Vaginismus – the unspoken sexual dysfunction.

Vaginnisums is the term used for a condition that affects a woman’s ability to engaged in any form of vaginal penetration. This includes not only intercourse, but also use of tampons, or getting routine gynecological examination. The vaginal muscle becomes spastic in an involuntary way, which makes any penetration either very painful or impossible. (From Wikipedia).
People tend to believe that with the sexual revolution, and the widely available knowledge about sexuality, this kind of dysfunction no longer exists.  This is not the case; I have come across the conditions several times in my practice just in the last year.

We do not hear about the condition, possibly because  of shame or maybe because there is no pharmacological  solution available, so there are no ads  from the  pharmaceutical companies.
However, the good news is that it is quite easily treatable. All the women that I have seen with this condition, and that have persisted with treatment, succeeded in overcoming their issue and were able to have an enjoyable sex life.
The treatment consists in learning to relax the pelvic floor and vaginal muscles, and using dilators in increasing size to learn how to get used to penetration.
You can buy the dilators with instructions from Vaginismus. It is highly advisable to use specific physical therapy that addresses this issue. In my vicinity, you can find qualified physical therapists at the University of Michigan health center. . If the issue has already created stress in the relationship and secondary emotional issues, it is important to consult a qualified sex therapist.

 

 

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The Rashomon effect- the psychology of relationships

 

The Rashomon effect is defined as the way in which different people may describe the same observed event in very different ways. This may happen while all observers of the event believe that they are being completely honest.

We are all familiar with this phenomenon to some degree, yet we are often uncomfortable when confronted with the extent  to which our personal perception is subjective, a lens through which we view reality.

This term originated in a movie by Kurosawa, a renowned Japanese director. In the movie four people meet in the forest; a young samurai, his beautiful wife, a bandit, and a passer-by. The young samorai is killed. The four people come to testify in the trial that follows, including the ghost of the samurai.  Strangely enough, three of them plead responsibility for the murder.  The event appears very differently in the story that is told by each of the four participants. Each of them is convinced that he or she is telling the truth, and the events are shown through the protagonists eyes.   In the movie there is no resolution.

Unfortunately, this happens all too often in relationships. When People describe  events that have led to a crises in a relationship, they often give completely different accounts of these events. Often the people involved are convinced that the other person is not telling the truth.

I often come across this phenomenon in my practice. When a couple is in a crisis and are recounting the events that led to the crises, it is critical to first accept that, as a rule,   no one in the room is lying. The next step is to  listen to each other carefully and try to understand what lens each person is using to view reality. Understanding the distortions that these lenses impose upon our perception, can provide us  clues on how to repair a relationships that is ailing.
It is often humbling to discover how subjective our perception is.

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Healthy Relationship

These two books  by Shel Silverstein, are in themselves two parts that make a whole.  The two books describe peoples struggles with relationships and various alternatives.
The Missing Piece (An Ursula Nordstrom Book)
The Missing Piece Meets the Big O

In the first book, the  missing piece,  a circle that has a missing piece, goes on a journey. For me the circle is a female, although in the book she has no gender.  She believes that the her partner must be another piece, who would exactly match the slice that is missing and make a perfect circle. She  is able to enjoy the  journey to some degree, but is invested in finding  that missing piece. The circle meets  many pieces on her way, but none of them is an exact fit.  She  doesn’t give up. She  rolls along happily, talking to a butterfly,  smelling a flower, and singing her song. Although she enjoys her journey, she does not appreciate that joy since she is so intent on her search to find that precise match to her missing piece.  On the way the circle finds various slices that can fit to some degree but none is a perfect fit, some leave a void and others are oversized with their point gouging into the circle.

After a long eventful journey the missing piece joyfully finds a slice that makes her perfectly whole. Now as a perfect circle she whizzes past the flower and the worm so fast that she can no longer appreciate them. The circle decides that it is better to be without that perfect missing piece so that she is better able to take in her surroundings. The simple story can be easily interpreted as our search for the romantic notion of the perfect love, the precise match for us. What the book conveys is how being intent on searching for an answer to that romantic notion we can miss out on many things. Even more powerfully it shows the  the complexity  of relationships and that all relationships have a price that we may not be willing to pay.

In the second book “The missing piece meets the big O”  We meet the missing piece again. She roles around experiencing life. As she roles around her shape slowly changes and the missing slice eventually disappears so that she becomes a whole circle without finding a complimentary piece for her missing slice. At one point the missing piece finds a big O and together they role around side by side. This second, more optimistic book, shows Shel Silverstein’s view of human relationships. In his view, when someone seeks out a relationship to fill a void it will eventually lead to either a mismatch or suffocation. Only when a person feels whole with themselves can a mature relationship develop where two people enjoy life together.

Someone on Amazon recommended these two books as a wedding gift. Not a bad idea.

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Premature Ejaculation – Sex Therapy

First it may be useful to define what premature ejaculation is. Although it may seem self explanatory, one problem may be that you or your partner’s expectation of sexual stamina, often nurtured by popular culture, are unrealistic.

Usually, premature ejaculation is diagnosed when a man frequently  ejaculates sooner during intercourse than he or his partner wishes, either  before penetration or shortly after.

If you do suffer from premature ejaculation there are behavioral approaches to the problem and medication. While medication, such as SSRI, may help – they  are effective only while being taken. Once you stop taking the medication the effect also passes. The other downside of taking these medications is that you will need to cope with their side effects. This is why it is better to start with the behavioral methods rather than start with medication. Those can be added later if needed.

Contrary to common beliefs the behavioral approach does not involve either mental numbing, such as distracting yourself from the sensations, or physical numbing with some form of  numbing cream. Somewhat surprisingly, the most successful approaches involve heightening your awareness to your physical sensations, while maintaining physical relaxation. Only by increased awareness and mindfulness, you can learn to regulate better your arousal level, and hence your ejaculation.

These two  self help books teach the basic sex therapy techniques for dealing with this problem.
How to Overcome Premature Ejaculation

Coping With Premature Ejaculation: How to Overcome PE, Please Your Partner & Have Great Sex

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Low Sexual Desire – Women

One of the most common reason that women and couples seek sexual counseling is the women’s low sexual desire.

Surprisingly enough, many times the problem is the birth control pill. If you are on the pill, and are suffering from low sexual desire, try to switch to a birth control method, that does not involve hormones. You may want to consult your OB/GYN practitioner, or go to Planned Parenthood. Often the counselor at Planned Parenthood will dedicate more time to hear your concerns, and may suggest a wider selection of options to choose from. Be aware that it may take several months for your body to recover.

Clearly the pill does not always affect women in this way, or you may not be using the pill. There are many other reasons for the low sexual desire.

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