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| A neon sign that says "Your body belongs to you." Image source. |
So I happened to see this youtube video, What Is Vaginismus and How Is It Diagnosed?, and I have some things to say. (I used to have vaginismus- I've blogged about it.)
Basically the video is about what vaginismus is, how it's diagnosed, and how it's treated. Vaginismus is a medical condition where the muscles around the vagina involuntarily contract, so that penetration is difficult and painful, or even impossible.
When the video talks about how vaginismus is diagnosed... it made me sad, because I've never had gynecologists treat me with as much care and respect as what's described in the video. Like, hard for me to even imagine.
Here's what the woman in the video, Denise Conway, says:
You should contact your gynecologist beforehand, to let them know if you think you have vaginismus, because this will ensure that they are aware of your fears ahead of time and they can prepare properly for your visit. When you have your exam, they should begin by giving you a mirror so that you can look at your vulva. They can explain what the different parts are, and they can talk you through the exam before they begin. A speculum is often used for gynecological exams. They may be able to use a small speculum because of your vaginismus. Before they use the speculum, they will likely use a q-tip to see if you can relax for that, and if you're okay with the q-tip, they may guide you to insert either one or two of your own fingers, just to see how you manage with that. They're then going to proceed with the exam, if it's possible. And they will grade your vaginismus if they find that you have it.
Wow! Imagine such a utopia, where gynecologists did all those things! That would be so wonderful.
Do only patients who know the word "vaginismus" get to be treated so well? And if you don't know that word, and you just naively trust that doctors know what they're doing, then you get treated like your pain isn't real and you're a wimp? (Speaking from experience here...) Is that what they teach in gynecologist school?
Anyway, next in the video, she says,
Once you've been diagnosed, then you can discuss the treatment options.
She first recommends some yoga exercises which can help to relax the pelvic muscles. Also, she recommends therapy or couples counseling. And dilators. What are dilators, you ask? It means you get a set of special medical dildos of various sizes, and you practice sticking them in your vagina.
So... I mean, yes, that's what the treatment is, from a medical perspective. But I think something very important is missing. I think we have to take a huge step back, before doing any treatment, and ask: What do you want?
You, the person with a vagina. What do you want? Your body belongs to you. Your sex life (or lack thereof) belongs to you. What do you want?
Because, here's the important thing, which I never see mentioned in medical articles about vaginismus: Vaginismus is not a problem, in and of itself. If you have vaginismus, and you want to put things in your vagina, now THAT'S when it becomes a problem. But if you just want to go about your life never putting anything in your vagina, then yes, that's a perfectly valid solution. No problem with that at all.
Before you start any kind of "treatment", ask yourself why it needs to be treated. Why is it so important to put things in your vagina? Is it really important enough to justify spending your time on exercises, and therapy, and trying to grit your teeth and tolerate it while you "train" with a series of increasingly-bigger dildos? (Note that the "therapy" mentioned in the video was about figuring out why you have so much anxiety around sex- not about figuring out what you *actually* want.)
What do you want?
Not "what does society want?" Not "what does your male partner want?" Not "what does your doctor want?"
What do you want?
As I see it, there are a few reasons that people might want to put things in their vagina:
- You want to have vaginal sex
- You want to use tampons
- You want to have medical exams such as pap smears
- You want to get pregnant
For each of these, you can evaluate your own situation and decide if it's really necessary or not. Perhaps your desire to do any of these 4 things is not high enough to justify putting yourself through all the trouble of "treating" your vaginismus. (And let me say something about #3 there- don't think you "have to" just because it's a medical procedure. If you have never had vaginal sex, the risk of having cervical cancer is extremely low, and it's quite possible that the risk is low enough that it's truly not worth putting yourself through the pain of doing a pap smear. I'm not a doctor, so don't take medical advice from me, but my point is, you should definitely *not* think it's as simple as "I HAVE to get a pap smear because the doctor said.")
It just makes me so sad, seeing this video about vaginismus jump straight from diagnosis to treatment. (And actually all medical resources on vaginismus do this- don't take this as me singling out this video for criticism. It's all of them.) Like, they're saying that if you have vaginismus, something's wrong with your body and it needs to be changed. Why should your doctor get to decide that?
SO WHAT if you can't have vaginal sex? That's only a problem if you want to have vaginal sex. Notice that I said it's about if *YOU* want to have vaginal sex. That's not the same thing as "my male partner wants to have vaginal sex." That's not the same things as "if you're married then you have to have vaginal sex."
I'm just imagining a good little girl, who always wore "modest" clothes because she was told her body was dangerous to men, who was very careful about following the rules about purity... She finally gets married and she knows that it will be her responsibility to make sure her husband's sexual "needs" are met... and then it turns out she has vaginismus, and she can't even have sex correctly, oh no, she's not good enough for her husband, she's not holding up her end of the marriage vows. She has to go to a doctor and the doctor will tell her what she needs to do to make her body good enough for a man. She has to spend her time on yoga, because her body isn't good enough for a man. She has to endure the pain of trying to push dilators in, trying to force herself to relax, hoping she can make herself good enough for a man.
Meanwhile, what is her husband doing? Is he causing pain to his genitals? No, of course not. (Nobody expects men to put themselves through anything like that.) He is very kindly and patiently waiting for his wife to get back on track. He tolerates the delay, and doesn't even cheat on her, even though, well, you know how men are. Poor guy, this must be so hard for him. What a saint.
What do you want?
One of the risk factors for vaginismus is having a conservative religious background. The kind of background where girls aren't allowed to really ask themselves the question, "What do I want?" Where girls are told that their body does not belong to them, it belongs to their "future husband." Where masturbating is a sin. Where instead of real sex ed, there's just "abstinence only" and extended metaphors about how gross and unlovable you will be if you're not a virgin. That's why we can't jump straight from diagnosis to treatment. There's another option besides treatment- it's living a life where you never put anything in your vagina. Do you think you could be happy with that kind of life? If so, vaginismus is not a problem.
And, if you still want to have sex, please note that the clit is on the outside, and you can get an orgasm through clitoral stimulation, without any vaginal penetration required at all. (Here's a link to Scarleteen.) Why is everyone acting like vaginal sex is so important? Just because men like it? I'm imagining that naive young woman again, who has never even had an orgasm- even though THE CLIT IS ON THE OUTSIDE and she could totally have an orgasm with no pain at all. But no, she's not doing that. What's she doing instead? She's spending her time wincing in pain as she tries the dilators, for the sake of her husband's orgasms.
What do you want?
And okay, I recognize that when a patient tells their doctor about some medical issue, it's because the patient sees it as a problem and wants it changed. I'm not sure that doctors' typical approach would lead them to say, "Maybe this is not actually a problem, and we should dismantle all of society's heteronormative assumptions instead." That seems like... not really the thing that doctors focus on.
And that's why I'm glad I found the asexual community, instead of a doctor.
I tried to have vaginal sex, and couldn't figure out why it was so painful, sometimes even impossible. Everyone talked about sex like it was so easy and wonderful, and I couldn't understand why. I asked several doctors about it- "why is sex painful?"- and they said "just relax" and other completely useless things. Then I started to wonder if I was asexual- if this is what sex is, then NOPE I very much DO NOT have a desire for that.
And I read more and more about asexuality on the internet, and it was all about "What do you want?" They said that just because society says "everyone" has sexual and romantic desires, well, that's not true, you can figure out for yourself what desires you have. They said there are different kinds of attraction, and you can analyze your feelings and figure out where you fit in. They said some aces masturbate and some don't, and that's fine. They said some aces have sex and some don't, and that's fine.
What do you want?
That's how I found out that my body belongs to me. My sexuality belongs to me- not my husband. My identity belongs to me. My desires are my own- nobody else can tell me what my desires are.
And I started from there, and I explored what I want. And one of the things I wanted was to have vaginal sex- sort of for healthy reasons and sort of for problematic reasons- but there were other things besides that. I wanted to understand my own body- which definitely would not have happened if I had found a doctor to treat me for vaginismus instead. I would have been totally clueless at the start, and then totally clueless at the end, but with dilators, and the shaky hope that I might be "good enough" for my husband. No, that's no way to live.
One thing I should make clear here: I was never officially diagnosed with vaginismus, and never had treatment from a doctor- instead I figured out what to do MY OWN DAMN SELF. So here in this blog post, perhaps I am making it sound like whatever treatment doctors give for vaginismus is very scary and painful- but actually I don't have any experience with that, so that's not what I mean. I don't mean the treatment itself. I mean the idea of doing those treatments while still completely in the dark about how my body works, and only motivated by my fear of not meeting a straight man's standards. That's what horrifies me.
Sticking a dilator in because you have a whole flourishing sexual understanding of yourself, you know what orgasms are, and you specifically want to work on the vaginismus issue because you have goals about what you want to get out of sex, long-term- that's great! Sticking a dilator in because the only thing you know about sex is "penis goes in vagina" and you can't even manage that, therefore something is wrong with you, and you need to fix it before your partner gets fed up with you, because it's so unfair that you're doing this to him, this isn't what he signed up for- NOT COOL. DON'T DO THAT.
The next step after a vaginismus diagnosis should be to challenge heteronormativity, to challenge compulsory sexuality, to challenge the male-centered view of sex. A doctor is not going to do that for you- you have to do it yourself. And then, after that, after you've challenged those ideologies and figured out what you want, you may find that it is useful for you to get guidance from a doctor to address the specific physical bodily processes that cause vaginismus.
But if it's a choice between "strike out on your own and figure out what you want" (like I did) or "let a doctor tell you what to do, to change your body, just like you've always let men tell you what kind of sex you're supposed to have", well, definitely choose the first. Definitely.
So people who have vaginismus should ask themselves, "Is there any reason I need to put things in my vagina?" Perhaps there is, perhaps there is not. Only you can answer that question for yourself. Not your doctor. Not your male partner. Not any cis man. Just because you have vaginismus doesn't mean you have to get treatment for it. Only do it if it's what you want.
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Okay and 1 more thing I want to say about the video:
Near the 42-second mark, there are these 2 COMPLETELY WILD graphs:
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| Graph titled "From initial penetration, normal without vaginismus." The y-axis is "Pain & Discomfort" and the x-axis is the number of "Penetration Attempts." The pain starts at a "10" for the first 1-5 penetration attempts, then goes down gradually, till it hits "0" on the 35th attempt, and stays at "0" after that. |
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| Graph titled "From initial penetration, with vaginismus present." Same axes as above, but this graph shows the pain is a "10" every single time, even to the 55th penetration attempt. |
Okay, first of all, wow, maybe this explains why I've heard people talking about "the first time is painful for women" but something about it seemed *different* from my experience. Like, I have often felt confused about why I hear people say "sex is often painful for women but we don't talk about it enough" and also I hear people say "women enjoy sex but we don't talk about it enough." These graphs kind of show the idea of pain being sort of a "normal" thing, but the vaginismus experience is completely different than that.
And my second thought was, wait, it's "normal" for sex to be a 10 on the pain scale the first bunch of times, if you have a vagina? Like, is the idea "this is just the way it is" or is it "sadly, people don't understand foreplay, and therefore women are experiencing a lot of pain which is COMPLETELY AVOIDABLE"?
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| Scene from "The Lion King" where Timon says "And everybody is OK with this?" Image source. |
Like, why are people with vaginas even having vaginal sex, then? Seems like a total scam. I guess there must be some desire for it, where you intuitively believe that it's the sort of thing that, in the long run, will feel good?
Oh and also, no idea where the source data for these graphs came from. It's possible they're completely wrong. Who knows.
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Related:
How Pregnancy and Childbirth Changed My Asexuality (or, actually, A Post About Vaginismus)
On Gynecologists and Angry Turtles
Sea Monsters on Land, and My Life With Vaginismus
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