IF there is any medical condition that can be described as "female impotence", it is a disorder called vaginismus or simply "inability of a woman to engage in sexual intercourse" because the muscles around the vagina tighten (contract) against the woman’s will, causing the vagina to spasm. Quite like the more familiar form of male impotence when a man cannot "get it up", the woman with vaginismus is unable to "get it in" – so to speak. The bottom line is that there are so many ways in which this sexual dysfunction could be a significant factor in the inability of several couples to conceive and have their own biological baby.
WHAT IS VAGINISMUS
It is a psychological problem that shows itself in a physical way and is fairly common among women in the late teens to thirties, vaginismus occurs as a conditioned muscle reflex in the lower pelvic muscle called the pubococcygeus (PC) muscle, which clamps shut , making penetration into the vagina either extremely painful or in many cases, virtually impossible.
The vaginal muscles go into spasm, usually in response to the vagina or vulva being touched before sexual intercourse. It can also happen if sexual intercourse is attempted, or during a gynaecological examination.
Some women find that they cannot use tampons when they have a period. They undergo distress and relationship problems and also have problems when it comes to starting a family. While they are able to achieve orgasm during mutual masturbation, foreplay and oral sex, when sexual intercourse is suggested or attempted, the vagina tightens to prevent penetration.
This is the way vaginismus can disrupt or completely stop a woman’s sex life and make routine gynaecological and pelvic examinations difficult or impossible. In some cases, a woman may need an anaesthetic before a doctor can perform such an examination.
Essentially, vaginismus is not rare and it’s likely that many women will experience it at some time in their life, even if they have had a previous sexual history of enjoyable and painless sex.
HOW IT CAUSES BREAKDOWN IN MARRIAGES
While its severity varies from woman to woman, vaginismus is often a primary cause of the breakdown of some marriages as a result of the stress of the inability to have sex. Interestingly, it is not uncommon to discover that some couples are quite happy to live together happily without having sexual intercourse, however, they most certainly seek medical help when they want to plan a family.
Traditionally, the "act" of "having a baby" is largely accepted as the woman’s responsibility, hence the multiplicative effects of the sexual inability and the infertility creates a problem which seems to be insurmountable.
By reasoning, no woman opts for vaginismus to happen to her; it is largely a learned reflex reaction. In comparison, it is like the eye shutting when an object comes towards it. In a way, vaginismus can be described as a reflex reaction designed to protect the woman’s body from pain. This is so because a woman with vaginismus expects pain to come with vaginal penetration and so her mind automatically sends a signal to her PC muscles to clamp shut, thus making penetration either impossible or very painful. This conditioned reflex creates a vicious circle.
CAUSES OF VAGINISMUS
Let’s look at it this way. If a teenage girl is made to believe that having sex for the first time would be very painful (and this is particularly true in conservative societies where sex education is not provided) she may develop vaginismus because she expects pain. Attempts to engage in sexual intercourse subsequently send her muscles into spasms. The muscles clamp shut and sex becomes very painful.
This confirms the woman’s fear of pain as does each further attempt at intercourse. Every time this fear is confirmed, the brain is being "shown" that sex does hurt and that the reflex reaction of the PC muscles is needed. This is why it is important that if a woman suspects she has vaginismus, she is better off stopping attempts to have sexual intercourse. This is not to say a woman with vaginismus can not partake in other sexual activities. She can, but only as long as vaginal penetration is avoided. Largely speaking, it is a common misconception that a vaginismic woman does not want to have sex as a lot of the time. The truth is that she desperately does.
You as a woman may have vaginismus for certain reasons. Actually there are a variety of contributory factors. They may be psychological or physiological and the treatment required will usually depend on the specific causative factor. Things such as sexual abuse, strict religious upbringing, being taught that sex is dirty or wrong or simply the fear of pain associated with vaginal penetration, and in particular, loss of virginity are some of the reported reasons behind vaginismus. There are quite many more. Essentially, vaginismus is a very personal condition and so each case is looked at individually as causes and treatment can not be generalised for all women with the problem.
It is particularly worthy of mention that several women who suffer from vaginismus do not realise they have it until they try to insert a tampon or attempt penetrative sex for the very first time and so it may come as quite a shock to them. Whether they choose to treat the problem or not is entirely a matter of choice but what is important is that such women should never be led to believe that vaginismus MUST be treated. In reality, the condition will not get worse or more serious if left untreated unless the woman is continuing to have sex/use tampons despite feeling pain on penetration.
THE DIFFERENT DEGREES OF VAGINISMUS
There are grades or degrees of vaginismus. Primary vaginismus occurs when a woman has never been able to have sexual intercourse or achieve any other kind of penetrative sex. This is more commonly discovered in teenagers and women in their early twenties more so as this is often the age when majority of women tend to attempt to use tampons, begin sexual intercourse or complete a pap smear for the first time. The fact is that it can often be very confusing for you to discover you have vaginismus especially as you have been led to believe that sex is something that is supposed to come naturally. It is even more confusing when you do not know why you have this condition, as is true for many women.
HOW IT CAN BE TREATED
If you are suffering from this disorder and desire to treat the problem, then you can do so in many different ways. Really it does not have to be expensive and in fact, relief can be achieved without help of a health professional although proper diagnosis is required.
Of course the best way of treating the associated " infertility" is to treat the underlying vaginismus even if this does not sound too easy. As a psychological problem, treatment can be time consuming and difficult. Many couples would rather bypass the process and concentrate on having a baby, without having to worry about having sex. For these couples, artificial insemination is a very effective treatment option. An alternative of self-insemination is also possible.
Usually if there are no psychological factors, physical treatment alone may be enough to fix the problem. Approaches like sensate focus exercises, exploration and desensitization of the vagina with dilators. Dilating (with lubrication) involves inserting objects (usually mildly resembling a penis in shape), into the vagina. In most instances, the most applicable dilator is a finger, so there may really be no need to spend money on expensive medical dilators. The idea is that not only can the finger be very precisely controlled; it’s also much gentler.
The process of curing vaginismus is usually a long one that requires patience, will power and determination. However, it is important to know that in 99% of cases, it can be successfully treated. To be taken into account are the emotional problems associated with vaginismus such as low self esteem, insecurities and often even depression, so it is very important that if you choose to seek the help of professionals, try to find someone who is very understanding and who has previous experience with the disorder.
Dr Abayomi Ajayi
Nordica Fertility Centre, Lagos
yomiajayi@nordicalagos.org
