Vaginismus as metaphor

[Soroush Ebrahimi]

Shame she does not know homeopathy!

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Vaginismus as metaphor
9.51AM 19 August 2011
A holistic approach to medicine, by definition, seeks to incorporate all aspects of body/mind/soul.
So when a patient presents with a symptom, we should strive to identify the cause of that symptom,
rather than to eliminate or suppress the symptom. What is this body trying to say, by manifesting
this symptom? What is the meaning of this symptom?
For many years, I have been running a 'psychosexual difficulties' clinic in a busy gynaecology
department in a hospital. In my early years in this post, the presentation of vaginismus had too
often been previously (unsuccessfully) treated with examination under an anaesthetic and vaginal
stretching, or surgical procedures that cut in to the perineum.
Fortunately, nowadays, I see the victims of this butchery fairly infrequently, and usually they are
patients who have undergone such a procedure abroad. The approach that I always take, in addressing
vaginismus, is to ask the question, 'What is this patient saying, with her body, that she cannot
vocalise verbally?' The vaginismus is a metaphor, which must be properly understood, in order to
successfully address it.
Most of the patients have primary vaginismus. Those that have secondary vaginismus always have a
clear precipitant, that can include sexual assault, traumatic delivery, and, disappointingly all too
often, inappropriate or brusque vaginal examination by a healthcare attendant. The latter,
fortuately, is becoming more infrequent but only a couple of weeks I saw a young woman who had
undergone a heavy handed and unnecessary vaginal examination at the age of 17 when she was not yet
sexually active, by a practice nurse. Subsequently she got married aged 21 and two years later had
still not consummated her marriage.
Those with primary vaginismus can be very interesting, indeed. There are often a number of common
features. They are often sweet-natured creatures who are 'best friends' with their mothers. They
have usually not had an adolescent rebellion, always having been 'good'.
The stifling nature of this overly close relationship, whereby the umbilical cord has not been
properly severed, leads the patient to lay down boundaries in this metaphorical way. She is usually
completely unaware of the reasons behind this process. And so I have to take her through a
separation experience from her mother in order for her to reclaim her own personal space and her
sexuality.
Generalising, a typical patient will be an infant school teacher, who will be very good at her job
and will be dearly loved by her students, with whom she relates well. She will have a very
'understanding' partner, who thinks that she is wonderful. He will be the only person with whom she
can express anger. They will meet their sexual needs in a non-coital fashion.
Vaginismus is such a wonderful example of a manifestation of a physical symptom, that has complex
underlying precipitants, that requires a holistic approach in order to achieve full resolution.
Treatment demands the making of mind-body connections.
General practice is replete with such patients, presenting with a variety of symptoms, challenging
us to attempt to fully understand them when we can, and not to just repress the symptom, usually
done by medication. Repression of the symptom bypasses the patient's innate healing mechanism and is
often only a temporary solution; the symptom will re-emerge in the same or sometimes different
manifestation, at a later date.
Listening out for the metaphors, and making connections with the patient's story, can provide a far
more satisfying outcome, for both patient, and doctor.
Dr Karine Nohr is a GP in Sheffield
Best Regards
Soroush