Do you really need Vaginismus surgery? Find your answer here
Dr. Maria Castellas

Dr. Maria Castellas

Feb 05Vaginismus

Do you really need Vaginismus surgery? Find your answer here

What is Vaginismus?

Vaginismus is a condition in which the muscles around your vagina (also known as your pelvic floor muscles) contract involuntarily, making any contact or touch within your vagina exceedingly unpleasant and painful. Many individuals experience this during vaginal intercourse, when attempting to insert a tampon, sex toy, or finger, and while undergoing a pelvic exam.

To understand the cause of Vaginismus, you need to identify the bio-psycho-social influences and the connection between your vulva and your brain. Pain can induce fear and a guarding response, which makes it harder to relax. For example, when penetration is perceived to be painful by your brain your pelvic floor muscles contract without you having control over it. This suggests that Vaginismus is a psychological condition with physical manifestations. The involuntary contraction of your pelvic floor muscles can happen with any type of penetration,  like when attempting to insert tampons, sex toys or going through a gynecological examination.



What is Vaginismus Surgery?

Vaginismus surgery is performed to treat the physical aspect of muscle tightness (pelvic floor muscles). The surgery includes splitting the muscles inside the vaginal canal, making more space,and in theory increasing mobility.

When treating vaginismus, physicians frequently recommend a hymenectomy with episiotomy or a labiaectomy with the goal of facilitating penetration. Unfortunately, while surgery exposes the vaginal opening, it fails to address the root cause of vaginismus, leaving the person with an unsolved condition, trauma and pain from surgery, and physical changes.



What to expect in the surgery?

There are different types of Vaginismus Surgery.

A, Hymenectomy involves making a cut in the hymen - a thin membrane that covers your vaginal opening and typically opens by the time you start menstruating to allow for the uterine lining to come out of the vagina. A hymenectomy is performed in case your hymen hasn’t opened up to allow for menstruation or sexual intercourse. The hymen is such a thin layer, that this can sometimes be misdiagnosed. 

Another type of vaginismus surgery is a vestibulectomy and this is performed at the vestibule, the area surrounding the vaginal opening. In this vaginismus surgery, the sensitive tissues feeling pain around the vaginal opening are removed.

The injection of botox for vaginismus is another invasive treatment considered a vaginismus surgery. In this scenario, botulinum toxin (botox) is injected into the pelvic floor muscles to stop the muscles from contracting or tightening further, thus ideally stopping the involuntary contractions from happening. It is generally performed after a local or general anesthetic is given. This treatment method also involves a dilator inserted into the vagina during recovery or sometimes overnight. Research suggests that botox alone is not an effective treatment for vaginismus, as it treats only the physical components of the diagnosis and not the psychological, which is considered the underlying root cause of the condition.

Post-surgery treatment often involves vaginal dilator therapy. It’s important to note that vaginal dilator therapy along with mental health counseling is the first line of treatment for patients with vaginismus, regardless of surgery.

Surgery should always be considered the last resort for treating Vaginismus. 



Is surgery an ideal treatment for Vaginismus?  

Vaginismus surgery is not an ideal treatment for vaginismus, especially when there are psychological factors involved, because it doesn’t address the root cause of the condition. Often, more pain and trauma results after the surgery, as there is cutting involved, which will aggravate the nerve endings in the pelvic floor. These nerve endings are extremely sensitive to pain, which is often a component of vaginismus in the first place. Surgery and botox is recommended for patients who have tried all alternative treatment strategies without improvement in function. 

A 2020 review of clinical trials found that mind-body therapy was associated with improved pain in people with vaginismus, which is why this is known. 

The most important treatment options for people with vaginismus are-

-Mental health counselling

-Sex therapy and counselling

-Physiotherapy

-Vaginal dilators

 

Vaginismus Program at Proactive For Her

The online vaginismus program is a well sought out, supportive, trauma-informed, 8 week program that enables you to overcome anxiety and the fear of pain that surrounds penetration. 

The 8 week healing program involves: one-on-one sessions with a vaginismus coach, pelvic floor relaxation sessions, women’s support group sessions, pleasure coaching workshops, a set of silicone dilators and partner support sessions if needed.

It’s an effective program that has helped over 200 women overcome Vaginismus!