Heard from a patient recently: “I really wanted to self-video using the dilators in order to show myself that I am doing it correctly, and to remind myself that I can do it. I need a visual reminder…”
When asked to explain further, she said: “There are moments when I feel capable, and others when I feel/think that I cannot do it. The thoughts in my head tell me that I am in the wrong position, or not at the right spot, in a bad angle, or inserting the dilator too slow… It is really hard to do it on my own whereas it is so much easier to do it at the office under treatment supervision… Sometime I wish I had a key to the office to sneak in after hours and practice there where I feel a great sense of comfort…”
What is going on? It’s complicated…
Does a woman need to see herself inserting a dilator into the vagina? Not at all. We are wired to know our orifices and to use them intuitively without a visual cue: we feed without a mirror, we wipe after voiding without looking, and we can put a finger in our ear or nose without a problem. Had we not been wired such, blindness would have been a devastating affliction, and being in the dark or without a mirror would have stopped us from using our bodies. We would have been extinct…
Vaginismus is psychosomatic disorder, which means that anxiety is at the core of it. And anxiety is a powerful, illogical reaction that convinces the affected woman that it make sense, hence the quotes above. Even showing that patient her (perfectly normal) vagina through an open speculum was not enough to wrestle the anxiety away.
To effectively treat vaginismus, the guide (expert clinician) must represent healthy-normal, not anxiety-altered body perception and bodily experiences. Treatment is a delicate balance of diffusing the anxiety while demonstrating to the affected woman, again and again, that her vagina is perfectly fine if not for the anxiety that says otherwise.
Also, it is about reminding the woman that the vagina has no eyes to see nor a GPS to know where it is in space — it is just a body part that needs to ‘do its thing’ (if not for the anxiety that is ruling it).
As the treatment processed progressed, our patient realized that she need not self-video her ‘insertions’ but rather fight hard the anxious, manipulative thoughts while reminding herself, over and over, that if she can have successful, good penetrations at the office, she should be able to have them anywhere unless the anxiety is allowed back in!