Aparna sat across my desk and said Vaginismus is an isolating monster. That’s about the best way I can describe it. It makes you feel alone in a situation that no one understands, broken and unable to be fixed, helpless despite countless attempts, and betrayed by your own body. You feel frustrated that while with every other situation you are an extremely logical person, you just can’t get your body to listen to you or you can’t understand what is going on. I on my part couldn’t agree more.
Jiya on the other hand is a woman in her late 30’s who was referred to me for infertility treatment. Jiya and her husband of almost two years really wanted to start a family so started trying to conceive shortly after their wedding? Martha had never attempted intercourse before her marriage. Whenever she and her husband attempted intercourse they had to stop because it was too painful for her. She said that at first, they attempted more frequently, however, after many failed attempts at penetration they gave up and stopped trying altogether. I tried doing a physical examination but that was unsuccessful due to her pain, fear and anxiety.
Vaginismus is a condition affecting women where vaginal penetration for the purpose of intercourse, or gynecological examination by a doctor, or Pap smear or any other such activity is either extremely painful or impossible. Vaginismus would not allow even superficial penetration and the typical experience of intercourse is described like hitting a brick wall.
Vaginismus can be Primary wherein the woman has never been able to have penetrative sex or Secondary wherein the woman has developed this problem after maybe a vaginal infection or menopause or injury during vaginal delivery etc.
I once had a husband come and ask me if his wife is faking it.?
I did of course give him a piece of my mind no doubt, but I guess this is an ignorance which exists amongst a lot many people, men and women alike. Vaginismus results from involuntary spasm of specific muscles around the vagina which is not under the control of the woman. As Rina said earlier, she is an extremely logical person otherwise but during intimate moments, logic gets thrown out of the window and the body seems to have an odd control of its own.
Q Why does such a condition occur?
One is not very sure why this problem occurs but several theories are suggested, both psychological and physical.
Some people simply have a personality that is not very interested in sex. They just aren’t sexually inclined. It’s not a pathology, it’s just how some people are wired
Then there messages around sex and gender- many of us grow up to believe virginity is a virtue and sex is dirty. It really impacts many women’s sex lives. For eg: I remember we were told women who are sexual are loose charactered. There is a deep moral angle that comes up for many.
Some Other reasons might be
– an idea that sex is painful
– lack of sex education
– sexual trauma
-lack of safety in the relationship and other relationship issues
– not being sexually aroused
– OCD and phobias / anxiety – when a woman is anticipating pain she goes into a sympathetic nervous system response which in turns leads to cortisol and adrenaline flooding her system and prevents the relaxation response required for sexual intercourse.
– previous sexual experiences that have been painful. And at time there is no specific reason.
Ofcourse each individual is unique and Has their own reasons for experiencing vaginismus.
Vaginismus being a complex issue….How do we doctors make the right diagnosis?
During the consult we ask for a complete history and try and understand the exact nature of the problem. We try and ascertain if the psychological component is more or the muscular dysfunction is more. we then proceed for examination we would be able to understand the spasm of the muscles and gauge the severity of it.
Q What is the treatment for Vaginismus?
A complex problem like Vaginismus cannot have a simple, one point approach. The treatment is a combination of Psychological counseling, Behavioral therapy, Use of Vaginal Dilators and use of Medicines like Botox to relax the muscles around the vaginal area.
Before I move onto explaining how Botox can be very successfully used in vaginismus, we must discuss the psychological aspect of the problem. When a couple comes in with vaginismus and you realize there is a strong psychological component. How do you go about solving their problem?
We work on it on a mind body spirit and couple level. In individual sessions we work on thoughts, emotions and the body. In couple sessions we work in helping the couple deal with vaginimus together.
I start with sex education. Getting to know the body. And then. Most importantly we work on identity and “ sexual empowerment “ – which is basically working on her identity as a sexual being. What it means to be a woman, unpacking the word pleasure and enabling her to experience sexual and non sexual pleasure, and befriending her body.
On a physical level, Women are taught to use use dilators to teach the NS who is in charge and switch it from red flag to green flag. Once the muscles retrain to learn that insertion is not pain they begin to relax.
I recommend that while working with me, women do yoga or other body work modalities that focus on loosening the pelvic muscles.
For many, trigger point release can be very helpful. Chiropractors offer that.
Before I wrap up dr rajeev, I would like to add that
There are alot of identity issues and emotional pain that comes with vaginismus and you must remember this is not your fault. If there’s one take away from my part- it’s that nothing is wrong with you. You didn’t choose this and you aren’t any less for it.
Vaginismus as I said earlier is also about having tight vaginal muscles. Botox is a snake venom which when diluted many many times is used brilliantly in solving many disorders like migraine, overactive bladder and is extensively used in cosmetology for treating wrinkles and face contouring. Because Botox paralyses muscles, it can be injected into specific areas of the vaginal wall and this can result in beautifully relaxing the muscles. This done, vaginal dilators are put into use and within no time the couple can start sexual functions normally. This injection needs to be given only once, takes less than 5 minutes and is not painful at all since it is done under sedation. The lady goes home in 2 hours and is back on her feet the very next day. This is an internationally accepted treatment for this problem with minimum or no side effects.
Obviously, the next question will be … What is the success of the treatment?
Success depends on involvement of the couple as pair rather than the woman as an individual. It depends on the pro-activeness of the woman to accept and embrace treatment and come for the counseling sessions and also follow instructions as given from the clinic. By and large success is almost 100% in most cases. However long term follow up is required to ensure relapses don’t happen.
Living with Vaginismus is like dealing with the world’s most painful pleasure. In the end it turned out well for Aparna and Jiya and it could do so for you too but for that you need to speak out, accept that there is a problem and be willing to seek help and we are right here to help you all we can.
This brings me to the end of yet another discussion. This discussion is also available as a podcast – check out here.
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