Many women in suffer with pain disorders. Recent statistics suggest that 12-21 percent of North American women suffer genito-pelvic pain from varying causes.

I wrote vaginismus (vaginal muscle spasms) in March 2016, but did not focus on what we now know about how anxiety and fear potentiate pain sensations. As I wrote back then, the first step in getting help for pain is to get seen and diagnosed by a gynecologist.

But once you’ve got your diagnosis and you have a treatment plan, you need to become your own psychologist.

If what ails you is the involuntary pelvic musculature spasms that we used to call vaginismus, your ability to conquer the problem depends entirely on your ability to manage your fear of pain, to not procrastinate, and to do your physical therapy and sex therapy exercises.

Sean McKey, M.D., Ph.D. and author of a Stanford study of pain stated: “Fear of pain therefore becomes a physical phenomenon, not just a mental and emotional one.”

In other words, the more fear and anxiety you have about the pain, the more pain you will feel. Recent research on the connection between anxiety, fear, and pain showed a connection so strong that it completely astonished the researchers.

Your job as the patient is to be creative and courageous in confronting your pain.

Sometimes, pain means something is really wrong with our body. As humans, being frightened of pain is in our hard drives.

But when it comes to muscle spasms, the pain does not mean danger. It means you have a job to do. Work those muscles. Tame them.

I use graduated dilator homework with my patients, and I provide them with a specially designed sheet to keep track of their multi-dimensional progress in doing the exercises. 

I emphasize that if you do the homework many times a week, and fill out the tracking worksheets, you can follow your own progress and feel pride and a sense of expanding confidence that you can make your body do what you want it to do.

Because lessening anxiety and increasing relaxation is very important for controlling the fear of pain, I make a special relaxation tape for each woman to use as she is preparing to do the dilator exercises.

I encourage you to go on the Internet and find some mindfulness exercises and some mantras that speak to you. You also can make your own tape, and then when you are about to do your exercises, you can play it back for yourself.

But you have to speak very lovingly to yourself in the tape you make, the same way you would speak to a precious child. Some important things you could say in your tape are:

• I have seen a physician and there is nothing serious wrong with me.

• I am stronger than this pain.

• Even if I feel some pain as I do these, I am in no danger.

• I will not hurt myself.

• I am meant to have a fully functional body.

• I will push myself a little further each time, because that is what will help me.

• ________ loves me. (This may include God, lovers, and significant others.)

If your physician agrees that your pain comes from involuntary spasms in your pelvic musculature, your prognosis is excellent — as long as you confront your fear.