Vaginismus and biofeedback on Dr. Oz

03/15/2010 at 6:06 pm | Posted in Uncategorized | 7 Comments
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What this? Dyspareunia appearing on television twice in three months? On the same show? I think we’re on a roll here, people. Or at least Dr. Oz is. Well sort of, anyway.

Sometime in March 2010, the television show Dr. Oz aired a short segment on vaginismus, and on March 8, the segment was added to the Dr. Oz website. Click the link to see for yourself. (No transcript available @ this time.)

Vaginismus is condition in which the pelvic floor muscles, including the muscles in and around the vagina, tense up. This tension can be occasionally uncomfortable in and of itself if you’re aware of it as I am, but more frequently, it can cause pain if you try to insert an object into the vagina while the muscles are tensed up. That means that it can make PIV sexual intercourse painful, or prevent it altogether. The pain & prevention of certain acts involving the vagina isn’t limited to hetero sex though – you may have difficulty with pelvic exams at the gynecologist’s and with using insertible menstrual products like tampons and cups.

Unlike a few months ago when Dr. Oz did vulvodynia, this time he did not have a representative from a vaginsimus awareness organization on the show. Perhaps this is because there is no such nationally recognized vaginismus organization (that I’m aware of,) as there is with the National Vulvodynia Association. There are patient-led organizations, treatment clinics, support groups, and doctors prepared to address vaginismus, yes. But for some reason Dr. Oz did not have anyone from one of these groups on the show to talk about it. Instead, he called a random audience member, Ronnie, onto the stage.

I think it is no coincidence that on this episode, without the direction of someone experienced in dealing with vaginismus, it was treated more flippantly than vulvodynia was a few months ago. Vaginismus was compared to panic attacks, localized to the pelvic floor.

For some reason, this comparison generated a lot of laughs in the audience.

I don’t understand that comparison. While I struggle with general anxiety, I have never experienced  a bona fide panic attack, so I cannot compare the two. My understanding is that panic attacks are acute episodes of intense fear and terrifying sensations. For me, the pelvic floor tension is a chronic problem, though it may be made worse in anticipation of penetrative activity. I’ve heard comparisons of vaginismus to a blink reflex, but this is the first time I’ve heard it compared to a panic attack. At one point, Dr. Oz compared vaginismus to a back spasm – this makes more sense to me intuitively, but a back spasm and a panic attack are not the same thing.

What really bothered me about comparing vaginismus to a panic attack though, was Dr. Oz’s & the audience’s reactions – laughter. What part of a panic attack is funny? What part of vaginismus is amusing? Sex and pelvic floor problems must be a laugh riot to anyone who’s never experienced them, har-de-har-har. This laugher could have been prevented or addressed by Dr. Oz, but if he said anything to the audience about the seriousness of the situation for people who are bothered by vaginismus, (and I don’t have any reason to believe that he did,) that part didn’t make it to air.

Dr. Oz showed Ronnie and the audience a computer-generated animation of what happens during a pelvic floor spasm. The muscles of the pelvic floor around the vagina and rectum draw in, making entry difficult, painful or impossible.

Dr. Oz focused briefly talked about possible causes for vaginismus, starting with physical, tangible causes for vaginismus – notably infections and menopause. I’ve experienced pelvic tension from infections – stress and physical discomfort. He also briefly noted “Psychological causes,” but did not detail what some of these causes may be. (I’m uneasy about framing vaginismus as a purely psychological problem, as it manifests & can be treated physically. Nonetheless psychosexual counseling may be appropriate for some women with vaginismus. I’ll pass on that though…) This few-second crash course in causes of vaginismus was disappointing. More detailed lists of possible causes (the experience will vary from person to person,) is available on several websites, such as the list on vaginismus.com or the Vaginismus Awareness Network.

Dr. Oz then moved on to possible treatments for vaginismus – or rather, only one treatment, biofeedback. On the one hand, I was glad to see biofeedback for vaginismus covered in great detail, as I’ve had a positive experience using it, and it’s non-invasive. It is also an option for treating vulvodynia, on the caveat that not all vulvodynia patients benefit from it. But on the other hand, that only one treatment was covered in detail is another drawback, as he did not talk about other therapies available, such as at-home dilator use, counseling, physical therapy (which can be combined with biofeedback,) botox, or just leaving it alone and not seeking treatment. Biofeedback is not readily available to everyone who may be interested in it; trained professionals prepared to show patients how to use it may not be local, and even when it is an option, there’s a risk that it can be prohibitively expensive – the equipment setup shown on the Dr. Oz show isn’t cheap!

Dr. Oz showed Ronnie an insertible biofeedback sensor, to be used vaginally. Dr. Oz pulled Ronnie over to an examining table, although this being a mainstream daytime TV show, he did not demonstrate using the probe on Ronnie. Instead, as a stand-in, Dr. Oz proceed to demonstrate how to use a biofeedback device using external sensors intead, applied to Ronnie’s arms. The camera panned over to a laptop with biofeedback software running on the screen and…

…Wait a second… that looks familiar… wait… Huh?!

Woah!

Wait a second – I know that software! Wait, that white box that the wires are attached to – I know that thing! I think that’s the same setup we used at my physical therapist’s office. I recognize the interface. I believe that this biofeedback device is from the Prometheus Group. (It’s probably way out of price range for patients, so if you’re thinking about getting that set up, you’ll probably be better off looking for an alternative. I think that setup is really designed for clinical settings rather than at-home use.)

Oooh… I know exactly what’s going on there! Allow me to explain (TMI alert!!!):

Essentially, biofeedback shows you when your muscles are tensed and when they’re relaxed. My physical therapist taught me how to kegel efficently using biofeedback, although Dr. Oz never uses the word “Kegel” on the show. One of my problems was, since my pelvic floor was basically always in a state of tension, I couldn’t relax it on my on at first. I didn’t know what that felt like. The graphs from the biofeedback software showed me the difference between tense and relax states. I was pretty bad when I first came in – a tense and relax state had almost no difference in graph height. Eventually, I got better at it, and learned how to spend more time in a relaxed state, so the peaks and troughs displayed on the graph became bigger. Keeping the pelvic floor relaxed is still a struggle for me, since I must have spent years in spasm or near-spasm, but it’s better than it was.

If you’re apprehensive about inserting something into your vagina, especially in a clinical setting, don’t worry – You don’t necessarily need to insert a vaginal sensor in order to practice pelvic floor biofeedback. As an alternative, there are external sensors that stick to the skin instead. I have never used the insertible probe, I have always used external sensors for pelvic floor biofeedback. These external sensors can be applied to muscles around (not inside) the vagina, and with proper training the external sensors can be just as effective as the probe. External sticky pads are used once and then thrown away.  I felt absolutely no pain or discomfort from the external sensors. Wires connect the disposable sticky probes from you, to the white box, to the laptop.

Possible drawbacks to the external sensors are: They can be tricky to apply to the right spots, aren’t super-sticky (may fall off after awhile, but you’ll probably be done by the time that happens anyway,) and they don’t work when wet. (That means if you dilate while the external sensors are attached, be careful to keep them dry – don’t let lubricant get on them.) Nonetheless, they do work, and they do their job well.

Whether you go with the insertible probe or external sticky pads, the sensors measure muscle tension, I seem to recall the units of measure were in microvolts. There is a moving graph on the computer monitor. It will refresh every few seconds. When  your muscles tense and relax, the lines on the graph react in kind – more tension, the line on the graph rises. Relax, and the line on the graph falls. Eventually you learn the connection between the stuff on the computer screen, and what you’re feeling, so you learn how to control those muscles.

This particular software shown on the Dr. Oz program also has an audio feature. Once every few seconds (your PT can program the interval,) a voice will say “Work,” and you’re supposed to tense the muscles of interest on purpose. When the voice says “Rest” a few seconds later, you’re supposed to relax as much as you can. The graph will tell you if you’re on the right track.

The software on the show also has a save feature, so you can monitor your progress over time.

“Why are there two graphs?” For pelvic floor biofeedback, most of the sensors were attached to the muscles around my vagina, and one sensor was attached to my abdomen. So one graph measures your pelvic floor tension, one graph measure the abdominal tension. This is because when pelvic floor patients first learn how to tense & relax those pelvic muscles, they may be incorporating the abdomen muscles more than necessary. You don’t necessarily need to have both graphs on at the same time though.

I may be making this all sound more complicated than it actually is. When you’re actually having it done it makes sense, at least, after awhile, and so long as your therapist is well-trained.

At the conclusion of the biofeedback demonstration, Dr. Oz briefly mentioned that it can be used to learn how to relax in general. He also advised that vaginismic patients ask their OB-GYN about biofeedback. It’s not bad advice but… unfortunately in practice, for some reason, there are still gynecologists who do not know what vaginismus is or how it can be treated. There are still gynecologists who frame it as “All in your head, have a glass of wine and relax.” If you think biofeedback may be right for you, and your current gyn refuses to or is unable to help you, you may need to seek out another doctor, or you may need to seek out a different treatment, if you want one at all.

Overall, while the segment did biofeedback justice, I would have preferred to see vaginismus in general given more detailed coverage, or, to have seen the title for the segment changed from “Vaginal panic attacks” to “Treating vaginismus with biofeedback,” which would have been the more accurate title. The audience laughter was inappropriate and insensitive.

This coverage of sexual pain leaves much room for improvement.


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