Vaginismus: The debilitating fear of vaginal penetration leading to marital stress

February 19, 2019

Healthcaretoday, Vaginismus, vaginal penetration, Dr Agilan Arjunan, KL Fertility Centre, Usha Ponnudurai, fear of penetration, painful sex, vaginal scan, vagina, painful intercourse, traumatic childbirth, painful sexual penetration, endometriosis, gonorrhea, syphilis,

Lisa discovered she had vaginismus two years ago, shortly after marrying Daryl.

"When we attempted to have sex, it was impossible due to an intense burning sensation, as if I were being stretched to the point of tearing. The discomfort lingered for a day or two whenever I used the restroom. Consequently, we took long breaks between attempts. However, we did not seek any pain relief," she recalls.

According to Dr Agilan Arjunan, a Gynaecologist and Fertility Specialist at KL Fertility Centre, Lisa's experience is not uncommon. "Many women suffer from vaginismus," he explains.

Lisa, who had never experienced abnormal menstrual cramps in her teenage years that might have indicated vaginismus, vividly remembers a particularly distressing visit for a vaginal scan.

"After being married for a year, we went to a male doctor at a women's clinic. Despite my protests, he attempted a vaginal scan, but it was impossible. Afterward, while I was trying to dress, the female assistant refused to leave until I insisted on privacy. The doctor then told me that I was intentionally closing up and not helping the situation. I left feeling severely traumatized and didn't seek medical help for the next two years."

In March 2018, however, Lisa decided to visit a specialist clinic. "They inserted a vaginal speculum and expanded it. The pain was excruciating, and I cried, begging them to remove it. The doctor and nurses insisted I could cry all I wanted. I don’t think she meant to be unkind; she probably thought she was helping."

After the procedure, the doctor told Lisa and her husband that if a stranger could insert the speculum, her husband should be able to do so as well. They were advised to try again at home and return in two weeks. Unsurprisingly, Lisa didn’t go back.

"After receiving that advice, we tried again but failed. My husband thought we should try harder since the doctor had managed it. Seeing how upset I was, he felt helpless. Determined to find a solution, we decided to research the issue rather than simply following the doctor's advice," Lisa explains.

The couple eventually found a blog post addressing a similar problem and consulted a fertility specialist, who helped them realize their dream of conceiving.

Causes of vaginismus
Dr Agilan attributes vaginismus to both psychological and physical factors. Psychological causes may stem from a childhood fear of intimacy, leading to the belief that intimacy and pregnancy are painful.

"This fear can be reinforced during adolescence," he notes.

Usha Ponnudurai, a licensed counselor and lecturer at the Faculty of Behavioural Sciences at HELP University, elaborates, "Life events, trauma, or abuse can create associations that the body remembers, resulting in involuntary clenching or spasms when the idea of intercourse arises."

Physical causes
Dr Agilan further explains that physical conditions such as vulvodynia—chronic pain or discomfort around the vaginal opening—can contribute to vaginismus.

"Traumatic childbirth can lead to injuries around the vulva and vagina, resulting in scarring that may cause painful sexual penetration, known as secondary vaginismus. Not all cases of vaginismus originate in youth."

Other physical conditions, such as endometriosis, can also manifest as painful penetration rather than just painful periods. Sexually transmitted infections like gonorrhea and syphilis may further increase the risk of vaginismus.

Dr Agilan clarifies that vaginismus does not always mean a complete inability to achieve penetration. "Some patients may insert fingers or engage in penetrative activities but stop due to pain, leading to difficulties in conceiving."

Treatment options
Treatment for vaginismus can be categorized into two main approaches. Psychological treatment typically involves working with a psychologist to alleviate the fear of penetration.

"The second method is vaginal dilatation, which can be performed using an anesthetic gel available at pharmacies. Many patients have successfully undergone vaginal scans with 50% of their fear alleviated, building their confidence for further attempts at penetration."

Is conceiving possible?
"If the goal is to conceive, we first assess the husband's sperm quality. Assuming it is good, the woman can try intravaginal insemination (IVI)," Dr Agilan explains.

"This method can replace traditional sexual activity and be done at home. On the day of ovulation, the husband produces sperm through masturbation into a collection container, waits for about 30 minutes for liquefaction, and then uses a small tube or syringe to inject the semen into the vagina. This process effectively replaces intercourse."

Dr Agilan points out that there is a high chance of pregnancy with IVI if vaginismus is the underlying issue.

"If this method fails, we can proceed with intrauterine insemination (IUI), where sperm is deposited directly into the uterus in a fertility clinic, often under sedation to minimize pain. Some patients, however, may manage this without sedation after overcoming vaginismus to some extent. If IUI is unsuccessful, the next step would be in vitro fertilization (IVF) to achieve pregnancy."

Vaginismus: The debilitating fear of vaginal penetration leading to marital stress

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