I suffer from vaginismus but I want to get pregnant. Which fertility treatment do you recommend?

Vaginismus is an entity caused by an involuntary contraction of the pelvic floor musculature. This circumstance occurs during sexual intercourse, causing significant dysfunction in the woman who is often unable to tolerate penetration or suffers significant pain in doing so. This picture is fed back with the anxiety and depression it generates. In these cases of women who want pregnancy, the picture of depression, anxiety and guilt multiply.

The approach to these situations implies above all an exhaustive review of possible organic causes that give rise to vaginismus. A gynecological examination which in these cases has to be carried out with exquisite care will make it possible to detect: anatomical anomalies of the vagina or external genitalia, endometriotic implants, tumors. However, in most cases, there is no organic cause and the origin of vaginismus is exclusively psychic. Adequate psychological orientation must determine whether there are abuses or traumatic sexual experiences or couple conflicts which should be worked on first.

Once these possible conditioning factors have been eliminated, efforts are focused on preventing vaginismus as a learned reflex before the sexual act. To this end, we will act at various levels:

• At couple level to avoid reactions that imply guilt, distancing, aggressiveness..... In fact, the implication of both members of the couple is fundamental for the definitive approach to the problem.
• Work on the vagina: pelvic floor exercises, dilators, lubricants...
• Work on self-esteem and body image.

Ideally, treatment of vaginismus should be the solution to the couple's "sterility problem". Once sexual dysfunction has been overcome, pregnancy can be achieved naturally. Vaginismus treatments are often long, which can conflict with the desire for motherhood, especially in cases where age or ovarian reserve are in limit ranges. In cases of this type, we may find ourselves in the need to start reproductive treatments directly. These range from vaginal insemination of the semen sample at the time of ovulation, a technique that does not require medical assistance if the woman is able to self-inoculate the sample, to more complex reproduction techniques. Self-insemination can be the first step for young couples with no known pathology. At older ages, the relevance of carrying out sterility tests and reproduction treatments will be evaluated in each case.