Mediscene

CLOSING UP

By Smriti Daniel

"Vaginismus is a condition that affects a woman's ability to have sexual intercourse," says Dr. Kulasiri Buddhakorale, consultant venereologist. Understandably, the latter can and does take a heavy toll on relationships.

Symptoms

Most women who suffer from vaginismus do not even discover that they have it until they first have sex, says Dr. Buddhakorale. They may find out earlier, while attempting to use a tampon.

"The muscles inside go into a spasm," explains Dr. Buddhakorale. The muscle that is the source of the pain is the PC or pubococcygeus muscle. This hammock shaped muscle, found in both sexes, stretches from the pubic bone to the coccyx (tail bone). It forms the floor of the pelvic cavity and also supports the pelvic organs. It is the PC muscle that controls the urine flow and contracts during orgasm. When this muscle clamps shut, it makes penetration either extremely painful or in many cases, impossible. The severity of vaginismus varies from woman to woman. However, vaginismus can take two forms:

Primary vaginismus

What happens when a woman has never been able to have sexual intercourse or allowed any other kind of penetration

Secondary vaginismus

This occurs when a woman who has previously been able to accept penetration, acquires vaginismus for some reason. This can be traced to physical causes such as a yeast infection or trauma during childbirth or may be due to psychological causes.

How men cope

Male partners of women with vaginismus are often understandably frustrated by the situation, says Dr. Buddhakorale. Not only do they feel entirely helpless, he explains, but feelings of rejection, guilt, anger, confusion and even fear are common, making matters worse. Some distance themselves from their wives, opting to come home late or to communicate less, thereby damaging their fragile relationships further.

What can men do? One can start with being patient and supportive. It is important to understand that this is not something the partner chooses for herself, instead it is an involuntary reaction. Helping her work through areas of fear and confusion can form crucial bonds of trust. Also by educating yourself and talking to her knowledgeably and rationally, you can help your partner work through emotional stress and her own feelings of failure. When she does make progress, celebrate her successes with her - knowing that you are also excited about her progress could be a powerful motivation for your wife. Continue to be intimate with your spouse, even if actual penetration is not possible.

Explore other options and you will find that in doing so, neither of you feel the pressure so much.

The cause

While vaginismus can be the result of a combination of physiological and psychological factors, the balance weighs heavily in favour of the mental and emotional rather than the physical. "It is a psychological phenomenon," explains Dr. Buddhakorale. Some examples of causes of vaginismus, explains Dr. Buddhakorale are sexual abuse, strict religious upbringing, mutilation of the genitalia, being taught that sex is dirty or wrong or simply the fear of pain associated with penetration, and in particular, losing one's virginity along with the accompanying blood loss.

Many of these ideas come from one’s family or peer groups, he adds. Aside from this, vaginismus can also be caused by STDs (sexually transmitted diseases) such as genital herpes, reveals Dr. Buddhakorale. It is important to remember that the woman does not choose for this to happen, it is a learned reflex reaction. It becomes easier to understand if one compares it to the way we involuntarily close our eyes when an object suddenly comes close. This, like vaginismus is a reflex reaction, which our bodies take to protect us from pain. A woman with vaginismus cannot shake the conviction that severe pain will accompany the penetration and so her mind automatically sends a signal to her PC muscles to clamp shut.

Treatment

The process of curing vaginismus is usually a long one and will require patience, will power and determination. Vaginismus will not get worse if left untreated unless the woman continues to have sex despite feeling pain on penetration. Dr. Buddhakorale advises strongly against using oils and creams, saying that they will only aggravate the situation.

If the cause of vaginismus is psychological then it is usually important to treat those aspects of the problem as well as the actual muscle spasm. This is why women with vaginismus must seriously consider counselling, advises Dr. Buddhakorale. Physically, a doctor will be able to show a woman how to use exercises and vaginal dilators to help cope with the muscle spasm.

Some myths about vaginismus

=Women who have vaginismus are frigid
Women with vaginismus are not sexually unresponsive; in fact many deeply desire to make love. However, when sex always hurts or is uncomfortable it is understandable that intimacy becomes something to be avoided.

=If we just try harder (keep trying to have sex) it will happen…it will go away.
Continuing to attempt penetrative intercourse despite the woman's pain will only aggravate the situation, making the vaginismus worse - not better. It is best to stop having intercourse and to seek treatment if this is the case.

=Sex is supposed to hurt
Sex is not supposed to hurt. With first-time sex there may be some discomfort but ongoing sexual pain is not normal and needs to be treated.

=My husband/partner is just "too big" for me
Although it may seem a likely reason that intercourse is so difficult because your husband/partner is well-endowed, penis size usually has nothing to do with vaginismus. With vaginismus the vaginal muscles are tightening up (without your conscious control) so there is not enough room for the penis to enter. No matter the size of an adult woman, the vagina is designed to accommodate a fully erect penis.

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