When 24-year-old Varsha* felt ready to have sex with her boyfriend for the first time, what should have been really special and fun turned out to be a nightmarish experience.
Everything was going well until the couple tried to have penetrative sex. “It felt like a thousand knives were trying to push in,” Varsha recounts. “Initially we shrugged it off as first-time anxiety, but when it kept happening, it scarred me mentally.”
When she first went to a gynaecologist to seek help, the doctor refused to examine Varsha because she was unmarried. So, she turned to Google. Her research indicated that she had vaginismus, a condition that affects one in five women, which was later confirmed.
“Vaginismus is a condition where a woman experiences recurrent or persistent difficulty in allowing vaginal entry. This becomes a cause of concern when she is trying to use tampons, menstrual cups, and during intercourse,” explains Dr Manjula Patil, an obstetrician and gynecologist from Motherhood Hospital in Bengaluru.
Around a woman's vagina are pelvic floor muscles, which play an important role in sexual function. These muscles are located at the base of the pelvic bone (hip bone) and help to support the bladder, uterus, and the colon. When a woman has vaginismus, the pelvic floor muscles remain in a state of persistent contraction. However, the problem itself is not just physical and can also be psychosomatic.
“There is a spasm of the pelvic floor muscles, which makes it difficult for any penetration to take place. This can be due to an underlying physiological component, however, we have also found that the issue can also have several psychosomatic aspects to it,” she adds.
But it’s not just about the inability to have sex, women with this condition also have difficulty using tampons, menstrual cups and it can also have a significant impact on one’s mental health. Women with vaginismus also sometimes face trouble when trying to conceive.
Such was the case with 38-year-old Smita*, a resident of Nagpur.
“My husband and I found it difficult to be intimate, but we worked around it. It was only when we were trying to have a baby that it became a real issue. It was too painful for me to have sex and we ultimately turned to IVF,” she tells TNM. Her daughter is almost 5 years old today and while the couple has been able to conceive, Smita’s condition has not improved, making it difficult for her to engage in sex.
Both Smita and Varsha initially approached a gynecologist when faced with the problem. Varsha was shamed by the first doctor she met, who chided her for being sexually active as an unmarried woman. Smita, however, was sent from one doctor to another, none of whom could tell her what the issue really was, until one gynecologist gave her the official diagnosis.
“Even then she didn’t tell me much, she just wrote down the diagnosis and told me to go read about it online,” says Smita.
The toll this took on the two women is more than just surface level.
“My boyfriend was very understanding and that definitely made dealing with this a lot easier, but it did take a toll on my self-esteem. I somehow felt like the problem was with me and that began to affect how I viewed the relationship, inadvertently,” says Varsha.
Smita, on the other hand, stated that while her husband was extremely supportive, it impacted her on another level.
“We have been conditioned to think that the onus of providing our partners with a certain satisfaction lies with us. When I couldn’t do that, I started doubting myself and kept wondering if he was happy with me and in the relationship,” she says.
How can it be treated?
As Dr Manjula explains, there is no one way to help someone who suffers from vaginismus. A detailed history must be taken and possible phobias must be explored.
“We are trying to understand if there has been any past trauma, childhood abuse, sexual abuse or maybe a very painful first time experience,” she says. In addition, it is important to ensure that the woman is familiar with her genital anatomy.
While in some instances, the women find that their condition improves on its own in some time, others require some additional support in overcoming mental blocks.
“Systematic vaginal desensitization is a process by which we help the woman to relax and become more comfortable during intimate activities. In some cases, she may require counseling and possibly may need anxiety medication. If there are any physical causes contributing to the spasm, then the appropriate measures are sought to relieve these conditions,” adds the doctor, "For instance, certain infections, some cases of endometriosis, and even an imperforate hymen have been known to cause vaginusmus in some women. The treatment for vaginismus also has to consider these causes to best determine the right treatment option for each woman."
Names changed*