Understanding Vaginal Dilators with Tracy MacNeal

LISTEN TO THIS PODCAST EPISODE HERE.

In this podcast episode, Tracy MacNeal, president and CEO of Materna Medical, joins us to talk about vaginismus, pain with penetration, and how to treat the symptoms.

What is vaginismus? 

Most people who have vaginismus have never heard of it and don’t know that it’s quite common. Vaginismus is a high tone pelvic floor disorder, an overactive pelvic floor disorder. Essentially the pelvic floor is in a circle. As those muscles become involuntarily contracted, penetration becomes painful or impossible. The symptoms of vaginismus are painful intercourse, or pain during any kind of wanted penetration, whether that’s a tampon, or a pelvic exam. It is characterized often by anxiety as well. Not necessarily generized anxiety, but the kind of anxiety that if you know something’s going to hurt you tense up. That’s really what it is. The American College of Obstetricians and Gynecologists, ACOG, estimate that anywhere between five and 17% of women have vaginismus at some point in their lives.

Do you find that vaginismus is highly associated with trauma?

It’s interesting, when I sit down at a table with multiple women, what I found is they may start with, “I’ve never heard of vaginismus, that’s not me.” But by the end of the conversation at least half of them, if not more, are either saying, “Oh my gosh, that’s me and I had no idea.” Or “it’s my daughter or my sister or my girlfriend.”  I do think it’s quite common and trauma is certainly one of the categories. In regards to sexual assault, I see numbers anywhere from one and four to one and six women are survivors of sexual assault. And obviously, that’s an incredibly traumatic experience, and it can become something that echoes in the body in the form of vaginismus. 

What are some other causes of vaginismus outside of trauma?

The first group that people often think about, at least the way it’s taught in medical school, if it’s taught at all, is referring to what I would consider to be relatively less common primary vaginismus. That is from a young age, she can’t get a tampon in and nobody knows why and nothing bad happened. It’s just that those muscles are chronically tight the way maybe some people’s neck might be is they get chronic neck spasms. 

But, I would say vaginismus is more common as a secondary condition. Meaning there was some other thing going on whether it’s sexual assault as the primary issue or something else. I would say the biggest group of women suffering from vaginismus are women in menopause. What happens is the tissues becomes drier, thinner, and sex starts to hurt. Then you can end up with this chronic contraction of anticipating the pain. 

Other groups would be cancer survivors. Patients often have radiation delivered vaginally, and that can damage the tissue. Additionally, chemotherapy often puts patients into sudden menopause. So these women have all the same issues on top of the trauma of going through cancer diagnosis and treatment. There may also be some emotional issues there. So, it would be pretty normal for patients like that to end up with chronic pelvic floor contractions. 

Moving on to how this ends up to be up to 17% of people of women, at any given time there’s about a million women in the United States recovering from childbirth injuries. So, it’d be normal to have pain, postpartum, and painful sex, postpartum. And returning to intercourse is usually kind of a big deal for people who’ve given birth. So you certainly can end up with some vaginismus after childbirth injuries. And then you have endometriosis and fibroids and fibromyalgia and Crohn’s disease, and on and on. When you think about the number of reasons that women have painful sex to begin with, and how often it’s dismissed, it’s not really surprising that this chronic pelvic floor contraction is a pretty common secondary condition.

How do you treat vaginismus?

Some people might not realize that when you get FDA clearance, it’s actually for marketing authorization. It’s the way you talk about the product that you got FDA clearance for, not the product itself. So, we actually don’t treat vaginismus.We help relieve the symptoms of vaginismus. The symptoms of vaginismus that we would help relieve would be painful intercourse and the associated anxiety that occurs around vaginismus. 

What’s interesting is the standard of care for vaginismus before our product, the milli dilator. The standard of care for patients with vaginismus really was born in the 1800s. It’s essentially a set of dildos. And patients are asked to jam different sizes in to try to crank the tissue back open. It’s kind of a forced entry in a way and there’s a few issues that patients don’t like about them. First of all, they’re embarrassing looking. It really does look like a pile of sex toys to the untrained eye. And so they’re not very discreet. 

And then there’s also a jump in sizes between them. You might get used to nine millimeters but the next size up is 15 millimeters. That’s a six centimeter jump and a six millimeter jump can hurt people. And so it really is a bit antiquated. Now, I should point out, I’m not the founder of Materna, I joined Materna to take these products from the founder to the patients that need them. And I was very surprised when I learned about vaginismus and static dialators as a med tech engineer, absolutely shocked by all the things that we can do, from heart pumps to imaging to precision medicine and this is what we’ve got for patients who have pain and anxiety about penetration. Our product, Milli, is the only expanding dilator. It expands inside the anatomy. So it’s a single insertion for treatment. Essentially, it’s used at home as a home practice, called vaginal dilation. The patient inserts the Milli which is about the size of your pinkie. Then inside the anatomy, Milli expands one millimeter at a time at the patient’s discretion and pace. It also has optional vibration, we don’t have any marketing authorization specifically about the vibration. Patients usually know what to do with it.

How do you control and expand the dilator?

The dilator has a handle, it’s not remote. You have to hold it, but it’s offset so that it doesn’t touch the urethra. The controls are going to be on one side or the other depending on if you are right or left handed. The wand is inserted inside the vagina and then you just press up or down and vibrate to low and vibrate high and turn off. It’s very straightforward to use. It also has a nice LED readout, so you can track your progress. That is something you can share with your clinician. We found that our clinicians really liked that feature that they can share goals.

To hear Tracy talk more about vaginismus and expandable dilators, listen to episode 158: Understanding Vaginal Dilators, on the Vaginas, Vulvas, and Vibrators podcast.

You can find resources about vaginismus and the Milli for Her on the website, milliforher.com

LISTEN TO THIS PODCAST EPISODE HERE.