Why Should Psychotherapy be a Part of Vaginismus Treatment and Other Pelvic Pain Issues?
Have you ever paid an attention to how vaginismus and its treatment are depicted in the media? How realistic are pelvic pain problems on TV shows and movies?
You may be familiar with a TV series called Private Practice. In this medical drama show, an OBGYN joins a group private practice for holistic treatment in Los Angeles. The private practice has a pediatrician, fertility consultant, physical therapist, a psychotherapist and so on. Season 1, episode 3 was about vaginismus and I was highly disappointed with the way that the show depicted vaginismus treatment. A young couple consults the OBGYN and they share their discomfort during sex. The doctor looks at the wife and basically says, “You have vaginismus.” Meanwhile, the husband looks at the doctor and asks, “Can you fix her?” The doctor prescribes a muscle relaxation medication and tells the couple, “Get this 1 hour before having sex and give your best shot!”
The next day, the couple shows up sexually frustrated and appear angry. They inform the doctor that they could not have sex and the medication did not work. The doctor seems surprised, and asks, “Really?” The wife holds herself accountable and thinks, “What’s wrong with me?” Her shame and guilt intensify with the doctor’s reactions. The wife starts to feel anxious and tells her husband that how perfect he is. The wife tells her husband that she is afraid he will leave her because they cannot have sex. The husband says, “It’s okay. Sex is not everything. We can do other things that connect us.” The wife continues to say, “No. I know you’ll leave me”. Meanwhile, the doctor listens their conversation quietly.
The doctor shares this case with her coworkers at the same practice. Many of them comment, “Wow, a marriage without sex!” Finally, one of them says, “Maybe it’s psychological.” The OBGYN ignores this comment and decides to perform surgery. At this point, it’s not clear what the surgery is. Also it is questionable how a doctor decides to perform surgery within two days without asking any medical history or consulting with a psychotherapist and/or a couples counselor.
The doctor changes her mind and decides to apply trigger point injections of lidocaine and steroids in the pelvic area. Meanwhile, nobody considers addressing the wife’s fear of abandonment, her trauma history, her body image issues, the unnecessary amount of responsibility that she takes, her fear or anxiety. The doctor and her colleagues fail to understand why and how this young woman associates love with penetrative sex. The young couple has not received any information about what vaginismus is and what the treatment looks like.
When it comes to pelvic pain disorders, psychoeducation is crucial. It is intuitive for patients of pelvic pain to assume that there is something wrong with them and that they need to fix it. Pelvic pain disorders may be impacted by quality of the patient’s current romantic relationship; having past medical, religious, sexual, and emotional trauma; body image issues and self-esteem; underlying depression or grief and emotional safety in a relationship. When the patients do not receive psychotherapy during the course of their pelvic pain issues, it is extremely common to assume, “This is my fault and if I can’t fix this, my husband will leave me.”
The injection scene is uncomfortable to watch. During the injections, the wife is in tears and in distress. The doctor continues, “4 more, 3 more…”. The doctor promises that these injections will take care of the cause of vaginismus and the wife will be able to have painless sex. At the end of her treatment, the doctor says, “Good luck tonight” and pats her shoulder.
Here the concern is about the pressure that has been put on the wife with that pat on the shoulder. If the wife experiences sexual pain that night – she will experience sexual pain because she had just received painful injections, then she will continue to feel hopeless and helpless. This is what we call a learned hopelessness and learned helplessness. After unsuccessful treatment attempts, often sexual pain patients assume that “Nothing works, and nothing will work.” While these hopeless feelings cause pain to intensify, stress, anxious and depressed moods also intensify.
If your OBGYN or a member of your current medical team makes you question your self-worth, ignores your mental and emotional wellbeing, causes you to feel stressed out or anxious, or if you are experiencing learned hopelessness and/or learned helplessness, it’s time to change your doctor. A sex and/or a couples therapist should be a part of your treatment team. Your therapist should work collaboratively with your OBGYN and with the other members of your medical team.
We are working with an amazing set of trauma-informed professionals who are ready to be your treatment team. Vaginismus and other pelvic pain disorders are treatable with a proper treatment plan and collaborative work with other healthcare providers. You may feel hopeless, and this is because you learned to feel that way due to inadequate/improper treatments you have received in your past. If you are experiencing sexual pain, contact us today and let us build learned hopefulness.