Dr. Chew Answers: Painful sex and vaginismus

In Singapore, annulment statistics due to non-consummation of marriage show an upward trend. In 1996, there were 178 cases and the figure soared to 369 in 2010. Many cases were attributed to women being unable to have intercourse or who did so with difficulty, a condition medically known as vaginismus. This condition is due to the contractions of the involuntary muscle around the vaginal opening in anticipation of penetration. The muscles go into spasms because of pain or fear of pain. Penile penetration becomes difficult or impossible. Left untreated, it may lead to marital conflicts and divorce.

Many such marriages could have been saved through medical intervention and sexual counselling. Unfortunately, women suffering from vaginismus are usually too shy to seek medical advice or believe there is no solution. Here’s one woman’s story about dealing with vaginismus:

Inability to have sex

Kate*, a 32-year-old engineer whose marriage was at the verge of collapse because of vaginismus, packed up enough courage one day to consult me.

“How embarrassing and humiliating if other people found out,” she used to think.

On her first visit, she looked apprehensive, anxious and slightly depressed. She was raised in a strict traditional Chinese family — the subject of sexual intimacy was never discussed.

“I approached my wedding night with excitement,” she recalled. “This was shattered when my husband and I tried to consummate it. A beautiful wedding gave way to a painful honeymoon. We failed miserably every time we tried. No matter how much I wanted to have sex, it was just too painful.”

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Medical help

“After a few months of futile attempts, my hubby was getting upset and impatient. We seldom breached the subject of sexual intimacy. The frequency of being intimate was low. I wept uncontrollably after the very few times we tried and failed. I felt shameful and guilty.”

Kate would not allow me to examine her vaginally. Abdominal examination and ultrasound investigations did not reveal any abnormalities in her reproductive system. I suggested Kate to see a counselor for behavioral modification and started to teach her the use of plastic vaginal dilators together with relaxation techniques.

After much coaxing and encouragement, Kate finally had her first marital union after about 2 months. The couple was overjoyed when the urine test confirmed that she had conceived after another three months. She is due for delivery in June next year.

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Causes of vaginismus

We do not know the exact number of women suffering from vaginismus, but it is estimated that for every woman who seeks help, 10 suffer in silence. We also do not fully understand the causes. The majority are linked to fear of pain or dislike of sex. For some, it may be the result of being sexually abused, assaulted or raped. One physical cause is an inflammation of the vagina.

As in Kate’s case, a very strict upbringing where sex was never discussed or unhelpful messages leading to feelings of guilt and shame can be the causes. Religious or cultural taboos or the fear of getting pregnant are other possibilities. Psychosexual counselling using behaviour therapy is the preferred treatment. Couples also benefit by solving their interpersonal problems through communication.

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Surgery is seldom necessary. It cannot cure a psychological condition and may inflict further trauma. Recently, botulinum toxin (Botox) has been used to paralyze the vaginal muscles allowing almost immediate penetration. But this does not deal with any of the psychological issues. With psychosexual therapy and the use of a dilator, success is almost 100% if the couple is motivated and committed to resolving their problem.

*Name has been changed for privacy.

For more information from Dr. Chew, visit aLife.org.sg, or ask him something on our Ask Our Experts page.Make sure you like us on Facebook and stay up-to-date on the latest from Pregnant.Sg!