Intimate medicine for women in Paris



Dr Adriana guzman à Paris


In its physiological manifestations, vaginismus corresponds to a reflex contraction of the anus-raising muscles during any vaginal penetration initiative: by the penis, the finger, the hygienic tampon, or the speculum of the gynecologist.


It is a powerful and mostly psychological reflex .


Spasms render the musculature of the pelvis impenetrable and an attitude of flight, defence, and panic quickly settles in the woman with vaginismus.


Penetration is perceived unconsciously as an act that will pierce the genitalia.


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If the phobia of penetration has been occurring since the woman’s first sexual intercourses, and if it occurs during coitus at least 9 times out of 10, then the phobia is said to be “primary”.


It is said to be “secondary” when it takes place after a sexual assault, an unconscious fear of pregnancy, a premature resuming of sexual intercourse after childbirth, or due to poorly treated dyspareunia (pain during coitus).


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These are most of the time causes of psychological origins which correspond to a fear or even a phobia of the penis linked to a family history, a rigid upbringing, painful experiences.


The stimulations of the vulva area are linked to a risk of suffering and will immediately cause closure.


Vaginismus is caused by an unconscious and instinctive amplification of a hidden trauma that will affect behaviour, imagination, and sexual intercourse.


An authentic psychotherapeutic work needs to be put in place. Less than 20 % of cases are incurable.

Vaginismus makes penetration impossible and make sexual attempts by the partner seem binding, repulsive, and undesirable. A man with little erotic experience will quickly lose all confidence, experience self-doubt, doubt his partner’s love, and ultimately give up.


The frustration, the helplessness in front of the problem, and the possible lack of understanding from the partner will generate anxiety in the woman, along with a feeling of abnormality.


However, if the couple manages to overcome this absence of penetration, the partners will be satisfied with this type of sexuality and even experience pleasure and orgasms. Indeed, a woman who suffers from vaginismus can experience sexual enjoyment, have a normal lubrication, and achieve orgasm. She will come to consult only if she wishes to procreate.

The goal of treatment is to manage the unconscious fear that will reflexively close the vagina. Various techniques such as classical psychotherapy, relaxation, hypnosis, behaviourism or botulinum toxin injections (Botox) are proposed.


If the woman manages to touch the area that causes her anxiety and to tame it, she will be ready for the gradual incorporation of the man (often affectionate and harmless) during the exercises.


After an absence of penetration that can last several years, the partner as well needs to regain self-confidence, and to “feel manly” during the act of love and sexuality.


Couple therapy can be beneficial.