When The Heart Says Yes But The Vagina Says No

Damn Vulva drivers!
It feels like he has hit a brick wall.
It feels like he has hit a brick wall.

I see about five clients a month who suffer from vaginismus. Most of the women come from a cultural or religious background where sex before marriage is not allowed or frowned upon.

Women who suffer from vaginismus find that attempts at sexual intercourse are very painful or unsuccessful. This involuntary contraction of the muscles surrounding the entrance to the vagina makes the muscles around the vagina shut down and prevents her partner from penetrating. It feels like he has hit a brick wall.

Vaginismus is not due to a physical abnormality. Some women wonder if their vagina is too small or they have no vaginal opening at all and that is the reason why sex is so difficult. But in most cases the vagina is perfectly normal and would be capable of intercourse without pain, if the pelvic floor muscles around the vaginal canal could be relaxed.

Couples will usually experience this on or after their wedding night and one can imagine how distressing this is, they just can't understand what is happening to them. They waited so long and now sex is impossible and they are not able to consummate their marriage. The women often believe it is their fault and blame themselves or their partner, who will then feel frustrated, rejected or inadequate.

It is such a taboo that couples are often too embarrassed to discuss the issue with family or friends and suffer in silence. They find excuses when their family keeps asking why they don't have children yet and feel disappointed and sad when their friends tell them what a great sex life they have or fall pregnant.

Some couples take years before they finally look for help and then they are often misdiagnosed. It is quite unbelievable that in Australia, many GPs and sometimes even gynaecologists do not know about the condition.

My clients are often told: "there is nothing wrong with you; it is all in your head", "keep trying, you will get used to it", "use an anaesthetic cream" or "drink some alcohol to make you feel more relaxed".

Some women were told their vaginas are too small and they need an operation to widen its entrance or that they need to undergo hymenectomy, a procedure to remove all or part of the hymen.

Most of the women I see have spent much of their lives in Australia, they are university-educated professionals in their mid or late twenties who are settling down and getting married. They may not be that religious, but out of respect for their family and culture have decided not to have sex before marriage.

Almost all women with vaginismus were told not to use tampons when they were young for fear of breaking the hymen. Most had inadequate sex education and received unhealthy sexual messages that sex would be painful and there would be blood.

Both sexually experienced and inexperienced women can develop vaginismus. Primary vaginismus occurs when a woman has never, at any time, been able to have pain-free intercourse.

Secondary vaginismus occurs when a woman who previously has enjoyed intercourse without pain develops the condition later. It can be triggered by a traumatic experience like a difficult child birth, sexual assault or painful experiences with intercourse due to underlying conditions such endometriosis, pelvic or vaginal infections, low sexual arousal with lack of lubrication, menopausal dryness or other vulval conditions.

Vaginismus can be treated by counselling, education, anxiety reduction and retraining of the pelvic floor muscles. Psychosexual education is important as it is essential the woman gains knowledge of her sexual anatomy. Through counselling she can free herself of the negative moral understandings and beliefs that may have contributed to her condition.

The treatment of vaginismus involves unlearning the fear-contraction reflex and being taught to keep the pelvic floor muscles relaxed during intercourse.

Overcoming vaginismus does not require surgery, Botox injections, hypnosis or any complex invasive techniques.

This blog first appeared in November, 2016.