• ANA SOUSA

    @anasousa_3

    Madrid

  • ILLUSTRATION: CARMEN CASADO

    @holasoykaaa

Updated Sunday,13August2023-02:11

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At her second appointment with a gynecologist, Mar had to have a Pap smear. "I would grab his arm, writhe on the stretcher, cry and he didn't look like I was seeing him. It hurt me a lot," describes the anguished 24-year-old, who suffered this reaction to the introduction of the speculum, brush and spatula into her body due to the vaginismus she suffers.

It is estimated that 12% of Spanish women suffer from this condition, according to data from the Spanish Society of General Medicine. This medical condition is characterized by an involuntary spasm of the pelvic floor musculature. As a consequence, vaginal penetration is impossible.

The vast majority of women with this syndrome not only have problems when it comes to having sex. They also flee from the Gynecology consultation for years, due to the dread they feel just imagining that they must undergo a uterine examination. This constitutes a danger for the detection of diseases, such as cervical cancer and infections.

Those who suffer from vaginismus cannot medicate with vaginal eggs, refuse to use contraceptive methods such as the ring and only contemplate using compresses to contain the blood flow of the period. However, this topic is not limited to intimate health. On an emotional level and when it comes to meeting potential partners, these women stop thinking about the obligation to tell their most intimate secret, avoiding being too intimate to protect themselves from the feeling of fragility that invades them. That is, many of them spend a lifetime trying to ensure that no one discovers their curse.

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Carmen – who does not want to reveal her identity – managed to overcome the problem at the age of 54, which meant a "liberation". Previously, he had not given the doctor permission to do a Pap test (cytology). She had a boyfriend for eight years but during their sexual relations there was never any kind of penetration. Even today she is grateful for the "luck" of not having felt the call to be a mother.

For her part, Mar, who studies dance, has never shied away from flirting and telling the boys that penetration hurt her so she preferred to reach orgasm in another way. However, they have not always respected their condition: "They wanted to get to that point and I did it to please them."

Finding a sexual partner who understands the obstacles posed by this dysfunction is challenging. Even, sometimes, misunderstanding and prejudice comes from health professionals. Maria told her doctor that the tests hurt her and what she heard was devastating: "You have to have a glass of wine. An analysis is like sexual intercourse: at first it hurts, it's a matter of getting used to it."

Well, daughter, I can only tell you to look for a man with patience and to relax or seek psychological help.

Lucia's gynecologist replied

The "infantilization and normalization" of pain is "very frustrating," because it blames patients for uncontrollable suffering, says pelvic floor physiotherapist Ariana Gaona. Any area of the anatomy can somatize the problems derived from stress and the pelvic floor is no exception. "It seems that the vagina is Doraemon's pocket or an astral door. And it's not like that," he says.

Vaginismus causes an involuntary contraction, so there is no way to relax the affected muscles through a conscious decision. "If you have a cervical contracture, no one would tell you to 'relax' to remove it," emphasizes gynecologist Miriam Al Adib. This disease, explains the doctor with clinics in Madrid, Almendralejo and Marbella, can be triggered by a physical problem, such as vaginal dryness or atrophic vaginitis of menopause. Other times, the origin is psychological caused by traumas related to the genitals after rape or repressive education.

Distortion of body awareness is another reason. If a girl does not look at herself, or touch her genitals because it disgusts her - "on TV the vulvas have to be shaved or the lips have to be tiny pink" - or because of a feeling of guilt, this part of the body will not have representation in the brain. This disconnection "will surely prevent penetration", because the muscles of the vagina tense before what they interpret as a danger and that is why they close.

So, how do you do a gynecological check-up on a woman with this genital dysfunction? There is no medical protocol with guidelines for how a woman with vaginismus should be examined. The experience taught Al Adib that he is first touched on the outer lips and, with permission, gently opened open. If the patient tolerates these movements, the first phalanx is inserted until the woman says it does not hurt and gives her authorization to place another. In some cases it is possible to do a vaginal ultrasound, in others there is not even the possibility of touching from the outside, postponing the examination for a moment of therapeutic improvement.

"

I have, for example, a patient who is very safe to hold the ultrasound probe itself, while I insert it. Knowing that they are in control, that they can say 'look, no, it's over', already gives them peace of mind, "exemplifies the author of Let's talk about us (Oberon).

In the event of any pain or impossibility of penetration, the role of the gynecologist is to rule out physical pathologies that may be associated with vaginismus and that can be treated. In addition to Medicine, treatment may also go through Physiotherapy and Psychology.

The blue tablet of the female genitals

Mar, who also suffers from vulvodynia (pain on the outside of the genitals, including in the clitoris), has been accompanied for nine months by a physio-sexologist and for more than a year by a psychologist. The therapy has "very hard and frustrating" moments, specifically when she fails to introduce the sex toys scheduled as a treatment in her vagina: "Either you feel when you get to the top or there is like a stop that does not let something rise." And he vents: "Really, will this ever go away?"

The dancer assumes to have silenced many emotions over time, which has made her body tense. Before, she was triggered by anxiety just thinking about inserting a finger or tampon. Subsequently, he accepted pain and blood as standard in his intimate relationships. Now, he is working on controlling his fears and relaxing the body.

In fact, it is because of body knowledge that the first physiotherapy session begins with Ariana Gaona, with a clinic in Madrid. "Knowing what's down there, naming all the parts, visualizing them with a mirror, encouraging touching so that the body stops being devirtualized of certain sensations," he lists.

They feel weird, different, guilty, insufficient, helpless, less women. It's the first time they've heard that the pain they feel is real.

Ariana Gaona

Lucia – who also prefers to use a false name – met Gaona when she was desperately searching the internet for "remedies, cure, vaginismus, Madrid" and, there, the "miracle" happened. It was not a "path of roses" to reach the last day of consultation, in which they did a test with gynecological speculum that they introduced without any relevant discomfort. "When I overcame it, I felt a sense of mourning, depression and sorrow for everything I had suffered alone for so many years and from which I sensed that I needed psychological accompaniment to heal some wounds that I had very repressed," she concludes.

Who has already treated thousands of women with this condition is Pilar Pons, pelvic floor physiotherapist specializing in vaginismus for 35 years. From patients with 40 years who want to get pregnant or fear infidelities to others with religious values that until the night of the wedding had not discovered that they had it. Different beliefs, but the same shame to talk to their relatives about this issue. "I really like it when young people come because I think about the pain they are going to save," says Pons.

Rape is not a mandatory condition for the existence of this syndrome, reiterates the writer of the book Pelvic Silence (Vienna Editorial). He remembers a girl who was raped at age 14 in Germany and who began curing vaginismus at age 40, guaranteeing Pilar that she would have suffered from the problem, with or without abuse.

From despair and self-undervaluation to emancipation. Accompanying patients in their evolution is one of the most beautiful parts of the job, she says. The clinic is attended by very distressed women who cry with happiness when they manage to place the first (small) dilators, reinforces Pons. There's no reason to fear, "The vagina is a tunnel, don't be afraid to get lost if you put something in there." Right after being discharged, the physiotherapist confesses that they have another attitude in life. Once, they wrote to her: "Pilar, today I bought a dress because I felt like a woman."

There is no established number of sessions to overcome this genital alteration, since it depends on several factors, including the degree of resistance of the muscles to a movement or irritation of the mucosa. The fundamental rule is to continue with the exercises at home.

Another tip, according to Maria, is to let the couple participate in daily workouts. "When you put on the dilators, you're in control. In sex, who has control is the person in charge of penetration. It's a question of trust," he says.

This 27-year-old, who wants to study a master's degree in sexology, overcame vaginismus after four months of physiotherapy with Pilar Pons, based on hydration, massage and dilation of the area. However, she lived with him during the stages of bodily discovery. During her puberty and adolescence, she felt "super inferior" to her friends as the dominant topic in conversations was sexual adventures. Once she told it, no classmate knew what it was.

Libido is no stranger to girls with this sexual dysfunction. Maria came to try penetrative relationships, but without success: "I do not exaggerate, I tried it with six boys and nothing went in." The Catalan stresses that this syndrome is not an obstacle to enjoying sex, although it forces you to look for other forms of pleasure. "Not everything has to be intercourse, girls don't have the G-spot inside the vagina."

Considering this disease as a "pernicious invisibility", and after 15 years in the search for a solution, Lucia guarantees: "If vaginismus were a man's thing, rest assured that we would not be talking about this in the XXI century".

Mar, the only patient in this article who is still in treatment, faces the problem naturally, she has even made it a topic in her social networks. Its objective is to show that sex can be pleasurable and, also, that many women still relate focused on the pleasure of the man, without thinking about their own.

Respect for oneself also involves knowing, healing and pampering our most intimate part.

Lucia

In the eyes of Ariana Gaona, it is essential to end the taboo and shame around vaginismus, as word of mouth can help more women. Pilar Pons agrees: "We ourselves have been to blame for the fact that it has been silent for so many years, because since it is not spoken, it does not exist."

  • Gynaecology
  • Sex