Let's talk about vaginismus
Imagine it's your wedding night.
You're a virgin and looking forward to having sex with your husband for the first time... but, despite best intentions, it doesn't happen.
The reason is a condition called vaginismus, a sexual problem that's rarely talked about.
Virginity and the issues surrounding it were discussed in a recent Australian program where the host spoke with medical professionals and guests from different cultures.
Several issues were covered but, unfortunately, vaginismus wasn't one of them.
As a sex therapist I see many women who come from a cultural or religious background where sex before marriage is not allowed or frowned upon; they sometimes end up with this condition, which can result in unconsummated marriages.
Women who suffer from vaginismus find that attempts at sexual intercourse are unsuccessful or very painful.
The condition is caused by the involuntary contraction of the muscles around the entrance to the vagina. The spasm constricts the vaginal opening, making it virtually impossible to have intercourse. The man cannot penetrate, it feels like he has hit a brick wall.
As this is often experienced on, or after, the wedding night you can imagine how distressing this is for a couple who can't understand what is happening. They have waited so long and now having intercourse is impossible.
Women with vaginismus may feel sexually inadequate and can experience feelings of intense shame and failure.
The male partner may experience loss of desire and problems with erection.
The combination of erectile difficulties and vaginismus is not uncommon. He fears hurting his partner and loses his erection whenever he tries to penetrate. Or he may ejaculate before he can penetrate.
It is such a taboo that couples are often too embarrassed to discuss the issue with family or friends and so suffer in silence.
They avoid questions from the family about why they don't have children yet and feel extremely sad when their friends tell them what a great sex life they have.
Some couples take years before they finally look for help and then they are often misdiagnosed.
It is quite unbelievable that 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 are 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. One recent client told me she just wanted to be "a good girl" but is angry that she waited so long and has now ended up with this problem.
Most women with vaginismus were told by their mothers not to use tampons when they were young; they just did not swim or go to the beach when they had their periods.
They were told not to insert any object into the vagina for fear of breaking the hymen.
Most had inadequate sex education and received unhealthy sexual messages. Many were told that sex would be extremely painful and there would be blood.
Vaginismus is easily 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 moral beliefs that can contribute to her condition.
Post-counselling I refer my clients to a pelvic floor physiotherapist who specialises in this area.
The treatment of vaginismus involves unlearning the fear-contraction reflex and being taught to keep the pelvic floor muscles relaxed during intercourse.
Successful treatment does not require drugs, surgery, Botox injections, hypnosis or any complex invasive techniques, and a full recovery is possible.
Sydney Morning Herald