By Dr. Rashmira Balasuriya
Most couples believe that when in love, sexual intercourse should occur smoothly without any issue; especially if in a relationship for a lengthy period, or if they’ve gotten married – as if the duration of their relationship or the signing of a legal document should make the process much easier.
However, this is not always the case, and it is increasingly common for couples to seek medical help due to difficulties encountered during sexual intercourse.
A common reason stated by women is that their body automatically seems to shut down when sex is attempted, preventing any penetration despite them wanting to partake in sexual activity. This condition is known as vaginismus, and can contribute to painful and unpleasant sexual intercourse.
What is it?
Vaginismus is the body’s automatic reaction to any form of vaginal penetration, whereby the muscles of the vaginal canal contract and restrict penetration without the person having any control over it. It is common during first sexual contact (primary vaginismus), but can be experienced even if vaginal intercourse has previously occurred without any pain or restriction (secondary vaginismus).
This can cause great distress to couples, even questioning the legitimacy of relationships. It is important to note, however, that arousal can still occur in the presence of vaginismus. Some women also experience vaginismus when trying to insert menstrual hygiene products like the tampon and the menstrual cup (primary vaginismus).
There is no definitive cause as to why some women experience vaginismus and others don’t, but contributory factors include beliefs surrounding sexual activity, bad sexual experiences, endometriosis, and painful vaginal infections.
Twenty-five-year-old Ms. Y hated sexual intercourse with her first boyfriend. She described her experience as “it always hurt me and sometimes I felt like my breath stopped. I did not like it in a pleasurable way; it was like some sort of acute pain each time”. She described feeling a spasm in her genital region each time that she couldn’t control.
It was only when she ended that relationship and began a new relationship that she realised sex did not have to be painful. On reflection, she identified triggers that contributed to her symptoms. She felt fearful of her previous partner and unsafe in their relationship. She had also experienced childhood sexual abuse. Both these experiences can significantly affect an individual psychologically. Due to fear of judgement like so many, Ms. Y did not seek a medical opinion, but instead turned to the internet. She was soon able to understand that the symptoms she had felt were that of vaginismus.
How can vaginismus be diagnosed?
A healthcare professional can diagnose vaginismus after a consultation and quick examination of the external genitalia to ensure that there are no other causes for the pain, like wounds around the genital area and infection. Many defer seeking medical attention due to the fear of an internal examination, but it is important to know that during this consultation, the healthcare professional does not necessarily have to conduct an internal examination to diagnose vaginismus.
How can it be treated?
Treating vaginismus does not entail a “one-shot” cure, and will take time and patience. Psychological management plays a significant role, whereby patients can be referred to clinical psychologists specialised in the field of sex therapy for psychosexual therapy and relaxation techniques intended to help learn to relax the vaginal muscles.
Pelvic floor muscle exercises may also help improve symptoms of vaginismus. For some individuals, additional use of lubricants has been found to reduce pain associated with vaginismus. Vaginal dilators and certain medications like antidepressants and anxiolytics may also be used as part of the management of vaginismus.
Vaginismus is far more common than we think, but many suffer in silence. Sexual health specialists and sex therapists are available in the country to offer help to anyone who has this condition.
(The writer is a general practitioner with a BSc [Hons] and MBBS, PGCert [MedEd], DFM, and is also Head of Mentors at The Arka Initiative)
