Three typical questions often raised by women with vaginismus:
These are excellent questions! Let’s review them one by one:
There is a basic perception that pregnancy can only happen with a ‘penis in vagina’ activity (vaginal intercourse), and those other sexual activities, also known as ‘outercourse’ (oral sex, manual sex, etc.), are safe. Even women without vaginismus, who prefer to refrain from intercourse, will often forgo the use of contraception because they feel that pregnancy is not possible. Not a good idea…
The truth is that a woman can get pregnant if the male ejaculates by her genital lips during the week leading to ovulation when the hormonal chemistry in her reproductive system is conducive to sperm survival! In other words, we have had many patients who were still virgins yet already parents… As much as they loved their children, they felt a bit of being “fake” about getting pregnant that way.
That is not to say that getting pregnant with vaginismus is a bad thing. Many women/couples that we met embraced this gift while admitting that they tried all they could to get pregnant: having the man ejaculate as mentioned above, or have the man ejaculate into a small cup and the woman self-inseminating (if she can insert the small syringe), or undergoing assisted reproduction (infertility treatment).
But what happens to the woman with vaginismus during pregnancy? Unless she can tolerate a pelvic (gynecologic) exam and a vaginal ultrasound, she will have to be managed “from the outside’ while also addressing her ongoing worries of internal exam/s at the time of delivery and whether the baby will come out; altogether…
As to the actual childbirth with vaginismus, physicians will typically opt to deliver the baby via a c-section with safety in mind, never examining the woman’s vagina beforehand for possible anatomical/structural abnormalities. As mentioned above, women with vaginismus who can tolerate an internal exam (albeit under duress) may very well deliver vaginally.
What about the pelvic floor muscles? Won’t their (vaginismus) clenching block the baby’s exit, make a c-section a must??? Not at all. The physiologic process of childbirth provides ample room for the baby’s exit, making the pelvic floor muscles a non-player.
Okay, so I had my baby vaginally, and now the vaginismus should be cured. Yet, it is still here… What is going on? The answer is simple: childbirth (‘coming out of the vagina’) did not address nor cured the fear/apprehension associated with vaginal penetration (‘coming into the vagina’)…
- Use proper contraceptive measures if you do not want to get pregnant, remembering that vaginismus is not a contraception method!
- Discuss the pregnancy/childbirth process with your OBGYN so that your vaginismus need will be addressed.
- Examine the pros and cons of becoming a parent while remaining a virgin with vaginismus.
- Seek treatment for vaginismus – there is no reason to live with it!