Episode 8: Vaginismus: What’s Holding You Back From Changing?
Hello and welcome to VagQuest: The Podcast! VagQuest was created to bring support, personal insights, and levity to those on a journey with vaginismus and related pelvic floor dysfunction.
My name is Missi and this podcast partners with a program I created to support those of you struggling with moving through vaginismus through a purely physical approach of exercise and dilating. Those are the things that got me started and moved me across the finish line, but in today’s episode, I’ll be introducing us to the magic of behavior change models. You will want to save this episode. If you are struggling with keeping up with dilating and exercises, or identifying your cycles of pain, or feel consumed with shame or guilt over sex, the list goes on, this episode can help you navigate all of that.
First, I want to introduce the Stages of Change, or Transtheoretical Model. This is just a fancy way of saying change takes time and has distinct phases, especially when we’re embarking on something totally new to us. The stages of change are precontemplation, contemplation, preparation, action, and maintenance. In precontemplation, we don’t know we need to make a change. In contemplation, we’re thinking about the change. In preparation, we gather our supplies, make schedule adjustments, and create space for change. In action, we do the thing. And in maintenance, we continue to do the thing as needed. It’s pretty self-explanatory, but I share this and break it down because I know some of you listening may feel frustrated or stuck, perhaps with having to learn a whole bunch of new information and skills, or if you’re like me, with yourself for understanding what you need to do, but not taking consistent action. You might be trying to skip ahead to action, when really, you’re still in contemplation or preparation, and you haven’t hit action yet. Knowing where you are can help you ground into that place and be really present with your needs in that stage, which ironically will help you move into the next stage faster. We tend to live in either the past or the future, and that’s what often keeps us stuck. So if you are listening and you’re trying to skip to action but really, you’re in the contemplation phase, for example— fully be in your contemplation phase. Listen to podcasts, read some books, journal about what changes you think you might want to make, why, what those changes might entail, the pros and cons, without any level of commitment to making a change. Your job in contemplation is to think about change. When you give yourself time and space to just think about it, you’ll start to envision yourself doing it. You’ll have a better sense of what you’ll need to prepare yourself to take the next step. Let’s say the change you want to make is consistently keeping up with your PT exercises. If you already exercise at home or an open gym on a consistent basis, you might be able to skip to preparation, which would be adding new exercises to your lineup, and action would come quickly. If you don’t exercise or don’t do so in a way that would be conducive to easily adding in some leg lifts and clamshells, like maybe you’re a swimmer or something, yes, you might have a list of fairly simple exercises, but if you haven’t thought about where and when you’re going to do them, and how you’re going to make schedule changes, you likely won’t be consistent. Contemplation is important because when we imagine ourselves doing something, we’re creating new neural pathways that solidify our ability to actually do it once we act.
We’re going to expand on how we can really make the most of this contemplation phase with a different model of behavior change— the Integrated Behavior Model. This model helps us take a comprehensive look at how and why we behave the way we do. If we are looking to make a change, it can provide a framework for looking at what might be holding us back and what we can do for ourselves to make our desired change easier. In the case of vaginismus, I admittedly inadvertently used this model to help me, yes, exercise and dilate more regularly, but also to identify my cycles of pain and develop viewpoints on sex that feel healthier for me. I say inadvertently because I would love to tell you that after I learned about this model in grad school, where I felt like I found some kind of like, Holy Grail of human behavior, and used it in my capstone, I turned around and applied it to every area of my life. I didn’t. Because you, know, you teach what you most need to learn, and this is a set of tools that has taken me longer than I care to admit to use on a daily basis, but I do pretty often now, and it has very literally changed my life. Again, I just needed to spend more time in the contemplation phase than I had been. Also, bonus— you can use this model to change any pattern you find yourself in— if you’ve had a series of unhealthy relationships, if you are working your booty off but can’t seem to make more money, if you’re trying to eat healthier, if you find yourself getting into the same argument with your partner or coworkers or family members over and over again, if you have trouble with perfectionism, shame, guilt, etc. when it comes to sex — you can use this model to help you overcome those things. We will return to this model multiple times in this series, so save this episode and pull out a pen and notebook.
So, the Integrated Behavior Model tells us that behavior is based on five things:
* Our intention to carry out the behavior.
* The knowledge and skills to carry out the behavior
* That the behavior be important and relevant to us
* Lack of environmental constraints
* Repeatability once we have experience performing the behavior
You might be thinking, duh, so let’s dive a layer deeper into our intention to carry out the behavior, because I think this is where things get interesting.
Our intention to carry about a behavior is based on the following:
* How favorable we think it is to perform the behavior
* Our emotional response to the idea of performing the behavior
* What we think the behavior will result in (do we think it will work)
* Other’s expectations of us, or our perceived social norm about performing the behavior (doing it or not doing it)
* Our motivation to comply with the perceived social norm
* Perceptions of what other people are doing (witnessing the behavior)
* Our ability to perform the behavior
* Our belief in our ability to perform the behavior
* Our perceived control over our ability to perform the behavior
Let’s take dilating as an example behavior and filter it through these questions.
* How favorable do I find dilating? Do I view this simple as something I like or dislike?
* Our emotional response to the idea of performing the behavior? Do I think it’s weird, scary, painful, annoying, frustrating, etc.? Am I afraid of all the things it might bring up for me? Or do I view dilating as a beacon of hope and something I look forward to as a way to connect with myself and learn more about my body?
* What we think the behavior will result in? Do I think dilating will work for me?
* Other’s expectations of us, or our perceived social norm about performing the behavior (doing it or not doing it). What do I think the people in my life would think about me dilating? What would my parents and family think? My friends? Other members of my broader community— like my coworkers, neighbors, or members of any organizations I belong to? My healthcare provider? My partner if I have one?
* Our motivation to comply with the perceived social norm? How much do I desire to comply with the ideas of my parents, family, friends, community members, partner? You could even rate this on a scale of 1-10 to get a sense for who influences you the most regarding this behavior.
* Perceptions of what other people are doing (witnessing the behavior). Do I know anyone or have I ever witnessed anyone engaging in this behavior?
* Our ability to perform the behavior. Do I know how to dilate and what to expect out of the experience?
* Our belief in our ability to perform the behavior. Do I believe I have the ability to dilate?
* Our perceived control over our ability to perform the behavior. Do I believe I have control over whether or not I dilate? Or do I believe my schedule is determined by an external source, or that I need certain tools to perform the job that I may or may not have (i.e., do I believe I need to have dilators or dilators of a certain size to perform this behavior).
If you’re game, answer those questions for yourself, feel free to pause this episode if you have the space and time. I also want to call out that if this exercise starts to feel overwhelming for you, take it slow, and take breaks. Use the nervous system regulation tools mentioned in previous episodes to bring your body back to a place of safety and stability.
If you thought through the questions and any of your answers to those questions didn’t align with the behavior, fret not, because this is where things get interesting and exciting! You have now identified specific areas where a mindset shift or expansion of knowledge may be necessary for change to occur, which is a really important step. Let’s dig into what actions you can take for each one of these answers:
* If you don’t find dilating favorable, we have a negative emotional response to dilating, or we don’t think it will work for us, I’m guessing it’s because of your answers to the subsequent questions, so we’re going to table these for now.
* If you think the people in your life would not support you dilating, first ask yourself why, and list out as many details as possible. It might be helpful to start with the people who influence you the most, who you are most likely to want to comply with. So if you think your parents wouldn’t support this behavior, and they are high on your list of influencers, contemplate why they wouldn’t support it. Then, imagine what it would look like if you had parents who supported your dilating with compassion and care. What would that look and feel like? We’ll dive into more practices that can help you reprogram your mindset regarding perceptions of others and motivation to comply in future episodes.
* If I don’t know anyone who has dilated before, take to the internet! There are many people who have had success with this practice and share their stories on Instagram, Facebook, Reddit, etc. You don’t have to know them personally for your ideas about what’s possible to start to change. Just find examples and stories that resonate with you. This is another practice we’ll dive into in future episodes.
* If you don’t know how to dilate or don’t believe in your ability to do so, again, take to the internet! You can find instructions or examples of how to use these tools and how others have personalized dilating. At yogaforvaginismus.com, I have a whole series of guided practices to help you through this as part of the membership, there is also free a de-armoring practice in the Vaginismus Starter Kit on my website if you’re curious and want to try it out.
* If you don’t believe you have control over whether you perform this behavior, identify why. Do you not feel in control of your schedule? Are you using not having dilators as an excuse…I say this because you don’t necessary need dilators, you can use your hands and do manual work…and if you are averse to manual work, you can take that behavior through this filter as well!).
* Revisit the first set of questions about finding dilating favorable, your emotional response to it, and what you think the results of dilating could be for you, and see if you can tie those answers back to anything else you uncovered.
Again, this exercise provides you with a blueprint for what to focus on in terms of moving you through those stages of change— from contemplation to preparation to action and finally to maintenance.
As I mentioned, we will dive deeper into how to change our mindset and reprogram our beliefs when it seems like the world is against us in future episodes.
If you just cannot wait for more, you can visit yogaforvaginismus.com, where you can sign up for the free Vaginismus Starter Kit, or the monthly Y4V membership which includes Yoga for Vaginismus, a library of asana, movement, and breathwork practices designed to support people with vaginismus; Divine Dilating, a series of what I call Power Practices, which are guided meditations to use while dilating, and lastly, VagQuest, the course, which is where the bulk of this type of work resides!
Until next time, take deep breaths into your lower rib cage and lower back, and wiggle out anything you’re holding onto from your day, and I’ll see you on the other side of vaginismus. Peace.
