Science of Sex: Vaginismus

September 15th, 2018

Welcome to this month’s edition of Science of Sex. This topic was suggested by one of my readers in my recent blog giveaway (thanks Courtney!). Vaginismus is a condition that you might never have heard of if you haven’t struggled with it (or known someone who has). And it seems like medical professionals don’t always take claims of pain as seriously as they should. It’s a shame because vaginismus is quite treatable as you’ll learn below.

Check out the rest of the Science of Sex posts here.

Vaginismus science of sex

Some people suffer from a condition known as vaginismus, which is characterized by involuntary contractions of the vagina that make sex painful or even impossible. It’s not uncommon for people who have this — or their partners — to describe it like hitting a wall.

There are two types of vaginismus: primary (lifelong) and secondary (developed).

A similar problem is dyspareunia or painful sex; although, vaginismus is a specific condition and patients with this condition have fewer issues with desire and self-lubrication than those whth dyspareunia.

Vaginismus is interested because it’s certainly tied to emotions, especially fear and anxiety. One survey found that people who suffer from vaginismus had a significantly higher phobia of sex while another found that over half of participants with vaginismus qualified as alexithymic (the inability to name their emotions).

While a past trauma such as sexual assault may potentially be one factor in vaginismus, people who have never engaged in any form of sexual activity can also suffer from this. And pain may be present in non-sexual situations like using a tampon or getting a Pap smear.

But there is doubt whether the emotional state causes vaginismus or whether pain leads to anxiety. Vaginismus is definitely a vicious cycle.

Researchers have looked for differences in brain and genital response in people with this condition. Interestingly, there are no differences in how the brain responds. Furthermore, while women with vaginismus report less mental arousal to erotic content, they don’t necessarily have decreased genital arousal. This is known as arousal non-concordance, and is a common theme of female sexual dysfunction.

Because of the emotional/mental aspects of vaginismus, many of the treatment options are psychological. Mindfulness, for example, can be an effective treatment.

Touching exercises are a common treatment for this condition. Patients are instructed to touch themselves progressively closer to their vagina until their can do so with less or no pain. Insertion begins with a single finger, then moves to devices (dilators) that become progressively larger.

Coping with vaginismus can be difficult for couples. Some professionals recommend erection-enabling medications if partners find it difficult to remain erect or to engage in penetration after dealing with vaginismus. Becoming accustomed to touch helps to desensitize people.

Treatment can allow for successful intercourse in as little as two weeks.

Medicine interventions have been explored, and botox may be one option for treating vaginismus. Surgery is also occasionally a solution. A hymenectomy (removal/reduction of the hymen) to make sex possible and pleasurable.

Although most people think of vaginismus in terms of sex, it can also affect childbirth and labor. Specifically, women with vaginismus are more likely to have C-sections and to suffer from perineal laceration (tears of the perineum, the skin between the anus an vagina) during vaginal deliveries. It stands to reason that fear of pain and muscle contractions or tension could make this area more vulnerable.

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Science of Sex: Mindfulness as a Treatment for Sexual Dysfunction

July 14th, 2018

This month’s Science of Sex post is directly inspired by the book that I reviewed by Dr. Lori Brotto and, in fact, will draw from several of her studies. Mindfulness at first times to be new agey– more hype that hypothesis. But multiple studies have shown that mindfulness can have a positive impact on many facets of life, sex among them. So this month’s Science of Sex post focuses on that.

Check out previous Science of Sex posts here.

Mindfulness as a Treatment for Sexual Dysfunction

Dr. Brotto does a good job of explaining what mindfulness is in her book: it’s an awareness of your thoughts, feelings, and sensations, that allows you to create a distance with them, which can reduce the impact of pain, for example. But mindfulness also helps you remain more in the moment to focus on sensation. We’ll start with Brotto’s work since she’s done so much.

In one study, Brotto and her team found that while mindfulness didn’t necessarily increase arousal, it does increase women’s’ awareness of their physical/genital arousal, in turn increasing arousal concordance (symmetry between observed physical and genital arousal).

Another study by Brotto et al found that a group of 31 endometrial cancer survivors experienced improvements in multiple aspects of sexual functioning — desire, arousal, lubrication, orgasm,  and satisfaction — after participating in three sessions of mindfulness-based cognitive behavior therapy. And the improvements remained six months later.

Yet another study by Brotto found four sessions of a “mindfulness-based therapy significantly improved sexual desire, arousal, lubrication, satisfaction, and overall sexual functioning”. Continued sessions resulted in further improvements in genital and mental excitement. Any immediate improvements continued to a 6-month followup.

Finally, a 2008 study found similar improvements in women’s’ sexual function when exposed to mindfulness training. Furthermore, women who had previously experienced sexual abuse benefited the most from mindfulness compared to all participants.

Clearly, Dr. Brotto has done a lot of research on mindfulness and sexual function and talks about a 60% increase in sexual function after mindfulness in one of her studies. I think we can expect that to continue. But she’s not the only one. Time and again, studies suggest that mindfulness could be key to an improved sex life.

One such study compared how long it took men and women to register their physical arousal, finding that men did it significantly quicker than women. Mindfulness meditation enabled women to require less time to notice bodily responses, putting them on par with men. Additionally, women who practiced mindfulness were less judgmental toward themselves. Others found that mindfulness may be helpful to people who experienced sexual abuse as children.

Yet another study posited that people with more disproportional mindfulness would be less likely to engage in sexually compulsive behaviors or use drugs and found this to be true. Finally, a survey of women who completed mindfulness-based therapy online only found improvements in sexual function.

Studies on mindfulness have focuses on women, perhaps because they’re more likely to experience certain sorts of sexual dysfunction (low desire, difficulty with arousal, impaired pleasure, etc), but it’s reasonable that men could improve their sex lives by learning and practicing mindfulness, too. Some sources even state that mindfulness could help people with ED and at least one study focuses on sensate touch, a type of mindfulness program originally developed by Masters and Johnson, as a possible aid here. I’d like to see mindfulness applied to men. Otherwise, the science is promising.

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Science of Sex: Female Sexual Dysfunction

May 19th, 2018

Welcome to my latest installment of Science of Sex. I’ve officially be doing these for more than a year and have more planned! If you want to check out my archives, click here. Otherwise, enjoy this month’s post!science of sex - female sexual dysfunction

Today we’re venturing into the realm of female sexual dysfunction, just what it is, and why that title might not actually be helpful.

At its heart, female sexual dysfunction is an issue with sexual functioning in a woman. This can include a number of conditions and concerns, but four of the main ones are:

  • Desire : Many women and sometimes their partners describe their lack of spontaneous desire as a dysfunction. However, studies show that women are more likely to have responsive desire than men. This is not a dysfunction as much as it is a difference in sexual function. Furthermore, some have suggested that the traditional stages of arousal may not apply as well to women whose arousal process is more cyclical. It’s also important to understand that a woman’s sexual brakes are often quite touchy (learn more about this). Finally, low desire often corresponds to relationship issues, so it’s not so much a sign of sexual dysfunction as it is one of relationship dysfunction.
  • Arousal: Female sexual dysfunction can also present as a lack of physical arousal. This highlights further incorrect assumptions or beliefs about female sexuality. First, it doesn’t take into consideration that women are much less likely to experience concordance – an alignment between mental desire and physical arousal – than men and, secondly, it ignores the variance in a woman’s natural lubrication.
  • Orgasm: Some women may describe their inability to orgasm through sexual intercourse as dysfunction, but multiple surveys have found that the majority of women need clitoral stimulation to orgasm and very few achieving orgasm solely through penetration. At least one study reports a group of women who prefer penetration/sex with their clit stim as a way to get off.
  • Pain: Too many women experience pain during intercourse (in fact, at least one study has found that the bar for good sex for women is so low that they simply describe it as sex that is not painful). This is often remedied by increasing foreplay to encourage arousal, using lube and improved sexual communication. While conditions such as vaginismus and endometriosis can lead to pain during sex, painful sex can also be a symptom of poor technique and can often be ameliorated by changing the script.

Of course, there are other types of dysfunction, including those that center on physical issues and are not rooted in psychological or romantic distress. But the solution or treatment to any one of these “dysfunctions” may not be at all alike to the treatment for any other dysfunction.

The problem is that the term sexual dysfunction itself is not well-defined, and female sexual dysfunction is even more poorly defined because the umbrella term lumps together so many potential issues, including those that may be easily rectified by a better understanding of female sexuality. Furthermore, having a stronger grasp on female sexuality would show that some so-called dysfunctions are simply functions of sexuality in women that do not need to be pathologized. Of course, it’s not like men don’t suffer from this. It’s not a dysfunction if men ejaculate within ten minutes — it’s the norm — but the deep-seated misunderstanding of female sexual function had led to a lot of suffering.

Fortunately, doctors have devised questionnaires such as the aptly-named Sexual Function Questionnaire, and other tools to more readily diagnose sexual dysfunctions and focus on the root of the problem, whether it may be physical, relational, or a combination of factors. Sex therapists and educators are also making great strides in adjusting public and personal views of normal and healthy sexual function. For example, Dr. Emily Nagoski has written about desire and arousal in her book Come As You Are, Dr. Laurie Mintz shed light on clitoral stimulation in her own book Becoming Cliterate, and Dr. Lori Brotto helps women experience greater sexual function in her recently-released book Better Sex Through Mindfulness.

It should come as no surprise that women working on sexual research and providing sex therapy offer unique insight into female sexuality and what truly is dysfunction. If you’re interested in that topic, check out my post on  about the Women of Sexology

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