We often hear about vaginismus as an isolating condition no one bothers with. So it was amazing to hear from Nina Parnham, a midwife and women’s health practitioner, and her client Sarah. Through communication and initiative, they worked together to improve Sarah’s pain. From physio, to meditation – nothing was off the table!
This really was a team effort, so we got chatting to both of them.
Sarah’s story
After struggling with tampons and painful penetrative sex, Sarah first went to her GP in her early twenties. Unfortunately, she describes her situation as getting ‘glossed over’, and subsequently didn’t have another intimate relationship for nine years.
‘I just assumed my hymen hadn’t been broken,’ she explained.
When Sarah finally felt ready to see a medical professional again, she asked specifically for a women’s health specialist. It turns out Sarah’s hymen had been broken, and they finally agreed she had vaginismus. But next steps were confusing. Being sent home with diazepam and a set of dilators left her overwhelmed and unsure where to start.
‘A friend told me about the Suffolk Women’s Wellness Centre – a local practice that had helped her with some pelvic floor issues,’ says Sarah. ‘I booked myself in for a general MOT’.
Sarah’s clinician was a trained midwife, and their first session started completely differently to the medical examinations she’d had before.
‘At the beginning, we talked. Nina asked me what my aims were, and then she examined me.’ But this didn’t happen in the traditional sense. Instead of diving straight into an intrusive vaginal examination, Nina approached things holistically. She looked at Sarah’s nervous system, including her breathing and the parts of her body that were most active during a ‘high-stress’ situation. Sarah learnt that during penetration, her diaphragm was tense and tight. Nina worked with Sarah on her breathing to relax the nervous system – incorporating calming techniques from her practice in the labour ward.
‘She even put on calming music and gave me a deep tissue massage,’ Sarah told us.
After establishing trust, Nina began to incorporate dilators into her sessions with Sarah. It was uncomfortable and painful at first, but in a no-pressure setting with plenty of time, they started to make progress. I wondered whether I’d really want someone else using dilators on me, but Sarah explained that as she moved up in sizes, Nina’s support was invaluable.
‘The fourth one was difficult. She had to massage my muscles internally and helped me get it at the right angle. I don’t think I would have been able to do it without her.’
It was teamwork the whole way through. Nina was horrified at the hard, blunt, industry-standard dilator kits, so ordered a silicone set for Sarah with dilators that were bendier and tapered at the tips (like a real penis). They discovered that oil-based lube worked better for her too. ‘She gave me loads of pelvic floor exercises to do alongside dilation,’ said Sarah. ‘I’d have never thought to do that.’
In terms of time frames, there really is no normal with this. It depends on your schedule, your resources, your practitioner, and whatever life’s throwing into the mix. Sarah decided to book sessions several times a week for a few months, which lessened as she progressed.
After a while she started to involve her partner too. They used sex toys together, and sometimes even dilators. ‘It was all about making the association between him and pleasure,’ explained Sarah. ‘I had to train my brain that someone inserting something into me means pleasure.’
Drumroll...Yes, penetrative sex has now been happening! Sarah’s over the moon with how far she’s come, but acknowledges there’s ‘loads you can do’ without penetration. In terms of their sex life and connection as a couple: ‘I don’t think we would have got to know each other to this extent if we had had penetrative sex straight away.’
We definitely don’t force silver linings at the Vaginismus Network, but I think I can speak for lots of us when I say that getting rid of society’s age-old concept of ‘foreplay’ can really change the game. Penetration has been our grand finale for too long.
Nina’s story
After working with vaginas for over two decades, Nina doesn’t think clinicians should ‘get personal’ on a first session. This means looking at the bigger picture before going straight to an internal examination.
‘Look at her posture. Where is she holding tension? Look at her back, look at the bra line.’
Nina checks the whole body first to see its effect on the pelvis. This gentler approach also works to ‘desensitise’ the client and build up trust.
‘My hands on her body allows her to gain trust without going straight into that intimate procedure,’ she explains. ‘By a second session, the client has met me, knows where they’re going, and knows what to expect.’
Paying attention to the details is everything to Nina’s practice. She explains how alongside using all the sense to make someone feel comfortable (‘comfy couch’, ‘aromatherapy smells’, ‘privacy’) she’s acutely aware of her own responsibility to be fully present during a consultation.
‘You need to feel grounded to help your client. It means you’re focussed and are able to read the cues of the person in front of you.’ She discusses how some people are disassociated with their bodies, while others are in ‘fight or flight’. She’s currently doing TRE(R) training (Trauma Relief Exercise) to improve these skills further and become even more in tune with her clients.
Perhaps the most inspiring thing about Nina’s work is her resourcefulness and creativity. Before meeting Sarah – and despite working in the NHS for over two decades – she hadn’t treated anyone for vaginismus before. ‘It just isn’t covered in medical training,’ she explained, ‘and this really worries me.’ But with a career dedicated to the female anatomy under her belt, she wasn’t put off. After all, this was just another pelvis. ‘I didn’t see why I couldn’t help her.’
A bit of initiative and a lot of common sense manifested itself into a series of bespoke sessions using skills from across her career; including breathwork, myofascial release, and meditation techniques. Nina explained how psychological support is a crucial factor when dealing with physical tensions in the body.
‘Women with vaginismus sometimes think ‘rationally’ too much’ – the voice that says you’re never going to get better. ‘With Sarah, I knew I needed to change the dialect of her subconscious. And that’s actually what did it in the end.’
She helped Sarah with basic meditation in their appointments, and made a personal recording for her to take home and use in the bath during dilation.
Nina hasn’t seen anyone else in the flesh yet for vaginismus, but she’s definitely open to it. She’s already made contact with her local surgery and put herself forward as another port of call for patients with vaginismus. ‘You just can’t unearth enough in ten minutes,’ she told us. But she understands that what might have worked for Sarah might not necessarily be the answer for everybody else.
I asked Nina what shifts she’d like to see in future with vaginismus care, and again, it came back to time.
‘Women have to have time to understand why this has happened. Has there been abuse? Has there been shaming? Has it come from body image? Has it come from pressure? What trauma do we need to help with? You need to peel back those layers to get to the root cause.’
We’re really excited about the progress that’s been made here – both for Sarah individually, and for vaginismus as a whole. It’s a condition that won’t move on without curiosity, patience, and a better understanding of how pain manifests itself in mind and body.
Nina works at the Suffolk Womens Wellness Centre. Find other practitioners in your area with The Squeezy Directory.