Veronica (name changed on request), a 27-year-old interior designer from Bangalore, recalls trying to insert a tampon during periods as a teenager and failing. “The tampon wouldn’t go in at all, no matter how much I try. I would also feel immense pain around the vagina,” she recalls. Attempting to insert menstrual cups, too, were met with similar consequences. Little did she know that her ordeal had a name — vaginismus.
While she knew something was amiss, she brushed it under the carpet. However, years later, it haunted her when she became sexually active. “Vaginal penetration would not happen, any attempts at penetration, despite foreplay, would cause excruciating pain and a burning sensation that would stay long after,” she says.
Painful contractions during sex
“Vaginismus is a recurrent involuntary spasm or contraction of the vaginal muscles during intercourse and other kinds of vaginal penetration — insertion of fingers, tampons or menstrual cups and gynecological examinations,” says Dr Shefali Tyagi, senior consultant, obstetrics and gynecology, Rainbow Children’s Hospital & BirthRight, Bangalore. These spasms make the vagina very narrow, preventing penetration or making it very painful.
Physical symptoms of vaginismus include sharp pain, burning sensation, and pressure in the vagina during penetration, besides psychological symptoms like anxiety.
“My then partner would describe the attempts to penetrate as hitting a wall,” says Veronica. These negative experiences instilled a sense of guilt, which put her off sex and made her avoid sexual situations altogether.
Degrees of vaginismus
According to the severity, the Lamont scale has classified vaginismus into four degrees.
Grade 1: The person has spasms of the pelvic floor that can be relieved with counseling and reassurance.
Grade 2: The spasm is present but maintained throughout the pelvis, even with reassurance.
Grade 3: The person elevates the buttocks to avoid being examined.
Grade 4: This is the most severe form of vaginismus. Here, the person elevates the buttocks, retreats, and tightly closes the thighs to avoid examination.
The Lamont classification was later expanded to include a fifth degree in which the person experiences visceral reactions such as sweating, hyperventilation, palpitations, trembling, shaking, nausea, vomiting or even losing consciousness.
Types of vaginismus
According to Dr Bratati Bhattacharyya, consultant obstetrics & gynecologist, Manipal Hospitals, Salt Lake, Kolkata, vaginismus is of two types — primary and secondary.
“In primary vaginismus, the person has never achieved painless vaginal penetration. In secondary vaginismus, painless vaginal penetration was previously achieved but is no longer possible due to various factors,” she explains.
What causes vaginismus?
Veronica says that the societal taboo about sex may have subconsciously influenced her, instilling a sense of fear. The causes of vaginismus can be psychological, physical, or a combination of both. According to Dr Bhattacharyya, the cause of vaginismus is usually psychological and includes the following factors.
- Negative attitude toward sex
- History of sexual abuse
- Sexual trauma
- Fear of pain during penetration
- Fear of sexual intercourse
Dr Bhattacharya enumerates some of the physical causes of vaginismus:
- Infections — UTIs or yeast infections
- Injuries during childbirth
- History of gynecological surgery
- Inflammation
- Menopause
- Medical problems — endometriosis
She adds that a strained relationship with the sexual partner and a lack of communication can also trigger vaginismus.
Seeking medical help is key
Though vaginismus is considered one of the most common psychosexual conditions in women, there is a dearth of social awareness, which can lead to women taking years to seek help and attain the right diagnosis.
Stressing the importance of seeking medical attention, Dr Tyagi says, “We come across couples who are married for 4-5 years and have never had penetrative sex. They seek help when they are trying to have a baby,” she says.
Vaginismus is treatable
For Veronica, finding an empathetic partner helped ease her struggles with vaginismus.
“My current partner has been very patient and compassionate with me. We decided to take things slow. He was gentle and would immediately step back the moment I felt pain. As the trust between us grew, I gradually felt comfortable and began feeling more at ease, which in turn reduced the pain,” says Veronica.
Vaginismus is a treatable condition and Dr Tyagi elaborates on the various treatments available:
Counseling: As the majority of causes are psychological, counseling plays a key role in treating vaginismus. Counseling involves restructuring the person’s attitudes toward sex, teaching relaxation techniques, and addressing relationship issues and past sexual trauma. The sessions are designed to help individuals and couples.
Lubrication: Using lubricants may help ease the pain in the vagina during penetration. There are numbing creams and local anesthetic gels that can be used to numb the area.
Vaginal dilators: These are tube-like devices that are gently inserted into the vagina to stretch the vaginal tissues and relax the pelvic floor muscles.
She advises engaging in ample foreplay before intercourse to mitigate the pain to a certain extent.
Takeaways
- Vaginismus is the recurrent and involuntary contraction or spasm of the vaginal muscles during intercourse and other kinds of vaginal penetration.
- Symptoms include pain in the vagina, burning sensation, and anxiety.
- The cause of vaginismus is mostly psychological, including negative attitudes towards sex, past sexual trauma, or fear of pain during sex.
- Treatment for vaginismus includes counseling, lubrication, or pelvic floor exercises, amongst others.
