“Another gynaecologist we consulted advised my husband to slap me if I didn’t cooperate. Fortunately, he wasn’t comfortable with the advice. It was only after researching online that I realised I was suffering from Vaginusmus,” she says.
The condition refers to the involuntary tightness of the vagina during attempted intercourse caused by contraction of the pelvic floor muscles. Sometimes, it can lead to pain, burning or stinging during sex, making intercourse impossible.
Dyspareunia, say experts, is the umbrella term used to refer to any kind of pain during penetration, intercourse, and/or following intercourse.
Associations of pain
“It’s often that women have no clue why they are unsuccessful in bed,” says Dr Rajan Bhonsle, HOD of the Department of Sexual Medicine at Parel’s KEM Hospital. In a large number of cases, he says, the fear of pain is psychological. “It’s possible that she may have suffered abuse as a child, or was told by a friend that sex is painful. For various reasons, she associates the idea of penetration with trauma,” he adds.
Treatment in such cases, Bhonsle adds, involves counseling the couple so that they are able to trace the root of the fear. “We get them to try exercises that help them get intimate at a leisurely pace, and comfortable with each other’s bodies rather than plunging straight into intercourse.”
Sometimes, the woman is asked to self-dilate her vagina using dilators or inserting her own fingers which helps her realise that the process needn’t be painful.
“Awareness is low. Several couples have to be made to understand that the vagina is capable of expanding enough to allow a child to pass through, so, entry during sex isn’t a problem,” says Mirror sex columnist Dr Mahinder Watsa. He adds that in a large number of cases, insufficient foreplay can lead to discomfort. “Women take longer to get aroused. If the vagina is dry, penetration is bound to cause pain,” he adds.
Nine out of 10 cases of Dyspareunia, says Bhonsle, can be attributed to dryness. Applying an anaesthetic gel — 15 minutes prior to the act and wiping off the excess — or using a lubricating gel can provide temporary relief.
In addition, physiological factors also hamper lubrication. The Bartholyn glands located in the vaginal wall are responsible for secreting lubricating fluid. However, in the presence of infection, they swell up, says Dr Duru Shah, scientific director of Gynaeworld. Treating this fungal or bacterial infection helps ease the pain, says Shah, who tackles at least two cases of painful sex a week.
A deep pain
In the case of Vaginusmus, the pain occurs at entry point. Sometimes, women, who do not experience pain at this stage of the act, may reel under debilitating pain during or after the act. In the case of women who are battling endometriosis, the uterus and ovaries are placed close to the vaginal wall. Thrusting may cause friction, leading to pain. The treatment — medical or surgical — would depend on the cause of the condition. “Most women who suffer from deep dyspareunia also live with painful periods,” says Shah.
When the cause of pain is psychological, there are doctors who will help you with a Botox jab. Two ml of botulinum toxin is injected into the skin in a non-surgical cosmetic procedure to block muscular nerve signals, which then weakens the muscle so that it can’t contract. Each dosage of two jabs costs Rs 30,000.
Dr Sanjay Pandey, consultant urology, andrology and gender reassignment surgeon at Andheri’s Kokilaben Dhirubhai Ambani Hospital, “helps patients relax the muscles of their vaginal wall with a Botox shot, so that they don’t clamp up.”
This, he admits, is reserved for rare cases of Refractory Vaginusmus after counseling and exercises have failed to help and starts showing results in a few weeks. Pandey has offered the treatment to 24 patients in the last six-and-a-half years. The effect of the jab lasts between four to six months, which means women have to come in for ‘follow ups’.
“There are no side effects, except that it may not work on some patients at all,” adds Dr Sejal Desai, consultant gynecologist and director of Saral Hospital in Santacruz. “Although it’s possible in some cases, that the woman dissociates pain from sex and is able to have intercourse normally even after the Botox wears off.”
The jab, she adds, is only provided to women above 18.
(Names of patients changed to protect identity)