The circumstance that men need to be sexually aroused in order to engage in sexual intercourse is something of a given. Many women have also been long aware that this applies to them in equal measure. This, however, had never been scientifically established until now. Indeed, some academic research actually concluded that arousal caused more pain during sex. How come? Reinhilde Melles: “I think that the context played a role in those studies. Women would be sat in a lab, watching a porn film, or masturbating, and were supposed to give a sign if and when they felt aroused. Then a research assistant would come in and take all kinds of pressure readings between their legs. Could you honestly call that a sexual, pleasant setting? That really does play a role when it comes to whether or not you find something enjoyable.” 

Hope for women with vaginismus

In Melles’ research there was no need for that kind of research assistant. A group of women - with no reported sexual problems - were asked to wear underpants fitted with a small latex balloon that, positioned inside the vulva, could be gradually inflated with warm water. The women then watched  either a sex video or a ‘neutral’ film to determine when they found the balloon pressure inside the vagina most pleasant. They mainly experienced that pressure as pleasurable when watching explicit sex scenes. The expectation is that sexual arousal will also be – a major – part of the solution for those women who do experience pain during sex. “Although that has yet to be studied using this instrument.”
 
In the case of the therapy developed by Melles together with her colleagues in Leiden, 70 women with vaginismus did take part. “Their average age was 28 and they were all still virgins. This was because they had previously been simply too afraid of the pain or of penetration. Some had never even attempted intercourse; others had tried but stopped after a painful experience during the first attempt.” It is known that a perceived threat causes the muscles of the pelvic floor to tense up, making penetration more difficult and increasing the pain. This therapy resulted in a strong reduction in that feeling of fear. Moreover, women responded more positively to images of sex after the therapy. “The fact that it’s possible to change those associations is something I find very hopeful.”

Partner forms link between therapy and home

The therapy did not focus so much on sexual arousal as on learning to feel the difference between tense and relaxed muscles in the vagina. The main aims were pain reduction and overcoming fear and avoidance. “This required the presence of the partners because they’re sometimes just as tense as the women. And the man forms the link between therapy and the home situation.” This is because, however many practical tips and psychological insights the therapist may provide, it’s the couple themselves that need to ‘press ahead’ when it comes time to put everything into practice. “At home, in that highly charged setting. That’s not easy for the men either, so we often give them a pill for some physical support.”

The good news is that, after a couple of weeks, nearly all the women (90%) were able to engage in intercourse. In other words: penetration by the penis beyond the muscles of the pelvic floor had taken place. In many cases this was followed by a pregnancy. Something which many couples had long wished for, but vaginismus had made impossible.

The ‘bad’ news: “Half the women reported that they still experienced some pain or discomfort during penetration, and for most of the women it still wasn’t truly enjoyable either. I regard vaginismus as a phobia. Someone with agoraphobia, for instance, would be happy just being able to cross a large square without having a major panic attack. A person like that doesn’t need you also telling them, ‘Oh, look how wonderfully the birds are singing here, or look at that amazing theatre.’ And while it may be possible to teach someone with a fear of dogs how to cope with their phobia, that person will still be highly unlikely to choose a dog as a pet, let alone open a dog kennel.”

There’s more than the ‘button’ and ‘being normal’

It seems there’s also some work to be done here in terms of female emancipation, because the offer of follow-up sessions to learn how to enjoy sex was in fact rejected by the very women who could have stood to benefit from them the most. “Many women want to be ‘normal’ and, for them, that simply means being available for their partners and, therefore, capable of being penetrated. In my 30-year career as a sexologist I have met very few women who’ve said at their very first appointment that they’ve come to learn how to enjoy sex.”

And yet this is exactly what Dr Melles wants to see women do: have fun in bed. “It’s something we really need to focus more attention on, also in the information we give to young people. Girls should be taught that sex is something they’re allowed to enjoy. Find out what the clitoris looks like, including things like the clitoral bulbs located inside the vagina, under the labia, and how you can stimulate them. The vagina is a birth canal and relatively insensitive. None of us would be here at all if it was actually very sensitive. So, women need to find out where their pleasure zones are, recognise those places in themselves and share that with their partners. This all deserves more attention. And that applies to the biology books too. Often, they only show the external ‘button’ or glans clitoris. Just like men, women also need to have an ‘erection’ before penetration takes place. It takes strong sexual arousal for the clitoral bulbs and the ‘root’ of the clitoris, also known as the G-spot, to connect with the vagina and make it sensitive in a positive way.”

Wanted for further research: women with symptoms and a creative manufacturer

Melles is really keen to press ahead with further research. Is her conclusion indeed correct? Can sexual arousal also help those women who normally experience pain during penetration by reducing that pain significantly? And she’s very eager to find a manufacturer to work with on taking the ‘balloon underpants’ to the next level. “The current design really could do with an update. Preferably something made of artificial material that can expand and respond to genital arousal. And it would be absolutely great if it could move as well. We want to approximate nature as closely as possible.”

Melles expects that by using this instrument in a setting that isn’t associated with pain, where women can control the level of pressure in the vagina for themselves, the negative feelings those women harbour about sex can be re-conditioned. “Replacing pain with pleasure. Because these people have been struggling with this for years, in their homes, with those partners, which means it’s all highly charged.” In addition to this, she’s working with an international team to study the effect of group therapy and partner-relationship sessions on women who experience pain during sex. She’s still looking for women who suffer from this and would like to take part in the research.

Text: Femke Kools | Photo: Harry Heuts