Vaginismus and Birth in Israel
Understanding Your Options and Preparing for a Positive Experience
What is Vaginismus?
Vaginismus is a condition where vaginal penetration is difficult or painful due to involuntary muscle contractions. It can make gynecological exams, tampon use, and intercourse challenging.
Many women with vaginismus worry about how it will impact their ability to give birth. However, birth is a completely different physiological process than penetration. With the right preparation and support, women with vaginismus can have positive and empowering birth experiences.
Some women are not aware that they have vaginismus, or they may have found ways to cope with it during intercourse and may not consider how birth could trigger it. For those who have experienced difficulty with penetration or avoid vaginal examinations for one reason or another, this information might be relevant for you as well. Understanding how vaginismus could manifest during labor and birth can be an important part of preparing for a positive birth experience.
Steps for an Empowering Experience
Preparing for Birth with Vaginismus
The time spent preparing during pregnancy can make a significant difference in your birth experience. There are many ways to approach both pregnancy and birth with intention, helping to create a sense of confidence, safety, and empowerment.
1.
Personalized Pelvic Floor Therapy
Working with a pelvic floor physiotherapist can help create a tailored plan to improve comfort and reduce fear around birth-related interventions. Together, you can develop a step-by-step approach for handling vaginal examinations in a way that feels manageable and respectful of your boundaries. A physiotherapist can also suggest practical strategies to make vaginal examinations easier (see list below), ensuring you have a clear plan in place before labor begins.
2.
Trauma-Informed Birth Preparation
A comprehensive birth preparation course is always a good choice. If vaginismus is linked to past trauma, attending trauma-informed birth preparation sessions can provide emotional tools to navigate pregnancy, labor, and birth. These sessions can help you identify potential triggers, develop coping strategies, and build confidence in your body’s ability to give birth. Working with a provider who understands both trauma and the physiology of birth can make a significant difference in feeling safe and supported.
3.
Choosing a Supportive Birth Team
Selecting a support team that is right for you is essential. Whether it’s your partner, friends, or a knowledgeable doula, having people who understand your needs and boundaries is key. A doula trained in trauma-informed care can help you navigate challenges, advocate for your preferences, and provide continuous emotional and physical support during labor. Ensure your birth team is aware of your plan and willing to advocate with medical professionals to accommodate your needs.
4.
Meeting with the Hospital in Advance
Scheduling a prenatal consultation with a midwife in the hospital can help ensure the medical staff understands your specific needs and preferences. You can bring a written plan prepared with your physiotherapist regarding vaginal examinations or one developed during trauma-informed birth preparation.
Requesting to have this document added to your medical file can help ensure sensitive care. However, it is still helpful for your birth partner or doula to remind staff about it, as hospital teams rotate frequently.
5.
Considering a Home Birth with a Familiar Midwife
Unlike in a hospital, you will already know your midwife, and vaginal exams are typically minimal or not performed at all—only if there is an urgent medical reason, and always with the utmost sensitivity and respect for your comfort and consent.
For those who prefer a hospital birth but want continuity of care, Laniado and Ma’ayanei HaYeshua hospitals offer the option to hire a private midwife. Other hospitals do not currently offer this option.
6.
Timing Arrival at the Hospital
If planning a hospital birth, arriving as late as safely possible can reduce the likelihood of multiple internal exams.
The standard practice is to have a vaginal examination during admission, followed by additional exams every 1-4 hours, depending on the hospital.
7.
Epidural Before Internal Exams
For those wanting an epidural, requesting internal exams only after receiving pain relief can help reduce discomfort.
This approach allows you to manage the pain during exams and helps you feel more in control of the process. It’s important to communicate your preferences with your birth team to ensure your comfort and reduce unnecessary stress.
8.
Asserting Your Autonomy
It is essential to remember: this is your body, and you decide if, when, and who is allowed to perform an internal exam.
Israeli law states that women must give informed consent for any procedure, and no one can be forced into an exam or intervention. However, in practice, the medical system relies heavily on internal exams as the primary way to assess labor progress. Many women experience intense pressure to undergo these exams.
Discussing advocacy strategies with your birth partner or doula can be crucial in ensuring your boundaries are respected.
9.
Educating Yourself and Your Birth Team
Many medical professionals do not realize the fundamental difference between inserting something into the vagina and the body naturally pushing a baby out. Being informed and, when possible, choosing providers who understand this distinction can improve your experience.
In a hospital birth, however, you usually cannot choose your care providers. This makes prenatal meetings and having a support team even more important.
Strategies to Make Vaginal Examinations More Comfortable
These strategies can make vaginal examinations more manageable by reducing discomfort, increasing a sense of control, and helping the body stay relaxed. It is beneficial to explore these options during pregnancy, so you can identify what works best for you and communicate your preferences in advance.
Turning fingers during insertion rather than inserting them straight – This can help reduce discomfort by easing the muscles into the process more gradually.
The woman guiding the provider’s hand and inserting it herself – Allowing the woman to control the pace and direction of insertion can increase comfort and reduce fear.
Taking clear steps with breaks in between – Pausing at each stage of the exam gives the body time to adjust and helps prevent involuntary muscle contractions.
Using laughing gas during the examination – Nitrous oxide can help relax the body and reduce both physical discomfort and anxiety.
Lying on the side with a pillow between the knees – This position can minimize tension in the pelvic floor muscles and create a greater sense of security.
Using local anesthetic spray – Applying a numbing spray can help reduce the sensation of pain or discomfort during the exam.
Common Myths About Vaginismus and Birth
“If you can’t insert two fingers, the baby can’t come out.”
This is false, and yet, I have heard a doctor say it to a woman. The vaginal muscles respond differently to penetration versus birth. During labor, the body releases hormones that allow the cervix and vaginal canal to soften and open, and it is the uterus—not the vaginal muscles—that drives the baby’s descent. The feeling of expelling something is very different from that of something foreign entering the body, so the vaginal muscles typically do not spasm during the birth of the baby, especially if a hands-off approach is chosen. (A hands-off approach means midwives and doctors do not touch your vagina; a hands-on approach is standard practice in Israel.)
“You must have multiple internal exams during labor.”
Routine internal exams are not always necessary. If they cause distress, you can discuss alternative ways to assess labor progress, such as monitoring contractions and external signs of progress.
“A C-section is the only option for people with vaginismus.”
While some choose a C-section for personal or medical reasons, many people with vaginismus give birth vaginally. With the right preparation and supportive care, a vaginal birth can be a positive experience.
“Vaginismus is permanent and can’t be treated.”
This is false. Vaginismus is treatable with the right approach, including physical therapy, psychological support, and trauma-informed care. Many people with vaginismus find significant relief and go on to have fulfilling, pain-free sexual relationships and successful births. The experience of an empowering birth can also have a healing effect.
“Vaginismus only affects your sexual life.”
While vaginismus is commonly associated with sexual discomfort, it can also impact other aspects of life, such as gynecological exams and childbirth. It’s important to recognize its broader impact and address it holistically.
“A vaginal birth is not possible for someone with vaginismus.”
As mentioned earlier, many people with vaginismus can give birth vaginally with the right support. The muscles involved in birth are different from those involved in penetration, and with the appropriate preparation, vaginal birth is entirely possible.
Who is behind this page?
Lea Reichel, MA, certified doula, birth educator, B.O.T. facilitator
Lea’s mission is to empower parents for birth in Israel. She provides evidence-based information while also offering compassionate and comprehensive guidance. Certified in trauma-informed care, she nurtures a non-judgmental space for parents to grow, focusing on enabling the best possible start into parenthood.
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