VAGINISMUS: THE DEBILITATING FEAR OF VAGINAL PENETRATION LEADING TO MARITAL STRESS
FEB 19, 2019 @5PM
Lisa first found out that she was having vaginismus two years ago when she married Daryl.
"When we attempted to have sex, we couldn't do anything because there was a terrible burning sensation and it felt as though I was being stretched to the point of tearing. The burning sensation would remain for a day or two whenever I visited the restroom. So, we took long gaps in between trying again. However, we did not try any pain relief," she says.
Just like Lisa, a huge number of women suffer from Vaginismus," says Dr Agilan Arjunan, Gynaecologist and Fertility Specialist at KL Fertility Centre.
Lisa who had no abnormal menstrual cramps in her teenage years to indicate that she had vaginismus, recalls the fime when she did a vaginal scan.
"After a year being married, we visited a male doctor in a women's clinic. He tried to do a vaginal scan despite my protests. It obviously did not go in. When he was done and I was trying to put my clothes back on, the female assistant wouldn't leave until I insisted on wanting some privacy.
The doctor then proceeded to tell me that I'm closing up intentionally and am not helping. When I left, I was severely traumatised and made no attempt to see any doctor for the next two years."
"In March 2018 however, I went to a specialist clinic. There, they inserted a vaginal speculum and expanded it. It was excruciatingly painful. I was crying and wanted it removed. The doctor and the nurses there refused and one of the nurses even told me to go ahead and cry away."
I don't think she meant to be unkind. She probably thought she was helping.
When we were done with that little experiment, the doctor told me in the presence of my husband, that if a stranger like herself managed to insert the speculum, my husband should have been able to do so as well.
We were then told to try again at home and come back in 2 weeks. Needless to say, I didn't return."
"After we were given the advise above, we tried again and of course failed.
My husband thought that we should try harder since the doctor specifically mentioned that even she had managed to do it. Seeing how upset I was, my husband felt helpless. We were then determined to do more research on the matter rather than just whinging it as advised," says Lisa.
The couple who had seen a blog post on a similar problem, then consulted a fertility specialist who made their dream of conceiving come true.
Agilan attributes it to be caused by either psychological or physical factors. Psychological reasons where a child was instilled with the fear of intimacy - that it is bad and painful.
"This may have been further ingrained as a teenager that intimacy and pregnancy is painful."
"It could pertain to events preceding intervention such as life events for the lady; for example history of trauma and abuse that they associate with and that the body remembers in muscle memory that causes involuntary clenching or spasm to take place when the idea of intercourse is brought forth," explained Usha Ponnudurai, a licenced counsellor and lecturer at the Faculty of Behavioural Sciences, HELP University.
Agilan further explained that it could also be Vulvodynia - chronic pain or discomfort around the opening of your vagina (vulva) for which there's no identifiable cause.
"It could be due to a traumatic childbirth – where she could have sustained lots of injuries around the vulva and the vagina resulting in repair and scarring. This may cause painful sexual penetration (secondary vaginismus) in the future. So not all vaginismus starts since young."
The other physical conditions can be due to endometriosis which can present – not necessarily as a painful period but as painful penetration.
Sexually transmitted infections
Contracting sexually transmitted infections - such as gonoria and syphilis may also put a woman at risk of suffering vaginismus.
Agilan explaned that vaginismus does not necessarily be complete inability to have penetration to the vagina.
"Sometimes, it could be partial. There are patients that are able to insert fingers, some of them may even be able to have penetrative sexual activities – but it is very painful that they stop – so that leads to the inability to conceive, hence they present to a fertility specialist."
Treatment can also be divided into two. Psychological treatment is typically carried out by a psychologist to pre-programme the mind and alleviate fear of penetration.
"The other method would be vaginal dilatation. This can be done using an anesthetic gel which can be purchased from a pharmacy. This method has been successful where patients are able to have a vaginal scan done with 50% of their fear alleviated. This builds confidence that the wife is able to do things. The couple could then slowly get a lubricant to try vaginal penetration.
Is conceiving even possible?
"If the patient's goal is to get pregnant, we would look into the husband's sperm quality. Assuming the sperm quality is good – then the woman can try a simple method of intravaginal insemination (IVI)."
“This treatment replaces sexual activity and can be done at home. On the day of ovulation – the husband produces sperm by masturbation – into a sperm collection container, waits for the sperm to be liquidified around 30 minutes or so before using a small tube or a baby suction to shringe out the semen. The tube is then inserted into her vagina and injected. This whole process replaces sex."
Agilan pointed out that there are high chances of pregnancy with an IVI, if vaginismus was the reason.
"If this method fails, we could proceed with an Intrauterine insemination (IUI) where sperms are deposited in the uterus. This is done in a fertility clinic under sedation to avoid pain. However, there are some patients who are able to do this without sedation – as they have pre-programmed their mind and to a certain degree overcome vaginismus. If IUI is unsuccessful, then they’d have to progress to an IVF to get pregnant."
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