What is Vaginismus?
It’s a condition when the vaginal muscles automatically tighten up when there is an attempt to insert inside a vagina. The effect of this contraction might also be felt in the thigh muscles.
Ignoring these contractions, while an insertion is attempted, can be uncomfortable or outright painful. The insertion in the vagina could be a penetration by penis, a sex toy, insertion of a tampon or a menstrual cup, insertion of fingers, and also medical examinations that require the gynaecologist to touch in or around the vaginal opening.
The pain can occur even when a penetration is only attempted and has not actually been done. This pain may last only a moment of actual or attempted insertion, but may also continue long after it.
It's not a vaginal infection. People may also have situational Vaginismus, in which case, few kinds of vaginal insertions, say inserting a menstrual cup, may be possible but other insertions – sexual penetration by penis, for instance – may not be possible.
What causes Vaginismus?
The causes of Vaginismus are understood to be a mix of two kinds:
Psychological factors – such as fear of sexual intercourse, history of sexual violence or abuse, emotional rift and/ or incompatibility with sexual partner(s), religious beliefs against sex and intercourse, anxiety, etc.
Physiological factors – like inflammation, vaginal atrophy or the thinning and drying of the vaginal walls due to fall in the body's estrogen hormone level (usually after childbirth or menopause), etc.
How to diagnose Vaginismus?
The only way to know whether you have Vaginismus is to get an examination done from a gynaecologist. Do remember: self-diagnosis (and treatment) by reading up on this article or other things on the internet is never a good option.
However, in India, access to gynaecologists for sexual dysfunction is quite limited for women and persons with vaginas. This is largely on two counts: women’s social conditioning and the judgemental attitudes of medical service providers.
Women are always taught to tolerate pain as a given part of sex (ever heard there was a medical term for painful intercourse? It’s dyspareunia), limited usage of menstrual hygiene products that require vaginal insertion -- tampons and menstrual cups, and cultural conditioning against sex unless it’s for reproduction.
Judgemental attitudes of gynaecologists, especially against young persons who are not married and are sexually active is the other reason why people don’t approach gynaes for sexual dysfunctions. These reasons cause Vaginismus to not get diagnosed or even get misdiagnosed.
Treatment and way forward
The good news is that Vaginismus is entirely treatable. It is not vaginal infection. The time of treatment and healing may vary from a few weeks to a few years, and will be different for each person. To begin with, it is necessary to not go on tolerating pain or to let a person (your sexual partner, friend, sibling, child, whoever it is) experiencing such pain to go on without medical intervention.
If the affected person wants it, you should also accompany them to the gynaecologist. The gynae must be unhurried and gentle with their examination as well as in their discussion with the affected person.
Based on the diagnosed cause of their Vaginismus – psychological, physiological, or a combination of both – the gynae may prescribe appropriate course of treatment.
Sex therapy and/ or counselling may be suggested for psychological causes.
For physiological causes, the doctor may teach the person about basic anatomy, and also about slowly attempting to insert their own finger in their vagina, Kegel exercises, and also the use of dilators to control their muscle relaxation.
Remember: dilators must be used only after applying a topical anaesthetic – creams or ointments used to numb the area of application – around the genital area, so that the muscles (that contract voluntary in Vaginismus) are desensitised to be eventually trained afresh.
Affected persons may also be prescribed a combination of the two treatment courses – counselling and sex therapy [that may even involve their partner(s)] and one or more of the physiological treatment methods.
Reminding again: Vaginismus is entirely treatable. It is not a vaginal infection.
To protect the identity, the person in the picture is a model.
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