Treating vaginismus before the first sexual experience

[minnied]

Hi there. I’d like to share a few thoughts with you here on the forum.

I live and work in Poland as a sexologist, mainly for a health service associated with the government.

We used to have a very high rate of vaginismus in our country, and lots of (young) female patients reported sex related pain issues. Poland is a very catholic country, where virginity plays an important role. Most teens don’t use tampons, cups or other internal protection, and inserting things into their vagina is a taboo. Until a few years ago, 90% of all women had a fully intact hymen and never explored the inside of their vagina before they had sex for the first time. This resulted in a high number of women reporting pain during sex.

What we did during the last five years was actually encourage women to start self exploring their vagina. During sex ed at school, girls are taught in small groups how they can use two fingers combined with a pushing technique to stretch (and sometimes tear) their hymen. Girls are also encouraged to visit a doc when they notice they keep on having pain during the exercise, which is in most cases an indication of vaginism or a tight hymen. Over half of all girls with vaginismus are already following treatment at a therapist before they start having sex for the first time, which has a giant positive impact on the success rate. The most difficult part is still to convince them that not having an intact hymen doesn’t mean the same as not being a virgin.

IMHO, the earlier vaginismus can be treated, the better. As soon as someone starts having sexual intercourse, this adds a layer of complexity because patients often associate sex with pain.

[recessivegenequeen]

Hi Minnied – thanks so much for sharing your experience! This is really amazing insight and honestly doesn’t surprise me since I think a lot of people with issues around vaginismus often find they are severe because they were raised in some type of environment that discouraged or pathologized sex. Speaking as someone who had vaginismus for a decade, my issue was definitely more entrenched because so much time passed before I understood anything that was happening – I had years to feel pain, develop shame and inadequacy around that pain, and have even more of a complex about that pain as a result. If I had been able to discover a tendency toward pain and tightness before I was sexually active and to undergo treatment before it even became something to be self-conscious about, I’m sure I would have been saved years of misery.

Is this program you’re doing being promoted widely in Poland? Are there ways other educators and medical professionals are being taught what you’ve learned? Early-life techniques like this could cause a paradigm shift around sexual pain disorders if they became widespread!

[hellenmia]

Good point!

I wrote a paper on this when I graduated from college.

In many European countries, especially in the more Catholic areas, inserting something in your vagina is considered to be a taboo. There are differences among countries of course, but generally speaking the majority of girls in Catholic countries like Poland, Bulgaria, Greece, etc… masturbate less, don’t use tampons, internal exams are only done after being sexually active, etc… Girls are told not to touch themselves down there, it’s a sin, etc…

If my memory serves me right, 80% of all European girls were in pain when they had sex for the first time, vs. 30-40 percent in the States, which is a remarkable difference. The only explanation I could find for this phenomenon was that in Europe, most girls still have intact hymens and aren’t used to feeling something in their vagina. Girls often end up in a downwards spiral thinking the second time will be painful as well, which is sometimes – not always! – a trigger for vaginismus.

I live in Greece myself and over the past years, several articles have been published in youth magazines and newspapers on how girls can tear their own hymen, which is a good thing. I’m convinced a part of the vaginismus cases reported in Europe can be avoided when more girls do this. It’s not difficult to learn and it can take a lot of unnecessary stress away from the first sexual encounter.

[mazemelissa]

This is such an interesting thread, and I think it is so important.

I also agree, early exploration and education is key.

We need to spread the word about this!

[recessivegenequeen]

hellenmia, that’s so interesting that you’ve seen that trend in Europe – as an American, I feel like I had the bias that Europeans were more sexually open culturally (the French in particular come to mind). I hadn’t considered the influence of Catholicism in Europe and how so many European countries are religious in a way that’s similar to the American south. It sounds like the whole world over we just need to be seeing more and more messaging around real sexual facts and healthier communication in general that sex – and ESPECIALLY sexual health issues like getting gynecological exams and using tampons – aren’t morally wrong. I hope the next generation sees us as prudish and are far more open about these topics because it would save so many women so much pain and shame!

[hellenmia]

In general, Europeans have less issues with nudity. Going topless on beaches, nudity in saunas, pubic hair, breastfeeding in public, nudity on tv… this is all pretty normal for most people here. However, this does not mean everyone is sexually active or interested at a young age. On the contrary, there have been some studies showing that the more open you are on nudity and the more it becomes normal, the longer teenagers will wait before having sex.

This all sounds positive, but it has a side effect: feeling pain the first time you’re having sex is considered to be ‘normal’ for most girls, which it probably IS since most of them still have an intact hymen. Girls read stories about it in teen magazines, your friends tell you about their experience, basically the message is “sex hurts” the first time, which opens the path (but not always!) to vaginism.

My impression is that the lack of nudity in public life in the States, causes women to have a more problematic relationship with their vagina, but on another level. They’ll start thinking about how they look down there, compare with porn, they’ll shave, go to the gyn at an earlier age, use tampons, have cosmetic surgery… while Europeans have “seen it all”: they know every body is different and they accept the way they look, which removes the need to touch/change things. I’m generalizing too much here, but you get the basic idea.

There are large parts of the world where religion is so important (like in most parts of Asia and Africa for instance) that having an intact hymen is crucial, and tampons cannot be used at all (they aren’t even available!). When a girl doesn’t have pain of bleeds during the wedding night, this is considered to be problematic. I know that in certain African cultures women put sand in their vagina to make sex as painful as possible – you could say they PROVOKE vaginismus instead of trying to get rid of it.

[recessivegenequeen]

Wow, that’s fascinating. I hadn’t thought about it but you’re right, most Americans who are exposed to nudity are NOT seeing normal bodies at beaches or out in public – it’s either porn or models/movie stars in magazines or in highly produced movies/tv shows. I remember several years ago when Lena Dunham did some of her first nude scenes on the show Girls, it was one of the first times I had ever seen a “normal” woman naked like that. It sounds like Europe is operating from a better place from a body image perspective, but interesting that the association with pain and sex is still there. I’d think starting being sexually active later would help a little in being more emotionally ready to deal with issues that come up, but on the other hand it gives anxieties or issues like vaginismus more time to potentially get a foothold in terms of your relationship to your vagina.

[minnied]

Hellenmia has made some pretty good points here.

I agree we shouldn’t generalize things too much, but in general European women are more used to seeing naked bodies. Breastfeeding is often done without covering up, women (young and old) go topless on beaches, youth magazines show nude pictures of ‘real’ teens so girls don’t end up only seeing picture perfect bodies from porn and glossy magazines, sex ed is pretty explicit, etc, etc. As Hellenmia wrote, this doesn’t mean teens start having sex at a younger age, on the contrary, I think here in Poland the average age when girls have sex for the first time is 19 or 20.

At the same time, virginity seems to play a much more important role when compared to the States. I have the impression virginity over there is something you need to “get rid off”, while in Europe having sex for the first time is generally a very valuable moment – one of the reasons for this is probably the influence of the catholic religion. When using tampons or inserting things in your vagina is discouraged, and masturbation (like in Islam for instance) is forbidden, the first time girls have sex automatically gets more valuable. But this also has a strange side effect: next to the pictures of naked teens in magazines promoting normal bodies, you can read articles on how normal it is to bleed and have pain when you first have sex. The fact it will hurt the first time is so widespread it becomes normal. Girls talk about it all the time. Boys are told they should “take it easy” when they have sex with a virgin. Unintentionally, pain and sex are associated and considered to be normal, which opens the path to vaginismus.

[recessivegenequeen]

What an interesting side effect of what seems like a healthier cultural attitude around sex. I wonder what the next step in communicating positive sexual messaging would look like.

[coldasice]

I’ve read some interesting things here and I want to add my own experience.

I’ve lived for 20 years in Finland, which is known for its sexual liberalism. Nudity is normal here. In sauna’s and pools, being naked around friends and colleagues is generally accepted. Teens invite their friends for pool parties. By the time I was 18, I saw all my classmates naked – yes, all sexes mixed together. No one cares. You get to see so many different body types you don’t even care how you look like yourself 🙂 Sex ed is very explicit when compared to the States. Books for teens contain passages with instructions on how to masturbate. My own mother explained to me how I should masturbate, and my father did the same with my brother. And I can assure you that was not the “explore yourself” stuff you always here, but clear instructions on what you should touch for how long and in what way. So yes, I was used to seeing quite a lot when I started dating.

However. At the same time, it’s ‘not done’ to insert things in your vagina. I don’t know why, it’s not recommended, not encouraged… during talks about masturbation for instance, the attention goes to the clitoris and not a single instruction will tell you to inserting things. You’ll hardly find young teens using tampons, or teens using vibrators… which at the same time means the first time sex becomes way more important when compared to the States because most girls have still intact hymens, have pain when they have sex for the first time, etc… so there are pro’s and cons.

[recessivegenequeen]

Thanks so much for your contribution, coldasice – that’s so interesting and different than how we do things in America in the ways you’ve described.

Do you know why there’s such an aversion to insertion in Finland? Even though we’re more prudish here in the US, tampons are still considered a pretty normal part of the menstrual experience even for teen girls. I’m surprised they aren’t more normalized there.

[rabbit]

I think in general people from the States overestimate the amount of tampon users in the rest of the world. There are several countries where tampons even can’t be found in stores. In France, Italy and Spain over 85% of all women use pads exclusively.

[recessivegenequeen]

That’s really interesting rabbit, I had no idea. In America the marketing of tampons in commercials is often based around the idea that you shouldn’t have to “miss out” on anything because you’re on your period – this usually emphasizes activities like swimming, doing sports, or wearing skintight dresses on dates. It’s an aggressive marketing idea put out by tampon companies.

In the countries you’ve mentioned, is it more normalized to not participate in certain activities (swimming for example) when you’re on your period? It’s a pretty taboo topic in the US (women would rarely admit in mixed company that they’re currently menstruating, probably just with good friends) so I wonder if tampons are more prominent because they help you conceal that you’re menstruating at all.

[coldasice]

It’s easy. When you’re on your period, you don’t swim. In schools for instance, a note from the parents is enough to let their daughter not participate. Yes, this means your school mates will probably able to guess you’re having your period, but so what?

Most of my colleagues at work are female and I usually know when they are menstruating. Not because they tell me, but because they take a pad out of their purse and take the pad to the toilet, without hiding it. That’s something you see a lot where I work. Not sure if you’re that open in the States.

[recessivegenequeen]

That makes sense – it wouldn’t be a big deal on its own, especially if it were more culturally normalized. I haven’t been in a high school gym class in quite a while so I can’t speak to whether this is still true, but a decade ago I think you’d just be encouraged to wear a tampon and wouldn’t be likely to get out of it because you were on your period (as uncompassionate as that is).

We’re definitely less open in the workplace here as well. It wouldn’t be considered SHAMEFUL to see someone taking out a pad or tampon here exactly, but I would say it’s the default mode to hide it in your pocket on the way to the bathroom. We’re just more secretive about it in general, which sucks, because the result is that I’m sure it makes periods seem more “dirty” even just on a subconscious level