VAGINISMUS : The struggle of being tight and dry

Sigmund Freud, through his psychoanalytic theories has tried to describe sex as a means for expression of power and domination, especially by males. He believed penetrative sex is the mere exertion of strength and potential enjoyed by the men.

Several psychologists, through their research have studied the sexual problems of both sexes, demeaning Freud’s anti-feminist ideas. Ever since, countless sexual dysfunctions and disorders have been learned and examined, their treatment and therapeutic applications have also been developed and applied.

Over the years, sexual discomforts and relations have been investigated more empirically, thus making it a very common area of research and study. Sex is considered one of the most primal biological instincts. However, it is more than just a physiological drive.

It has certain emotional and psychological components that make it dynamic. Hence, the sexual distresses are equally multi-dimensional and complex. One such disease, experienced by women is vaginismus.

I feel burnt out and discouraged, but I’ve made it this far and that is really brave

Introduction : Vaginismus

The symptoms of this disorder were first identified and studied in France, by an American psychologist named Dr. James Marion Sims in the year, 1861. Recognizing and comparing its symptoms with that of dyspareunia, they were grouped under what was called “sexual pain disorder and” and now termed genito-pelvic pain/penetration disorder (GPPPD). It is common among women of all ages, with a 0.5% frequency; 1 out of 500 women in UK suffer from this state. It is described as a condition of reflexive, involuntary, persistent and uncontrolled muscular or vaginal convulsions along the pelvic bed which results in tightening of the muscles and contraction of the vagina walls. Its medical definition has been unchanged for years but the methods of diagnosis and treatment have however, been evolving remarkably. Vaginismus is the human body’s automatic response or trepidation to all kinds of intrusion, but that in no way implies any sort of abnormality of the genital structure or functions. Vaginismus is most frequently surfaced when the vagina is subject to penetration, sexually or otherwise. It can cause severe pain and discomfort coupled with concurrent anxiety and fear of insertion in women. The woman may or may not be aware of her condition, and most of it stems of intense stress or apprehension, performance anxiety or lack of sexual excitation. Commonly, there is a high chance that this condition is not under the woman’s control. With efficient coping mechanisms and therapeutic approaches, this can be healed.

Types : Vaginismus

• Primary vaginismus

It is the condition that is present for the entire life span of a woman. The first sexual penetration feels as painful as the last one. It feels uneasy to insert almost anything into the genital without soreness.

• Secondary vaginismus

It is the state of distress experienced by a woman after she has experienced normal sexual intercourse. This develops due to certain events like strained relationship with partner, accident, surgery, childbirth, menopause etc. later in life.

• Global vaginismus

It is the ever-present condition which will resurface and activate because of every object.

• Situational vaginismus

It is extremely specific and will depend on certain situations. It may occur as a result of coitus and no other significant object; or it can be triggered only by a particular sexual partner.

Causes and Risk Factors : Vaginismus

There can be a variety of causes which lead to vaginismus. Primary among them is an unpleasant childhood experience or a history of sexual assault. Physical causes like infection, biological diseases, traumatic birth episodes and dead vulvar tissues can also contribute to its advent. Somebody with a strong flight-response and a harm-avoidance behavior is likely to develop this syndrome.

People from diverse socio-cultural backgrounds who have an inbuilt negative feeling or emotion towards sex or sexual practices or have conservative value education can be subject to this disorder.

A throbbing medical examination, a horrible first sexual experience, relationship complications, unsatisfactory foreplay, medical side-effects, surgery like childbirth or UTI are some common causes. Most people with a predisposed anxiety issue or hypervigilance and irritability may be prone to vaginismus.

Risk factors like sexual molestation, serious surgery, endometriosis or vaginitis should not be overlooked. These risk factors can be tended with special care and attention.

Signs and Symptoms : Vaginismus

• Immense pain or discomfort during copulation. This may also include a difficulty in penetration to begin with.
• A burning, stinging or shooting pain followed by tightness or dryness of the vagina due to insertion of a tampon, finger, vibrator, penis or any other object. Conducting a gynecological examination may prove to be extremely difficult.
• A constant and intense fear of penetration and thus sexual intercourse, as a result
• Loss of sexual tension, feeling of desire and lack of sexual excitement leading to frustration.
• A compromise on all relationships, a feeling of failure from being unable to consummate a marriage or bitterness arising from avoidance from coitus.

Treatment and Cure : Vaginismus

Different therapists have a variety of procedures to treat patients suffering from vaginismus. However, the most commonly advised method is Kegel exercises, for 10 minutes, three times a day. This is fairly simple and easy to execute.

Methods like systematic desensitization and Cognitive Behavioral Therapy (CBT) are mostly effective. Psychosexual therapy, although time-consuming can also be used. Indulging in sex-therapy or couple-counseling can go a long way. During these sessions, patients are often instructed to practice communication and relaxation techniques.

Sometimes, couples are recommended to have intercourse in a bathtub or swimming pool, where water acts as a natural lubricant or in a calm setting with slow and gentle trials. The use of dilators and fingers to condition the vagina has also been a vital step of treatment. For severe cases, local anesthesia and SSRI Escitalopram can be used under medical supervision.

Hence, educating yourself and others about the gravity of such conditions, and working positively towards overcoming all shortcomings is the primary step. Instead of feeling guilt or shame, it is essential to show empathy and kindness towards the other person and helping them embrace themselves. It is important to view this as a chance to grow as beings, rather than a weakness.