When we (Phil and Lorna Sarrel) worked as a sex therapy team, we treated more than 500 cases of vaginismus and the success rate was close to 99 percent. We say this, not to toot our own horns, but to emphasize how very effective the treatment is. We learned how to treat vaginismus from Dr. William Masters and Virginia Johnson, the team that invented the rapid approach to sex therapy. Their methods are still widely used.
Let’s talk to our imaginary couple, Jane and Tom. Jane and Tom, you may be wondering how you can confirm that Jane’s pain is actually vaginismus. You can see for yourselves at home or in the doctor’s office. Jane, you need to recline with your back at about a 45 degree angle, legs apart, knees bent so that your vulva (external part of female genitals) is visible. If you hold a mirror inside one knee you should have a clear view. Either Tom or the doctor then moves a hand toward your vulva. If you see that vaginal opening tighten in a clench or blink, that’s vaginismus.
Vaginismus is a learned or conditioned reflex. To treat it you must un-learn it. When vaginal penetration is about to happen, Jane, you will learn to relax and not be afraid. You will need to do some regular homework and you and Tom should not even try to have intercourse until near the end of therapy.
Jane, the homework involves your inserting a finger or two or inserting vaginal dilators (the preferred, simpler method). Look on the internet for “vaginal dilators.” You don’t need a set of 8 or 10; five, in graduated sizes from the narrowest, is enough. You’ll also need a tube of lubricating gel (not petroleum jelly). The depth of the dilators is unimportant. You are NOT trying to stretch yourself; you are retraining the muscles at the vaginal opening.
Jane, you’ll need to have private time for dilator insertion twice a day. Relax any way that works for you – music, exercise, yoga, meditation, deep breathing. Then, on your back at that 45-degree angle, insert the smallest dilator (or your index finger), lubricated, slowly and gently. Next, lay back and daydream, read or watch TV, for 45 minutes, with the dilator in place, as your vaginal muscles relax completely.
After twice a day for two days, using the narrowest dilator, move up one size. Use each width in turn for two days each. When you feel confident inserting dilator or fingers, about the width of Tom’s erect penis, you are ready to begin working as a couple.
During the ten days or so that you, Jane, are using the dilators on your own, you and Tom can be sexually intimate but without any kind of vaginal penetration. Jane, when you think you are ready to try having Tom’s penis inside your vagina, first enjoy some mutual sex play. Then, with Tom on his back, face him and kneel over his body, placing your knees at about the level of his nipples. You will slowly and gently, guide his lubricated, erect penis a little way into your vagina. Pause. If you are not in pain, move a bit further onto his penis. You will be in a sitting position with him inside of you. Tom, your job is to be still and allow Jane to be in control. Masters and Johnson used to tell couples, “This is not exactly intercourse; it is vaginal containment of the penis.”
Jane, sit still for about a minute and then experiment with contracting and relaxing your vaginal muscles. Next, try some gentle movement. If there is pain, it is essential to hold still briefly. You may need to stop and try again the next day. If one or both of you wants to have an orgasm, this should not be through intercourse.
For at least a few days following successful “containment,” you should limit penetration to the woman above position that we described and you must not allow any pain that lasts more than a second or two. Once you’re both comfortable and free of pain it’s okay to use any position you like.
After treatment, the golden rule still stands- not to allow sex that hurts