Back in April, pop icon, Meghan Trainor, opened up about her experiences with painful sex and her medical diagnosis of vaginismus (Portee, 2023). This resulted in a historic amount of coverage over the condition, which has remained relatively unheard of, despite the fact that an estimated 5 to 17% of the global population have reported experiencing it. And that is just an approximation (Pacik & Geletta, 2017).

Reporting of the condition remains low, largely due to the stigma that surrounds having a sexual “dysfunction” (If we want to call vaginismus a sexual dysfunction. I personally do not ascribe to this view and find it quite limiting.). It can be quite embarrassing and vulnerable to reveal such a personal struggle. Especially when it appears as though no one else is experiencing it.

The lack of conversation around pelvic pain, painful sex, and conditions like vaginismus, makes it even more challenging to talk about in the first place, ultimately contributing to a feedback loop where dialogues around pelvic health, pain, and sex are simply not had. At least, not as frequently and openly as would be beneficial to help create safe spaces where these discussions can occur, which could then lead to more widespread change including how medical professionals care for clients who have vaginismus/pelvic pain/painful sex.

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Info Inconsistency Regarding Pelvic Health

Even when we do talk about painful sex, the information that is shared is not always accurate. Our understanding of pelvic health and similar conditions is constantly evolving, as new research is conducted and published, and as more communities begin to form and share their experiences. Vaginismus was commonly characterized as an involuntary spasm of the outer third of the vagina, which results in painful or near impossible penetration, whether it be digital, penile, or by a tampon, but this characterization has been recently challenged, with many pelvic floor specialists trying to dispel this popularized misconception (Harish et al., 2011; Vagina Rehab Doctor, n.d.).

This issue is further highlighted by the fact that many clinicians strictly characterize and treat vaginismus as a mental disorder, with the leading treatment often deferring solely to cognitive behavioral therapy (CBT), an approach which, as the name suggests, focuses more on thoughts and behaviors than physical symptoms like pain. (This is strange considering pain is a huge part of having, well, chronic pelvic pain.) While pelvic floor physical therapy has been helpful for many who have chronic pain, not everyone knows this treatment is available. Access to these services is also quite limited, as not all physical therapy offices have a clinician who knows how to support clients with pelvic pain.

Transparency and Vaginismus

There is little transparency between medical offices and their clinicians as to how long their providers have actually been working with this issue, or how often they receive continued specialty training. Even if there is a PT who offers pelvic floor therapy, this does not necessarily mean they can provide the level of care clients need and deserve. This is where self-advocacy becomes so crucial for folx. If there are concerns regarding the level of care that is being administered, clients may request to speak to a supervisor and voice their needs directly, as well as ask any questions they may have.

One question I always ask up front at every doctor’s office is, “What policies and procedures does your agency have in place in order to provide trauma-informed care?” I believe that this invites the organization to be more accountable. Not only that, it is an explicit request to be treated with dignity and respect.

For years, the healthcare community has debated whether or not to classify vaginismus as a mental illness/sexual dysfunction in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This narrow view of the condition dismisses the diverse experiences of people who live with vaginismus. While there are some who may describe their pelvic pain as being very much impacted by both their physical and mental health, there are others who view their pelvic pain as a concern that is more physical than mental.

Offering clients the same care even when their symptoms, etiology of pelvic pain, and treatment goals differ, does little to honor the rich diversity of lived experiences people have. Instead of prescribing a one size fits all approach or characterization of pelvic pain, providers should encourage and empower clients to share their insights and intuitions. Medical professionals should be curious to discover what their clients believe about their health and ask them directly what they would like to see differently versus what they hope will continue.

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Media’s Role Regarding Vaginismus and Pelvic Pain

I believe media representations have had a huge role in sparking open dialogue around sexual pain and wellness. One of the first mainstream representations of pelvic pain that come to my mind is the character, Lily Eglehart, from the widely celebrated Sex Education, show on Netflix (Campbell et al., 2019).

In the show, Lily envisions her foray into sexual maturity as consisting of aliens and fancy, galactic costumes, all culminating into the intensity of the most celebrated ecstasy, but her dreams of perfection are dashed when she discovers how painful penetrative sex is for her. As the show progresses, Lily is able to explore ways to address her painful sex and uses therapeutic dilators to help familiarize herself with her body and her needs.

Sex Education is not the only show to depict vaginismus. The Japanese Netflix show, My Husband Doesn’t Fit, follows a young Japanese woman’s struggle to experience satisfying sexual intimacy with her husband. The show is based on an autobiographical work by author, Kodama (My husband won’t fit, 2019; Handore, 2021). ‘Otto No Chinpo ga Hairanai’ is the title of the original work in Japanese, or ‘My Husband’s Dick Doesn’t Fit’ in English. **Side note, if anyone knows how to obtain a copy, either in Japanese or English, I’d be happy to know how, as I cannot find copies on either Amazon or Thriftbooks.

I think it is clear that people crave more nuanced representation, more perspectives, and overall increased discussion of just what vaginismus is, and how it can be managed and treated. There are writers, advocates, health professionals, and activists out there desperately trying to get the word out.

Meghan Trainor’s personal disclosure of her experiences with painful sex has helped put a spotlight on what so many people around the world are continuing to navigate and I hope that this won’t remain a trend. I hope pelvic health and pain can become mainstream topics that are openly discussed, so more people can become connected to the resources and tools they need and deserve.

References

Campbell, J., et al. (Director). (2019). Sex Education. [TV Series]. https://netflix.com

Harish et al. (2017). Successful management of vaginismus: An eclectic approach. Indian Journal of Psychiatry. 53(2): 154–155. https://doi.org/10.4103/0019-5545.82548

Handore, P. (2021). Is my husband won’t fit a true story? The Cinemaholic. https://thecinemaholic.com/is-my-husband-wont-fit-a-true-story/

My husband won’t fit. (2019). Netflix. [TV Series]. https://netflix.com

Pacik, P. T. & Gillette S. (2017). Vaginismus treatment: Clinical trials follow up 241 patients. Sexual Medicine. https://doi.org/10.1016/j.esxm.2017.02.002

Portee, A. (2023, April 26). Meghan Trainor gets candid about painful intercourse and vaginismus diagnosis. Retrieved from Today:www.today.com

Vagina Rehab Doctor. (n.d.). Vagina Rehab Doctor. Howard, J. [Instagram Profile].Reels. https://www.instagram.com/vaginarehabdoctor/