When Vaginal contractions suffocate a marriage

A young couple studying in an engineering college was deeply in love. As per cultural values they had decided to have penetrative sex only after marriage. But they would enjoy kissing each other and getting intimate every time they got an opportunity. So, they were very surprised when after marriage they could not have sex. Every time they tried the lady would get pain. It felt like there was a wall which could not be penetrated. They felt that because it was his first time they did not know how to do it; they will figure it out with time.

However, when they could not figure out even after 6 months, she started thinking that something is wrong with her vagina which was resulting in pain. So, they went to a gynaecologist. But after examining her, the gynaecologist said that everything was fine; they just need to keep trying and it will happen. But when it did not happen for 6 more months, they went to a senior gynaecologist. That gynaecologist also reassured and during examination suddenly inserted her 2 fingers to reassure the lady that her vagina had enough space. She screamed loudly due to severe pain. The husband and everyone in the waiting room were left wondering what the hell was happening. The gynaecologist admonished her, if she acted so delicate her husband would leave her. Traumatised by this experience she decided to never visit any doctor again for this issue.

She was embarrassed what will people think if they come to know. So, she did not discuss it with anyone. Husband also reassured her that sex was not everything and they were friends first. They both were in early years of their careers and they started focusing on that. Engaging in intimacy started feeling stressful as they knew it was not going to lead anywhere. Soon the kissing, hugging and non-penetrative pleasures also stopped. The wife started feeling insecure that he no longer loves her and the couple started fighting on trivial things. Seven years rolled by like this and the love between them seemed to have vanished. The lady was taken by surprise when the husband suggested, “Should we take a divorce?” Her gut feeling told her that the problem in sexual life was the underlying cause of their fights. She started frantically researching on the internet. After 2 months of searching on Google, Reddit, Instagram, etc. she realised, what she was dealing with vaginismus.

While this may seem like an exceptional story, this is the typical experience of couples dealing with vaginismus – a psychosomatic condition having a poor level of awareness in our society. In this, muscles around vagina involuntarily contract every time the woman tries to have sex. In mild vaginismus, the couple will be able to have penetrative intercourse, but it will be painful. In moderate vaginismus the pain will be so severe that penetration will not be possible. Or the contraction will be so strong that it will feel like a wall and penis will not go in at all. In still severe cases the fear is so much that the lady would push the husband away, in reflex, as soon as the penis comes near the vagina. Then she would prepare her mind and initiate intimacy again. But when arousal would build up and they try penetration, she would end up doing the same thing again.

Husbands wonder why is she not able to relax? Does she not trust him? Has she not accepted him? Was she forced to marry? Is he not being good to her? She reassures him of her love but is unable to explain why she is not able to relax. The root cause of this vaginal contractions is in the mind. But the resulting pain is quite real; it is not imaginary. The lady does want to have sex but her unconscious mind wants to avoid the act. This is due to certain fears & beliefs that had got instilled in her mind, usually in adolescent years.

Some common reasons for this are:

1. Fear of pain: If an adolescent girl has been told that sex is painful for women or that 1st night is very painful, then she may develop a dread towards it. So, to avoid a painful experience, the unconscious contracts the vagina. But the irony is that the contraction itself is responsible for the pain.

2. Viewing sex as sinful: Many religions promote an idea that sex is something sinful; to be avoided as much as possible or to be done only for getting a child, etc. Also, now marriages happen at around the age of 25 or later, but God has still not postponed the age of puberty. So, after a girl develops sexual desire, her mother, teachers, and other well-wishers keep stressing to her for the next 10-15 years that she must preserve her dignity and not engage much with boys. Sincere obedient girls take this task of preserving family respect very seriously and the unconscious gets programmed to look at sex as something bad which is to be avoided.
3. Bad touch experiences: If a girl has had bad touch experiences and if they have left a deep impression on her mind, then the unconscious may always remain on the guard to prevent any repetition.
4. Harsh parenting: Out of a desire to discipline the child and to make her successful, many parents hit their children quite badly during school going years. The child develops a strong fear of pain. So, when she hears from someone that sex is painful, the fear generated in her mind is much more.
5. An anxious tendency: Women who are very anxious in general, who are perfectionists, etc. also have a higher tendency to develop this condition. Their mind and body are more attuned to worrying and remaining tensed, rather than relaxing and enjoying the present moment. Such a tendency can develop due to various reasons, including traumatic experiences in childhood, witnessing fights between parents, excessive stress on performance by parents, criticism over unintentional mistakes, etc.
6. A belief that girls are not safe in our society: In today’s age of media sensationalism and influencers, crimes against women like rape get a lot of publicity and young girls develop an exaggerated belief that all men are bad or that women are unsafe anywhere and everywhere in our society. This results in them developing a fear of men and/or of sexual touch. (To get some thoughts on how to help young girls take a balanced perspective over such crimes, one can refer to this video: https://youtu.be/8lKvrlTLInc)
7. Being shamed for masturbation: Many girls accidently discover during adolescence that rubbing over the clitoris feels very pleasurable. They end up repeating it now and then. But if there is an overall negative attitude towards sexuality in the social environment and no positive sex education, then she can develop a deep sense of guilt that she is a very bad girl as she keeps indulging in this pleasure. Especially if someone sees her doing it and criticises her for it.
8. Severe pain during menses: Some girls have painful and stressful periods, and develop a belief that things related to the genital region are very painful. So, they get more worried if they hear that sex is painful.

I would like to clarify again that most women with vaginismus are looking forward to intimate moments with their partners. Their current wishes can be different from their unconscious programming. Both thought processes are going on in parallel in the mind. For instance, now-a-days pre-marital sex is common in some social circles. A girl whose friends are having premarital sex may also feel like engaging in it with her boyfriend. But her cultural values may be against it. So, her unconscious may not co-operate and she can get pain. Once she gets pain while trying to do intercourse, that becomes another reason to fear sex and the condition worsens.

So, what is the solution to this psycho-somatic condition? A mix of psychological and physical interventions of course, like:

A. Education about the sexual process: Some women can heal with just an explanation of the sexual anatomy and physiology along with simple assurance that sex is designed to be a painless pleasurable experience. However, this does not work for many with deep rooted fears.

B.Training the vaginal muscles to relax: This is the most popular treatment strategy. In vaginismus, the problem is reflex contraction of muscles around vagina to any attempt to penetrate. So, the solution is to train these muscles to relax. This is usually done with the help of a set of ‘dilators’ of increasing sizes. However, it is not actual dilating. There is already enough room in the vagina. We just train the vagina to relax. First the lady practices with the smallest dilator and when it starts going in, she feels elated. She would not believe that something actually went in. Then as her confidence increases, she gradually moves to 2^nd, 3^rd, 4^th and then the 5^th When the dilator similar to the size of penis goes in, she feels confident that she can also have a painless intercourse. This allows her to remain relaxed.

However, many women cannot progress with dilators. They are unable to relax even when inserting just the dilators. Two things are crucial for it to work. One is regular practice of relaxation exercises like belly breathing, reverse Kegel’s, pelvis floor stretching asanas, etc. And other is to follow certain instructions that will be explained by the treating professional. One of the most important instructions is to go slow and do it in a relatively painless manner. To focus on relaxing vs pushing it too much despite pain. Whatever be the initial cause of vaginismus, the pain which a lady herself experiences becomes a reinforcing factor which strengthens her belief that sex is painful for women. Hence treatment process has to be relatively painless for her to feel safe.

You can go to a psychiatrist, psychologist, gynaecologist, physiotherapist, or any sexologist who has good experience of guiding women with this process. While dilators make it easier, it is fine to practice with just fingers as well. Some gynaecologists now give Botox injections in muscles of the pelvic floor if the lady is not able to progress with dilators. This makes dilator practice easier in some women. Muscle relaxants like Baclofen may also help some women in this process.

C.Healing the root cause: While this seems to be the most obvious solution, this is the least practised one. And this is the 3^rd reason why dilator practice fails in some women despite doing everything mentioned in strategy B above, including Botox injections. Because the reason which was making the unconscious contract the vagina remains untouched. This is partly because many professionals who work in this area are not mental health professionals. And partly because many mental health professionals also do not have much training in doing therapy for healing past emotional trauma. One of the gold standard approaches for healing past trauma is EMDR. So, you can go to an EMDR therapist or some other therapist with relevant experience, if you want to try this approach in combination with strategy B.

If there is history of sexual abuse, any significant emotional trauma, or a negative attitude towards sexuality, then emotional healing becomes very important for sexual life to normalise. I know a particular couple, where the lady endured very painful dilation from a professional because of threat of divorce looming on her head. Now sex is painless but she has zero desire. Either because root cause remains unhealed or because the painful dilation may have created further aversion towards the idea of sex. 

D.Sensate focus exercises: These are a set of suggestions which encourage a couple to resume intimacy in a gradual manner, with focus on enjoying the process and not bothering about performance. This helps in decreasing anxiety and is used as an adjunct in the treatment of many sexual disorders.

It is common for couples with vaginismus to spend 5 to 10 years struggling with this condition, partly because of lack of awareness even amongst health professionals about this condition and partly due to inadequate training opportunities. Despite spending 5 years in some of the best medical colleges, I had not seen/attended discussion of even a single case of vaginismus in those 5 years. I just had theoretical knowledge. So, I want to reassure you, do not despair if you are taking some time to heal. Try few professionals and you will also heal. This is a treatable condition.

Let us spare a thought for prevention as well. We must do all that we can to prevent couples in our family/society from going through this emotional turmoil.

• Most important would be we, as a society, opening to the idea of providing healthy sex education to our teenagers. We need to go beyond condom education and giving them various reasons for not having sex at that age. We must also help them cultivate a positive attitude towards sexuality so that they can embrace it when the time is right. We must normalise masturbation and we must teach girls that sex is designed to be a painless pleasurable experience for women also. It is just the first 1 or 2 times that is painful for some women and that too is manageable pain. Women who continue to get pain, get it because of vaginismus or some other cause. It is not normal. 
• We need to talk to young couples around us about this condition and spread awareness about it in general, so that couples can seek help in time. Share this article with all young people you know. Couples who suffer do not talk about it to anyone due to the stigma and a culture of silence about sexual life. It is more common than you think. My wife had it. One of my cousins had it. Another cousin’s wife had it and one of my wife’s cousins had it. 
• Many couples ignore this issue for many years. Partly because continuing to work on this while facing repeated failures can feel immensely stressful. But they must understand that they cannot avoid it if they wish to experience harmony & joy in their marriage. This and all sexual disorders are treatable. To take help in time and to keep working on it till it heals. In many cases husbands do not bring up the issue as they do not want her to get stressed. Husbands must realise that they are prolonging her stress as well by not encouraging her to work on it. Some women start to work on it only after their husbands let them know about their distress. After healing the couple wonders, “Why did we wait so long?”  

Thanks for reading and wishing you a very satisfying sexual life 🙂

(I shall be very thankful if you share your positive and negative experiences of sexuality with me by emailing to dharavshah@gmail.com. Your learnings will help me in guiding couples struggling with it. I promise to maintain complete confidentiality).