need time to relax/attempt to stop contracting while he is inside of me. It is a challenge to stay "in the moment/mood" while being in pain. My poor vagina burns, stings, aches, and shoots sharp pains everywhere.  Although my husband is barley moving, he still feels my vaginal muscles involuntarily contracting all around him. The stimulation is enough to cause him to orgasm and ejaculate. Luckily, by the time he is ready, he has made it to my third vaginal layer.

The only times I've had an orgasm with intercourse is when he makes it to this third layer of my vagina and ejaculates inside of me. This extra lube allows for my muscles to finally calm down and allow for slow thrusting movements from him. At this point, I'm finally able to concentrate on some pleasure and push most of the pain to the back of mind. Afterwards, my body is sore and my mind is exhausted. My vagina continues to ache for about an hour after penetration has stopped and I usually have to sit on an ice pack to soothe my pelvic floor muscles. Emotionally I am tired, but extremely proud of myself for being able to have an orgasm from intercourse. 

When I'm ready to attempt intercourse, which isn't often, most of the time we don't make it as far as described above.  My mind is ready to try, my confidence is high, but my vagina and body say NO. It is very frustrating to have such little control over my body when it tells me, "not today." Thankfully, I have the world's most amazing and understanding husband. 

I'd like to say that when my husband and I decided to get pregnant that I fully enjoyed having intercourse and was able to do so by first overcoming vaginismus. The truth is, however, I was in pain for about 3/4 of the time while trying to make a baby. I wish I wasn't, but that is not reality.  Since my husband and I are both very fertile we could have just aimed for a splash pregnancy, but I wanted to try via intercourse.  I have not overcome my vaginismus yet, but I'm very happy that we decided to try to get pregnant anyways. 

 

 

Part 3 – Appointments:

I’ve made it through pregnancy with primary vaginismus and you can too! There was only a few prenatal appointments in which my vaginismus became an issue, the 8-week visit and the final third trimester appointments.

The 8-Week Appointment:

At the 8-week visit, my doctors perform a routine pap smear as well as an internal ultrasound.

For those of us with vaginismus, a routine pap smear is anything but routine. I’ve never been able to have a pap smear before. As like in the past, I was unable to make it through a traditional pap smear and the doctor had to perform a “blind” pap smear and rely on what she could see and feel. The “blind” pap smear is still just as awful as a normal pap smear. Any internal exam is extremely painful for me and during this longer appointment my poor vaginismus vagina had to undergo two penetrations.
 
The second penetration was the internal ultrasound. If my husband and I decide to have another baby and I’m not feeling up for it, I’m going to deny this internal ultrasound. It is extremely invasive for someone like me and I don’t find it 100% vital. It does allow the doctors to confirm if you are having a singleton or multiple babies and helps them figure out exactly how far along the baby is growing. For parents, it makes them feel connected to their babies and helps to take away some anxiety about having a potential miscarriage.

For me the internal ultrasound was just a defeating, agonizing experience. I was in a lot of pain and holding back tears; I couldn’t even enjoy listening and seeing my baby for the first time. It took everything in me to stay focused to get through the procedure. I will say that the doctor I had that day was amazing. After the “blind” pap smear, she could tell how miserable I was and allowed me to insert the internal ultrasound tool on my own.

The internal ultrasound tool is terrifying at first glance. It looks like a wand that is longer and bigger than the largest dilator I own. After 5 minutes of not being able to insert this wand myself, I was ready to give up. The speculum for pap smears felt smaller than this internal ultrasound tool did. After some time and deep breaths, I ended up being able to push past that “wall” my vagina had put up and insert the tool. The only reason I mustered up the strength to get it in was the fact that if I couldn’t do it myself, the doctor was going to step in and insert it for me. Having control over what goes into my vagina, regardless of how painful it is, is much better than having someone else do it.

With the internal ultrasound, my husband and I could see and hear our baby for the first time. Since I was using every ounce of me to concentrate on not having a break down, I felt like I missed out on the whole happy part of the experience. I cried on the way home looking at the ultrasound picture. I was exhausted, and my vagina ached for a few hours.

Days afterwards, my attitude on the experience changed when I looked at the ultrasound. It felt good to be able to have visual confirmation of my pregnancy and made me look forward to becoming a mom.

The Final Third Trimester Appointments:

During the last month of being pregnant, many women want to see how far they are dilated.

Although I was curious, I opted out of being checked.  Having vaginismus made those last few visits an issue for me because I was torn between wanting to know if I was dilated and not wanting to undergo any type of internal exam. In the end, having my last prenatal appointments pain-free won. The doctors and midwives I saw during those last few visits were very understanding and agreed on wanting to keep me as comfortable as possible


When I went in for those final weekly visits, the nurses would give me a gown and tell me to get undress from the waist down so the doctor or midwife could check to see how dilated I was. I would politely mention to the nurses that I had vaginismus and that I wanted to talk with the midwife or doctor before changing out of my clothes to see if it was necessary to be checked. The important part to take away from this is that I spoke up. The midwives and doctors that I saw were very knowledgeable about vaginismus. Since I had a normal pregnancy and was NOT high risk, I was told by several of the doctors and midwifes that it was not necessary to check to see how far dilated I was. They said that unless I was past my due date, having contractions, or the baby was at risk that I could opt out of being checked, which I did and I do not regret at all.

Although I was passed my due date, it just wasn’t worth the pain or anxiety to have a doctor check my cervix. Checking the cervix is just as bad as a pap smear. If you are 2 centimeters dilated it means that the doctor can insert two fingers all the way past the third level of the vagina. If staying relaxed during a pelvic exam is difficult to do normally with vaginismus, adding 40 lbs of baby weight makes it even more difficult. My belly was so big that I could not see my feet and my back hurt no matter what position I would lay in. I truly did not want to be examined while already uncomfortable.

At 11 days past my due date I was scheduled to have an appointment in which they would have to check to see how far dilated I was. Pending on how far, they would then decide which method was best to induce labor and when. I really did not want to be induced and luckily I went into labor just twelve hours before that appointment.

 

Part 4 -  Essential Early Epidural:

When I first found out I was pregnant I was sure that I was going to opt for a cesarean because of my vaginismus. It seemed like the correct choice and I was terrified to put my vagina through the trauma of giving birth. However, one of the doctors told me that she believed all women have a right to deliver vaginally and to not just jump to having a Cesarean, even those of us diagnosed with vaginismus. She recommended that I get an early epidural.

After a few weeks of researching cesareans and epidurals, I decided that an early epidural and a vaginal delivery was the choice for my body.

I ended up delivering my little one vaginally and now I feel like my very own vaginismus super hero. However, now that I have given birth, I know I couldn’t have done it without my very own vaginismus sidekick - the Essential Early Epidural.

Ladies, let me just say that if you have vaginismus and you are planning to deliver vaginally, I cannot express enough the amount of gratitude my mind and body felt by opting for an early epidural. Since I was eleven days late, I have vaginismus, and I was getting an early epidural, the doctors didn’t check to see how far dilated I was until AFTER the epidural was administrated. At the birthing center at my hospital they check to see how far along in labor you are when you are first admitted.  

Personally, I wouldn’t have been able to get through the doctor checking my cervix without an epidural. After the lower half of my body went numb, the doctor wanted to see how far dilated I was. I remember looking down and saw most of his arm disappear and I didn’t feel any pain. I felt a little bit of pressure, but it wasn’t anything that I felt I needed to mention. I can barely handle a Q-Tip penetrating my vagina, let alone an entire hand!

 

Part 5 –  Postpartum Status:

One of my biggest curiosities I had while being pregnant was how giving birth vaginally was going to affect my primary vaginismus.


It has been over a year since I have given birth vaginally with vaginismus and the results for my body have been that my primary vaginismus has stayed the same with a very slight improvement in the penetration department.

During my pregnancy I did not use my dilators at all. I had every intention of starting back up with vaginal stretching, but the reality of pregnancy symptoms (morning sickness, constantly sore back, baby bump in the front, leg cramps, etc) kept me from even looking at my dilators. I went into the hospital ready to give birth vaginally without having over 10 months of vaginal stretching.

’ll admit I felt unprepared in the vaginal stretching department. It is suggested for all pregnant woman to practice vaginal stretching (without dilators, just fingers massaging in circular motions in various layers of the vagina) to prepare the body for a smoother vaginal birth. Vaginal stretching can help with tearing. I’m very grateful that I only had a second-degree tear when my baby came out. There are 4 types of tears that could happen, a fourth-degree tear being the worse and a first-degree tear being the least invasive. Since I had vaginal tearing, I had stitches in my vagina.

once the stitches dissolved (about a month) I was able to investigate the state of my vaginismus. There were three outcomes that I thought of that could happen once I tried penetration with my own finger:

  1. Vaginismus improves, and penetration is significantly less painful. Some of the doctors I had suggested that having a vaginal birth might help with my vaginismus because of how much the vaginal and pelvic floor muscles stretch when pushing out a baby. 
     

2.      Vaginismus stays the same. This seemed like the most realistic outcome to me. Whenever I would take a week or two off from using the dilators*, my vaginal and pelvic floor muscles would revert to being super tight and almost impenetrable again. Although giving birth vaginally is a huge stretch for those muscles, it only happens once during that event. Unless I gave birth 4 times within a week, my vagina would be most likely go back to its mind-of-its-own-super-tight self.
 

3.      Vaginismus would be worse. I’m not sure why some people enjoy telling expecting mothers horrifying birthing stories, but having vaginismus made those stories so much more terrifying. What if my pelvic floor muscle tore too much? What if my vagina went through so much trauma that I couldn’t even touch to touch the opening (nonpenetration) of my vagina without intense pain?

 

I think it is a bit nerve racking for any woman, with vaginismus or not, to explore her “new” vagina for the first time after giving birth. Upon inserting my finger into the first layer of my vagina, I knew right away that my vaginismus ultimately stayed the same. I was elated that it didn’t get worse! As a new mom, still having primary vaginismus after birth was actually a relief.  My body was going through so many changes and constantly looking and feeling like it wasn’t mine (shifting hormones, breasts leaking, baby weight going away, hair shedding, etc). It was nice having something familiar about my body prior to giving birth, even if it was primary vaginismus.

During my second month of postpartum I ended up getting a yeast infection and thrush. After going to the doctors, I was prescribed 7-Day Monistat (cream). I would have to insert a “tampon-like” smooth tube without lubrication into my vagina for seven nights. Before giving birth, inserting Monistat would have taken me at least a half hour to relax my muscles to be able to insert it (and it would be painful). Once I gave birth though, my mental state regarding penetration had changed a bit.

I just kept thinking,

 "a baby came out of your vagina. You pushed a small human being out of there. You can insert a small tube. The tube is nowhere near the size of a human baby's head. Not even close. You are your own vaginal superhero. You can do this!"

 
Giving myself a pep talk for all seven nights surprisingly worked! Delivering a baby vaginally puts things into perspective. I was able to insert each tube with cream with very minimal pain for all seven nights. There was a lot of pressure and it still took about 10-20 minutes to insert the tube each night. Being able to use Monistat vaginally felt like a huge success for my vaginismus. I was able to do it without the pain that I would have had prior to giving birth. I realized that my vagina was slightly looser than it was before giving birth. My vaginismus had stayed the same, but my body and my mental state had changed.
 
After a week of using the Monistat my yeast infection was gone. Unfortunately, I ended up developing an abscess on my perineum (the extremely small space between the anus and the vagina). It was extremely painful! It felt exactly like the pain I had once the epidural wore off in the hospital. It was like I gave birth all over again weeks after my body had started to heal. I had to go back to the hospital and was put on two types of antibiotics. The abscess ended up bursting shortly after.  With the combinations of antibiotics and my postpartum hormones, I ended up with another yeast infection. I had to do another round of Monistat. Again, it took time, patience, and a pep talk to be able to insert the Monistat for another week. Thankfully, I again had little pain and mostly just pressure. 

In terms of sexual penetration, I’m now able to have my husband insert half of the head of his penis into me with no pain. He isn’t thrusting and is only just barely in that first layer of my vagina, but it’s a huge accomplishment for my body!
 
Giving birth vaginally did not cure my primary vaginismus. However, my vagina did get slightly looser and my perspective on penetration has improved immensely. Overall, I’m very happy how everything turned out.

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