Detailed, evidence-based help for common painful problems

New PainSci article about vaginismus

 •  • by Paul Ingraham
Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

I have a 20-year history of writing mainly about pain problems that I have some experience with. Not this time.

For International Women’s Day, I have added a new resource to the PainSci library, about a topic that is well outside my expertise and my knowledge-comfort-zone: vaginal penetration pain disorders, especially vaginismus. Vaginismus is vaginal resistance to penetration, usually painful, and historically presumed to be muscular in nature — the vagina clamping shut, a kind of cramp. There’s an endless debate about whether this is physical or psychological or both (much like other unexplained chronic pain, but even more so).

I got help with this topic. Most of the new page is dedicated to an in-depth, article-like interview with Kirsten Loop of UnravelledSelf.com — someone who’s experienced vaginismus, and studied it. Someone who really knows this topic, deeply, inside and out.

Yes, those were sexy puns. The more serious the topic, the greater the need for whimsy.

The knees of Kirsten Loop — interviewed below — volunteering for a pelvic floor physiotherapy course at Entropy Physiotherapy & Wellness, Chicago, 2019, as she prepares for an internal exam. The arms belong to physiotherapist Sandy Hilton, who also writes about pelvic health.

Why would a middle-aged white guy do a deep dive into vaginismus?

Because there’s a great need and I have an audience. Because this website punches somewhat above its weight, and with “great” power yada yada yada. I want PainScience.com to be as useful as possible for people suffering from a wide range of painful problems — especially the tricky ones. Tricky is interesting. Tricky is where the need is.

And what could be trickier than vaginismus? It seems to face every kind of healthcare hurdle there is, but especially the bullshit prejudices that make it harder for women to get good healthcare — prejudices that only amplify around the private parts and their procreational and recreational uses.

Sarah Graham of the HystericalWomen blog documents examples of male doctors not taking women seriously, or worse. In one of the most disturbing, a male surgeon referring to endometriosis patients as “all f***ing mental.” That would be appalling no matter what, but about endometriosis patients? That’s a common and clearly biological problem. “Medical misogyny isn’t the only reason for the gender pain gap,” Sarah says. “but it is certainly still a massive issue.”

Well there’s your problem” getting help with your problem

In the aftermath of the 2020 Black Lives Matter protests, I resolved to give more editorial attention to inequality and prejudice in healthcare. Finding good help for chronic pain is hard enough without racism, sexism, and queer-phobia piling on. I created a page acknowledging and summarizing these issues, but I knew that was the tip of the iceberg. I needed to get serious ahout something specific.

Ambient sexism and racism in healthcare are bad enough, but it’s really nothing compared to what you get when you add stigmas against both psychosomatic illness (perceived or actual) and anything to do with sex (deep cultural sex negativity). Plus there are some unique misogynistic extremes that crop up with the specific phenomenon of penetration pain/resistance. There’s a long, shameful history of stigma and attributing these problems to “frigidity” and other according-to-men feminine failings. 🙄 😡

The sad truth is that the majority of GPPPD patients fail to find medical assistance, and most simply have to rely on other resources. Fortunately, there are a lot of those.

And now there’s one more. My thanks to Kirsten — it was an edifying hoot pulling this all together. Now, please go read what she has to say about vaginismus.

End of post marker

Last post: Defensive medicine and MRI for back pain

Next post: The remove-or-improve project: 2 major article upgrades so far