The Concept of Vaginismus
It is a sexual dysfunction that occurs due to the stress caused by attempts to enter the vagina, preventing sexual intercourse or allowing it to be even slightly painful, and causing unintentional repetitive contractions in the muscles in the vagina.
Vaginismus is defined as 'constant or recurrent involuntary contractions of the muscles in the outer third of the vagina that prevent sexual intercourse'. These involuntary contractions can be seen during gynecological examination, but in some women they can only be seen during sexual intercourse. In most cases, vaginal contraction does not allow sexual intercourse. In a smaller number of cases, penetration may occur by force, but intercourse is painful.
Prevalence and Frequency of Vaginismus
Vaginismus is one of the most common reasons that prevent sexual intercourse during married life. While it is one, its rate in the general population is between 3-13%; There are studies reporting that the prevalence of sexual dysfunction among clinic patients is between 21-48%. Although studies conducted in the West reveal that decreased sexual desire is the most common of all female sexual dysfunctions, vaginismus ranks first in eastern countries. Among all sexual dysfunctions seen in our country, vaginismus ranks first with rates varying between 43-73%.
Types of Vaginismus
They are defined as primary and secondary according to their onset.
Primary Vaginismus
The vaginismic response is considered a primary problem when it occurs during the first attempt at sexual intercourse, that is, if no sexual intercourse has been achieved before. Although a woman who encounters vaginismus problem in her first attempt at sexual intercourse can normally participate in all sexual activities, she cannot complete sexual intercourse as a result of the contractions that occur when she reaches the sexual intercourse stage. Generally, this situation occurs as a result of first night fear, lack of knowledge in the sexual field, sexual misbehavior, and negative and wrong thoughts about the woman's sexual organs. The majority of patients applying to sexual therapy clinics have primary vaginal A diagnosis of smus is made.
Secondary Vaginismus
If a vaginismic response develops after a period in which sexual intercourse is painless and accompanied by sexual pleasure, this situation is considered as secondary vaginismus. Secondary vaginismus, which is rarely seen, can be defined as a psychosomatic disorder. Negative feelings towards the partner may develop after recurrent vaginal infections, episiotomy and similar injuries and surgeries to the genital area.
Secondary vaginismus usually develops due to dyspareunia, but rarely, it may occur as a recurrence of the problem in people who have previously been treated.
Characteristics of Vaginismus Women
- They generally have a pessimistic perspective,
- They are more introverted people. They have difficulty expressing their feelings and thoughts,
- Schemas of seeking acceptance, approval and self-sacrifice may be encountered,
- Abandonment and abuse schemes may develop over time,
- Conflict in their families and they are likely to have witnessed problems,
- They have a low self-perception. They see women as weak and helpless.
- They may react with anxiety and fear not only to penis-vaginal intercourse but also to some other situations. They have an anxious psychological structure,
- They are not very at peace with their body perception. They especially have dislike attitudes towards their sexual organs.
- Most of the cases with vaginismus are said to be childish women who live like siblings with their husbands and are dependent on their families.
- Women with vaginismus have difficulty expressing anger and need excessive approval. It has been stated that they have different personalities.
- They are mostly women with a high level of education,
- They may have difficulty in embracing adulthood and marriage,
- They are usually women over the age of 20.
Causes of Vaginismus
When we look at the studies in the literature, there is no proven cause of vaginismus. Based on the opinions of clinicians working in the field, only possible causes are emphasized.
Problems arising from sexual misconceptions
The individual's reputation is affected from an early age. It is possible for people to acquire sexual misconceptions about sexuality due to wrong sources or hearsay. While these wrong thoughts can also pave the way for the development of vaginismus, we can list some of them as follows.
Lack of sexual knowledge
While not receiving a proper sexual education can lead to fear or hesitation towards the unknown, superstitions or information at an early age It can also show the same effect. In some cases, lack of sexual knowledge can lead to situations such as not physically recognizing the sexual organs, not knowing the entrance point of the sexual organ.
Sexual phobias and avoidances
Some women's own organs are congenitally narrow, the hymen is very thick and While her thoughts that her partner's penis is too big and will harm her and hurt her a lot (first night fear) may cause her to develop a phobia against the penis and sexual intercourse, some may avoid it because they are disgusted by the smell of semen or its contamination on themselves, which can pave the way for vaginismus.
According to a study, a significant statistical result was found between vaginismus and painful sexual intercourse on the first night, and the vaginismus rate was higher in the group of cases with painful sexual intercourse on the first night compared to those without.
Conducted by Engman (2007). In the study, the reasons why couples experiencing vaginismus abandon intercourse are explained under various headings. Accordingly, pain after sexual intercourse was determined to be a reason for discontinuing sexual intercourse to almost the same extent as pain during penetration. In addition, concerns such as very strong pain during penetration, very strong pain after sexual intercourse, severe pain during intercourse, couples deciding not to have sexual intercourse because of the pain in question, fear of sexual intercourse, the partner not wanting to have sexual intercourse due to pain, the partner not being able to penetrate due to fear of pain. It can cause vaginismus.
Vaginismus is also seen in women who fear that they will lose their virginity if they become mothers or that they will not be able to fulfill the responsibilities of motherhood. Similarly, if she becomes pregnant Women may not allow sexual intercourse because they fear that the child will harm their body and feel too much pain when coming out of the vagina during birth. In addition, a woman, who has been exposed to suggestions since childhood that her hymen is the most valuable asset that must be protected and should not be lost, may not have sexual intercourse when she gets married because she is unconsciously afraid of losing this value.
The woman feels intense anxiety and anxiety, thinking that she is ugly and inadequate. Fear of failure in sexual intercourse and fear of not being able to satisfy one's partner can also trigger vaginismus as failure and performance anxiety.
Disgust from sexual organs
Women with vaginismus have feelings such as disgust, dislike and shame about their own sexual organs. can be seen. It has been revealed that they take these feelings as a role model from their mothers, who also have vaginismus, do not enjoy sex, perceive sexuality as a bad situation, and are even ashamed. Being the subject of anecdotes or jokes, and publications in the press that present women as a sexual commodity, devalue women and thus paves the way for myths to settle in the individual's subconscious. There are many sexual myths that can cause sexual dysfunction. Those that may be especially effective in terms of vaginismus can be listed as follows.
- Talking about sexuality is shameful. Sexual intercourse is a bad and wrong thing.
- Sexual intercourse is the woman's duty, whether she desires it or not, she has to do it if her husband wants it.
- Men enjoy sexual intercourse, women do not, it is shameful and painful.
- Sexual organs are dirty, smelly and should not be hidden or touched.
- Sexuality is something that must be done for the continuation of the marriage.
- The woman who initiates lovemaking is immoral.
- The penis is too big to enter the vagina.
- The Creator is punishing me for something I did wrong in the past, so I became vaginismus.
Effects of upbringing
Childhood Disorders in the parental relationship during the period can negatively affect the person's own relationship, interpersonal relationships and sexuality in later life. may. Problems such as lack of emotion, love, and lack of physical intimacy in the relationship between parents can be an obstacle to the development of a normal relationship or sexuality. This problematic growth phase can cause a lack of self-confidence in personal relationships and therefore in sexual intercourse.
Strict religious and moral beliefs
Some people are raised with strict messages that sexuality is a sin or shame. When they become adults, they suppress their natural sexual desires out of fear of sin. Religious conditioning is observed in some women with vaginismus. In the homes where these patients grow up, parents ask them to follow religious rules more than usual. They do not allow the development of responsibility in sexual relationships and glorify not being interested in sexuality. Sexuality is a source of distress in such homes. Religious and moral values give rise to guilt and shame in all sexual interests and relationships. These families often have fathers who are obsessed with sexual morality. He wants his wife and daughters not to be interested in sexuality and to maintain a high moral level. It is usually the mother who fulfills these wishes and forces her daughters to comply with them.
In the effort to inculcate moral behaviors while raising girls, wrong or incomplete things such as "cover your legs", "keep your skirt long", "stay away from men" are used. The expressions used may remain in their minds as negative suggestions and may cause them to be afraid when they have sex in the future and to have a negative self-image.
Opressive authoritarian father, weak and powerless mother
Women with vaginismus are generally anti-social and obsessive-compulsive. It was stated that they had a oppressive and authoritarian father in their personality structure, that they grew up in a home where the father was an authority figure, and that they were constantly subjected to physical and verbal violence. In addition, in the childhood memories of these women, a father who did not show love to the mother, saw her as a sexual object, constantly forced her to have sexual intercourse, was obsessed with authority, used punishment to be dominant, was alcoholic, psychopathic and violent was described. The mother living with the described partner will also be a model of a weak woman, as she cannot protect both herself and her daughter from violence and other pressures.
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