When sex is a pain
Simple solution ... sexual discomfort can be alleviated with counselling and exercise. Photo: Stock image
Some months ago an article on this page called Virginity's Unwitting Casualties, author Luke Malone quoted my statement that saving oneself for marriage can bring on an unexpected condition called "vaginismus". This syndrome drew a lot of interest and some confusion. In today's column I will explain exactly what vaginismus is and how it can be treated.
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 could be relaxed.
As this often will be experienced on, or after, the wedding night one can imagine how distressing this is for a couple who 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. Also the women often believe it is their fault and blame themselves or their partner who will then feel frustrated, rejected or inadequate
It is also such a taboo topic that they often are too embarrassed to discuss the issue with their family or friends and suffer in silence. Some couples take years before they finally look for help.
My research tells me that primary vaginismus affects at least two per cent of women in Australia, who due to religious or cultural reasons have developed an overriding fear of penetrative sex. This was also confirmed in the article by retired Australian obstetrician and internationally noted sexologist Dr Jules Black who in his long career saw many patients who he says, were misdiagnosed by medical professionals.
Dr Black mentioned that some of his patients were advised by their physicians to undergo hymenectomy or a "Fenton's procedure", which is an operation to widen the entrance to the vagina. I was under the impression this procedure is obsolete. But two months ago I saw a client in my practice to whom the Fenton's procedure had been recommended - urgently - by a well-known Sydney gynecologist.
My client is a 21-year-old girl who comes from a strict religious back ground. She visited her GP after she found out that it was impossible to have penetrative sex with her boyfriend. This GP, who obviously did not recognise the nature of her problem, referred the young woman to a gynecologist. My client was devastated, the thought of having an operation at "that part" of her body made her petrified. Only after reading Luke Malone's article some days later, did she realise that she was probably suffering from vaginismus and contacted me. She was not alone, after reading this article another four women discovered they were suffering from it.
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. They often are unable to insert anything: the doctor's finger or speculum, when they need a Pap smear or vaginal examination; their own or partner's finger; or even a tampon.
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 is treated by counselling, education, anxiety reduction, pelvic floor exercises and retraining of the pelvic floor muscles. Psychosexual education is important as it is essential that the woman gains knowledge of her sexual anatomy. Women who suffer from vaginismus are often raised in moral or religious homes, schools or institutions and, after a childhood of anti-sexual messages, it can be very difficult to face sexual interaction and accept sexual pleasure, even within a loving relationship.
Through counselling by an experienced sex therapist, the sufferer is able to free herself of the negative moral understandings that contribute to her condition. Post counselling I refer my clients to an experienced pelvic floor physiotherapist who specialises in this area. The treatment of vaginismus involves unlearning the fear-contraction reflex and learning to keep the pelvic floor muscles relaxed during intercourse.
Successful treatment does not require drugs, surgery or any complex invasive techniques. Some plastic surgeons have been injecting Botox, a procedure that none of my clients ever contemplated and, in my opinion, should be regarded as a last resort.
I would like to make the public and the media aware of this condition as I realise that very few people know about it.
I also would like to hear from women who have had bad experiences.
Next time when you have an appointment with your GP or gynecologist, ask them if they know what vaginismus is!
Matty Silver is a Sydney-based sex therapist.