Patient's question:
I have organic spasm, and my vaginal opening is too small. Is it true that the only treatment for vaginismus is vaginal dilation? What are the side effects of vaginal dilation?Doctor's answer:
If vaginismus persists, efforts should be made to relax the muscle spasms, such as graded dilation, which is effective. The patient should assume the lithotomy position, using a well-lubricated, graduated rubber or plastic dilator, starting with the smallest size and maintaining it in the vagina for 10 minutes. The Young's rectal dilator can be used as an alternative because it is shorter and causes less discomfort. It is preferable for the patient to insert the dilator themselves. When the dilator is in the vagina, the patient should perform Kegel exercises to help control the vaginal muscles. The patient should be instructed to contract the muscles adjacent to the vagina for as long as possible, then relax, and pay attention to how it feels during relaxation. It is helpful for the patient to place one hand on the inner side of their thigh while contracting and relaxing those muscles, as this generally relaxes both thighs and also helps relax the vaginal muscles. Graded dilation should be performed at home or under medical supervision at least three times a week. The patient should perform similar dilation exercises with their fingers twice a day.Once the patient tolerates the insertion of a larger dilator without discomfort, sexual intercourse can be attempted. It is often helpful to conduct a pelvic examination before starting graded dilation; when the patient's partner is present, the patient can use one hand mirror to examine herself, and the doctor can assist in identifying the anatomical structures. This procedure often reduces the anxiety of both partners and encourages communication about sexual matters.