Analysis: a new study aims to capture the experience of couples where vaginismus is a concern and to raise awareness about the difficulty

By Maria McEvoy, Rosaleen McElvaney and Rita Glover, DCU

Defined as an "involuntary contraction of the pelvic floor muscle group leading to painful and/or impossible vaginal penetration", there are many different explanations of why vaginsimus occurs. Most medical definitions such concentrate on the spasming of the vaginal muscles when intercourse is attempted, but this reduces the explanation of vaginismus to just one body part that is not functioning as it should. 

Vaginismus can also be understood as a healthy reaction by the body that is protecting the woman from anticipated harm. The perception of harm can stem from actual experiences of attempted painful intercourse or from the anticipation that a sexual encounter will be painful because of the messages about sex that the woman has received growing up. 

These messages can come from religious culture. Studies conducted thirty years ago in Ireland found that Catholic orthodox messages that linked sexual behaviours with guilt were found to contribute to sexual difficulties. Ireland at that time was seen as unique in terms of its conservative attitude towards sexual matters and the reluctance of the Irish people to discuss anything to do with sex. The factors that contribute to vaginismus can be thought of as a spectrum from physical to psychological to relational and cultural and a different blend of factors will contribute in a unique way to each couple experiencing it. 

The silence surrounding sexual matters may prevent women from speaking to parents, sisters or best friends about sexual concern

The inability to have a sexual relationship has a profound impact on how the woman feels about herself, on her partner and on their relationship. Thirty years ago, relationship factors were only rarely considered to be responsible for vaginismus, rather they were considered as possibly contributing to maintaining the problem. For example, women with vaginismus were frequently found to be in relationships with men who were gentle and would not force them into sexual intimacy. Thus, relationships could last a significant amount of time in the absence of sexual intercourse and even in the absence of communication about the difficulty. 

Couples who experience vaginismus frequently have very supportive relationships and quite often circumvent their difficulties by being sexual and intimate in other ways. Few studies have included the perspective of the partner, but those that do have found a wide variety of personality, relationship factors and coping styles. For example, one of the few studies that interviewed the partners of women with vaginismus found that partners can experience significant distress especially if the couple is unable to talk to one another and appropriate help cannot be accessed. 

However, partners in relationships with strong communication and emotional intimacy said that going through the difficulty together, although distressing for both partners, also increased commitment to one another. What seems to be common to all is a sense of not being able to share their experiences outside of the couple relationship. What causes vaginismus, how it is experienced and the impact on the relationship will be unique to each couple.

The inability to have a sexual relationship has a profound impact on how the woman feels about herself, on her partner and on their relationship

In modern day Ireland, little is known about the factors that contribute to vaginismus in couple relationships.  However, preliminary findings by a DCU study, based on interviews with professionals who have worked with women and couples experiencing vaginismus, suggest that some of the factors identified 30 years ago continue to be important today. These include conservative religious messages in the home growing up where sex is either not talked about or portrayed in negative or frightening ways. 

The silence surrounding sexual matters may prevent women from speaking to parents, sisters or best friends about sexual concern. Sex education in Irish schools that typically neglects any discussion of the emotional or relationship aspects of sex also contributes to the difficulty. It is suggested that an Irish culture of silence has surrounded the discussion of sexual matters that may have left those with sexual difficulties feeling ashamed and isolated and feeling like they are the only ones who experience the problem.

The perceived association between vaginismus and sexual abuse may also prevent women and couples for coming forward for help. Sexual abuse has been found to be a factor in some - but not all - cases of vaginismus. The first studies of human sexuality in the U.S. found that orthodox religious messages (regardless of which religion) was found to be a more frequently cited contributing factor than prior sexual abuse. Interviews to date by the DCU study also support these findings. It is important to understand the complex blend of factors that contribute to vaginismus in the case of each individual couple as understanding these factors informs better responses.

It is difficult to know how many couples are affected by vaginismus as couples may not come forward for help due to shame and a reluctance to discuss sexual matters

The highest rates of vaginismus in sexual dysfunction clinics in Europe were reported in Ireland in 1979 when Karl O'Sullivan reported that 42 percent of female patients presenting at the clinic complained of vaginismus. This prevalence rate was reported to have changed little when Jim Barnes collected information in psychosexual clinics in Dublin in 1986. In a study by RELATE, vaginismus was found to be the second most prevalent female sexual difficulty presenting at clinics in Northern Ireland. No recent statistics exist for the Republic of Ireland, but surveys conducted in psychosexual clinics 30 years ago estimated that vaginismus affected 5 in every 1,000 marriages. 

It is difficult to know exactly how many couples are affected by vaginismus as couples may be prevented for coming forward for help due to shame and a reluctance to discuss sexual matters. Our current DCU study is the first known study in Ireland to try to capture the experience of couples where vaginismus is a concern and to raise awareness about the difficulty. Preliminary findings suggest that this is a common problem, but one that is rarely spoken about. 

The current study seeks to start a conversation about vaginismus in Ireland and to reduce the feeling of isolation and shame that all too frequently accompany sexual difficulties. We are currently seeking to interview couples who have experienced vaginismus. Couples must be over 18 years of age, be in a relationship for at least three years and the woman who has or has experienced vaginismus must have grown up on the island of Ireland. The interview will concentrate on their experiences of vaginismus, the impact of vaginismus on the relationship and attempts to seek help.  For further information, please contact Maria McEvoy at the study website.

Accord, Dublin Well Woman Centre and Relate Northern Ireland provide support for couples currently experiencing difficulty

Maria McEvoy is a PhD student at DCU studying the experience of vaginismus in Ireland from the perspective of couples and health care providers. Dr Rosaleen McElvaney is a clinical psychologist at the School Of Nursing and Human Sciences at DCU. Dr Rita Glover lectures on the Doctorate in Psychotherapy programme and the M.Sc. in Psychotherapy programme at the School of Nursing and Human Sciences at DCU.

The views expressed here are those of the author and do not represent or reflect the views of RTÉ