Can you overcome vaginismus and concieve naturally?

Vaginismus is a condition in which vaginal spasms occur and prevent vaginal penetration of any object (finger, tampon, speculum, penis), despite a desire to do so. It is the body’s protective response that causes an involuntary contraction of the pelvic floor muscles, leading to a closure to the entrance of the vagina. Hence, it is understood as a physical manifestation of an underlying psychological issue that is rooted at intrapersonal, interpersonal and cultural levels of an individual. It limits one’s ability to have intercourse, undergo pelvic exams, or insert a tampon/menstrual cup. 

Vaginismus can be categorised as primary, wherein one has never been able to have penetration of any kind, despite the desire to do so, and secondary, wherein you’ve been able to have pain-free penetration in the past, but are no longer able to. 

It is experienced as feeling like a “wall” blocking penetration, occurrence of pain during penetration, fear or anxiety during penetration leading to avoidance of sexual activity or pushing away the partner in anticipation of pain, and/or feeling like the vaginal opening is too small for penetration.  

Vaginismus and Reproduction

Vaginismus is an involuntary contraction of the pelvic floor muscles and prevents penetration. It can have a significant impact on an individual’s emotional, sexual, and relational wellbeing. Vaginismus does not directly impact fertility. It can indirectly impact the reproductive wellbeing of an individual in the following ways: 

• Painful penetrative sex: Vaginal penetration can often be impossible or extremely painful for those with vaginismus. For those wishing to get pregnant through natural conception, healthy and normal intercourse at the right time is required. It is essential to track the woman’s fertility window and accordingly time sexual activity for the highest possibility of conception. The physical and emotional implications of painful intercourse can make this process difficult. 
  
   
• Emotional and Psychological Distress: The fear and anxiety that can often be the cause of vaginismus is often viciously perpetuated when vaginismus interferes with ability to engage in sexual activity and efforts to conceive naturally. This can have an adverse impact on mental health as well. 
  
   
• Difficulties with Medical Care: If medical practitioners are not aware of or ignore the special conditions formed by vaginismus and pregnancy, this could further aggravate the underlying symptoms and emotional and psychological distress. Pregnancy women with vaginismus are also at a risk of non-follow-up during their pregnancy due to the felt lack of care and support by medical staff and due to related feelings of shame. Perinatal care routine involves pelvic examinations to monitor the pregnancy and related pain and anxiety would be essential to manage. 
  
   
• Increased Stress on Relationships: Romantic, sexual, and familial relationships can feel challenged due to the physical and emotional complications of vaginismus. This can also impact the emotional and physical intimacy between partners with an addition of question marks to the reproductive goals. Partners may experience feelings of inadequacy, frustration, disappointment and unfulfillment through the journey. 
  
   
• Additional Pelvic Health Concerns: Women with vaginismus often also have weak pelvic floor muscles due to anxiety and fear-induced contractions, leading to other pelvic health concerns that could impact childbirth processes. 
  
   
• Complications in Assisted Reproduction Treatments: Vaginismus can adversely impact the process of Alternate Reproduction Treatments for pregnancy like IVF, IUI, ICSI etc. as there can be challenges in procedures that involve vaginal access like retrieval of eggs. 

Vaginismus and Women’s Fertility Clock

Women’s fertility is also linked to their biological clock which dictates that the chances of pregnancy can decrease with age, as the number of eggs and viability of those eggs diminish as a woman nears 40 years of age. 

Did you know that females are born with all the eggs they will ever have, typically around one or two million at birth? A gradual decline in available eggs continues until one reaches menopause. However, not all eggs are lost through the process of ovulation. Some of these eggs naturally degenerate before reaching the ovulation stage through a process called atresia. The number of eggs lost through atresia also increases as a woman ages. 

A woman’s age also affects the quality of her eggs and in turn, has an impact on pregnancy rates. Ageing eggs simply do not behave as consistently as younger ones. 

Age can also affect a woman's fertility less directly through conditions such as uterine fibroids, endometriosis, adenomyosis or exposure to treatments such as chemotherapy. 

Additionally, paternal age can affect sperm quality and quantity as well, through the effects are not as pronounced as in the case of maternal age. Advanced paternal age, considered to be 50 years and older, can increase the risk of some genetic conditions as well as increase the risk of miscarriage due to changes in sperm quality. 

Pregnancy is possible in patients with vaginismus. Vaginismus is 100% curable and once healed, can allow for natural conception. Early identification and diagnosis of the condition along with a holistic, well-rounded treatment approach play a vital role in the healing and help a woman achieve her pregnancy-related and reproductive goals. 

Not all women may be ready to start a family at the time of their peak fertility age. Women with vaginismus who may be in the process of healing may need more time to be physically and emotionally prepared for all steps of the pregnancy process. Women in their 20s and 30s who plan to postpone pregnancy can consider freezing their eggs and embryos, which can be used at a later time for a successful pregnancy. Fertility treatments such as IVF are also available for women. However, aforementioned vaginismus related challenges can add layers of complexity to these procedures. Pregnancies at an older age also pose other complications for the women and the foetus. 

Vaginismus and Delivery

There are multiple childbirth related considerations for someone with vaginismus about their pregnancy journey. These are: 

• Psychological preparation: There can be anticipation of pain and anxiety for women with vaginismus during the process of pregnancy, including antenatal examinations. A sensitive and multidisciplinary medical team would be essential to consult beforehand and set adequate expectations from the process, including the physical examinations that might be required. Inadequate birthing preparation may increase anxiety. Additional care such as relaxation techniques can be sought. 
• Seek vaginismus treatment prior to the process: Vaginal delivery in women with vaginismus is possible. However, it requires sensitive medical staff and the frequency of vaginal examinations might have to be reduced to an absolute minimum. It is advisable to seek treatment for vaginismus before trying for pregnancy. Utmost care and sensitivity from the medical staff would be needed to reduce incidence of secondary vaginismus
• Physical Preparation: Consulting a pelvic health physiotherapist (we have a great team at Proactive for Her!) is essential to help anyone, especially someone experiencing vaginismus to prepare for delivery. This is beneficial for those planning either a vaginal or cesaeran delivery. Physiotherapists help prepare the body for a growing baby, along with pain management so that the pregnancy and birthing journey for those with vaginismus is as comfortable as possible. 
• Discuss availability of alternate delivery options: In consultation with the medical team, alternate delivery options such as a caesarean section delivery can be explored for those with vaginismus. 

What are Your Next Steps for Treatment?

As discussed above, women with vaginismus can get pregnant and have a vaginal delivery. Healing vaginismus has multi-faceted benefits, apart from the ability to have penetrative sex and have the option of natural conception and vaginal delivery, which often go unacknowledged. These include improved self-worth and self-confidence, change in sex-negative beliefs, improved body image, reduced strain on relationships, etc. 

Vaginismus treatment requires a multidisciplinary and customised approach to healing. The treatment components and timeline are unique to each individual, depending on the severity of the underlying psychological reasons, your activity levels, movement in your pelvic floor muscles, and if there are any tension points that need more attention. However, some components of healing remain consistent and must be equally paid attention to. These are: 

• Take the psychological approach to address the underlying beliefs or heal from the experiences that may be contributing to the vaginismus. 
• Physical training to relax and strengthen the body and pelvic floor muscles and vaginal training using dilators to develop mental and physical adaptation to vaginal penetration. 
• Seeking emotional support of those who understand - including other women who have been experiencing vaginismus as well. Support groups and trained medical and mental health professionals can provide unmatched support. 
• Communicating with your partner and strengthening the emotional and physical intimacy with you, with the use of professional help, if needed, can help to build a more empathetic foundation for the vaginismus healing journey.

Conclusion

Wherever you may be in your journey with vaginismus, know that there is hope for you to achieve your maternity goals as you envision them. If you need support in planning your vaginismus healing and pregnancy journey, reach out to us at Proactive For Her to consult with our trauma-informed and non-judgemental experts. You can set up an initial consultation and take charge of your sexual and reproductive wellbeing through our award-winning, holistic, and evidence-based Vaginismus Healing Program.