What is Vaginismus? Meghan Trainor opens up about discomfort during coitus

Meghan Trainor, on her recent podcast Workin' On It, opened up about her struggles with intercourse due to an underlying condition called Vaginismus. The Grammy winner who gave birth to her first child in 2021, revealed the psychosexual condition that causes her vagina to contract due to penetrative stimulation. This in turn induces vaginal spasms leading to painful intercourse. Given the ongoing stigma associated with sexual conditions, Trainor's candid confession has come as a win for women who are suffering silently.

Women living with Vaginismus often fall prey to the false belief that they are alone in this conundrum. The absence of healthy discussions around sex has made it difficult to identify, investigate and institutionalise the medical support needed to cure reproductive and sexual health problems. Those who suffer, continue to do so in silence. In order to avoid shame and social backlash, women don't seek help and hence, their medical condition goes unreported and untreated.

Meghan continues in the podcast, "I thought that every woman walking around was always in pain during and after sex. I asked the doctor if I could have sex and not feel a single bit of pain?" Meghan is one of those women whose sexual drive went for a toss after giving birth to a baby. To delve deeper into the agony of painful penetration, Midday.com reached out to By Dr Pratima Thamke, consultant obstetrician and gynaecologist, Motherhood Hospital, Kharghar and Dr Manish Machave, consulting obstetrician and gynaecologist, Ruby Hall Clinic, Pune.

What is Vaginismus? Roughly, how many women are affected by this condition?
Pratima: Vaginismus is the body's instinctive response to the fear of vaginal penetration. When penetration is attempted, vaginal muscles tend to automatically tighten. You have no say in the matter. Vaginismus can occur even if you have previously had painless penetrative intercourse. Vaginismus is more frequent than we think, and the numbers could be even higher than studies have revealed. Women are not usually at ease getting treatment for their illnesses. To compound problems, erroneous diagnoses are fairly prevalent.

Manish: Vaginismus is when a tampon or a penis enters a woman's vagina, causing her vaginal muscles to contract or spasm. It could be mildly uncomfortable or very uncomfortable.

What does one feel like when they undergo this condition?
Pratima: For those who are unfamiliar with vaginismus symptoms, it is a penetrating disease and/or pain condition characterised by involuntary spasms happening in the vaginal muscles. Tightness, tension, discomfort, and difficulty being entered or probed are the end results. Fear of penetration is a natural reaction.

Dr. Manoj Kutteri, medical director & CEO of Atmantan Wellness Centre shares the case study of a woman who acquired Vaginismus:

A 28-year-old lady (name undisclosed at request) got admitted with a complaint of tightness in her vagina and pain during coitus. Over a period, she also developed fear of intercourse. These symptoms were noticed one month after her marriage. She consulted gynecologists initially, who diagnosed the condition as primary vaginismus.

As per the advice of her gynac, she underwent hymenectomy but no improvement was noted. She also developed plenty of psychological symptoms including depression and sadness. There was no past history of any trauma or sexual abuse or earlier penetrative intercourse. She also had a normal menstrual history.

When she came to us, she was reluctant to do any local examination. In the past, she was prescribed medications such as Escitalopram 10mg. After investigations, we scheduled counseling sessions for her with our life coach and also prescribed other treatments such as yoga stretches, Kegel exercises, and acupuncture.

She was also asked to take hot and alternate sitz baths regularly at home. We also gave her meditation practices for proper sleep and relaxation. Sessions were conducted to balance the autonomic nervous system and thereby reduce involuntary contractions. The patient was counseled to become more aware of her body by looking in the mirror. In a matter of 6 months, her depression and mood changes were a lot better. Also, her vaginal contractions were minimal and occasional.

How many types of vaginismus exist?
Manish: There are two main types of vaginismus:

Primary
Primary Vaginismus occurs when a woman experiences discomfort upon an attempt of insertion into her vagina, including a penis (referred to as penetrative intercourse). It's referred to as lifelong vaginismus when she has never been able to get beyond the discomfort of penetration.

Secondary
This occurs when a woman previously experienced pain-free intercourse but finds it difficult or impossible after that. It's also called acquired vaginismus.

Pratima: Vaginismus is classified into three types: primary, secondary, and situational.

Women majorly acquire global vaginismus after their first intercourse. It demonstrates that suffering was always present. Secondary vaginismus happens after a woman has had normal sexual intercourse. This can occur as a result of a specific event, such as an infection, menopause, or delivery. Situational vaginismus arises in specific circumstances such as inserting a tampon which may not be so painful, but penetration from the penis, which can be fairly painful.

Who is at risk? What are the factors that make women prone to Vaginismus?
Pratima: Vaginismus symptoms may occur when a person has sex for the first time in their late teens or early adulthood. The problem can also occur the first time a person attempts to insert a tampon or gets a pelvic analysis done in the office of a healthcare professional.

Later in adulthood, some women acquire vaginismus. It can happen after several years of experiencing no discomfort too! Spasms or pain may occur whenever vaginal penetration occurs. You may also only experience them at particular times, such as during sex or pelvic examinations.

Healthcare professionals are baffled as to why certain people have vaginismus. It can lead to physical, psychological, and sexual problems. Bladder infections, urinary tract infections, and yeast infections can aggravate vaginismus discomfort. The following factors may lead to vaginismus:

1. Anxiety

2. Vaginal rips

3. Undergoing surgery

4. Fear of sex or unpleasant sentiments about sex, maybe as a result of sexual abuse, rape, or trauma in the past

What are the causes and symptoms of Vaginismus?
Manish: Doctors don't know the exact cause of vaginismus. The fear of having sex or stress is usually linked to it. However, it's not often clear, though, which came first: the vaginismus or the anxiety. Some women display vaginismus in all situations and with all objects. Others only occasionally go through it. Two additional health problems that can make sex difficult are infections and dryness. It's crucial to visit a doctor to determine the cause.

Pratima: Below mentioned are the symptoms of acquiring Vaginismus:

1. Dyspareunia, or painful sex, is a major indicator of vaginismus. The pain occurs during penetration only
2. Intercourse feels scorching or like the penis is "hitting a wall"
3. Stinging and burning sensation during intercourse
4. Numerous vaginismus sufferers also experience pain during tampon insertion or pelvic checks
5. Loss of libido and fear of intercourse

Pratima recommends that if you have painful sex or experience pain while inserting a tampon, you must visit a doctor.

How is the condition diagnosed?
Manish: Your symptoms, medical history, and sexual history will reveal insights about the underlying condition. A pelvic examination is performed to check for any additional medical issues that might be painful. Before you can handle the exam, you might require some treatment. Your doctor will work as gently as slowly as possible while explaining every step they take.

Pratima: Your doctor will inquire about your symptoms as well as your medical and sexual history. A pelvic exam can help rule out other issues as well as establish the existence of muscular spasms. To make the exam more comfortable for you, your physician may administer a topical numbing lotion to the exterior of the vagina before the exam.

What are the treatments available to cure Vaginismus?
Pratima: Vaginismus therapies aim to reduce the muscular response that causes them to tighten. Anxieties or concerns that lead to vaginismus are also addressed in treatments. Below mentioned are the treatments for Vaginismus:

1. Topical lidocaine or formulated creams may help relieve the discomfort associated with this illness
2. Physical treatment for the pelvic floor: A physical therapist will teach you how to relax your pelvic floor muscles
3. Therapy with vaginal dilators: Vaginal dilators are tube-shaped devices that come in a variety of diameters. Their main function is to stretch the vagina. Dilators are used by people with Vaginismus to become more comfortable with, and less sensitive to, vaginal penetration. To make insertion simpler, your provider may consider putting a topical numbing ointment on the exterior of the vagina beforehand.
4. Cognitive behavioural therapy (CBT) teaches you how your beliefs influence your emotions and behaviours. It works well for anxiety, sadness, and post-traumatic stress disorder (PTSD).
5. Sex therapy: Trained sex therapists work with individuals and couples to help them reclaim their sexual enjoyment.

Manish: Women with Vaginismus can control and relax their vaginal muscles using at-home exercises. The purpose of this gradual desensitisation procedure is to acclimatise oneself to insertion.

1. Start by using the same muscles that you use to stop the flow of pee during Kegel exercises
2. Squeeze the muscles
3. Hold them for 2 to 10 seconds
4. Relax the muscles
5. Do about 20 Kegels at a time

Throughout the day, you are free to practise them as frequently as you like. For females with vaginismus associated with fear or anxiety, therapy often helps.

What are the myths around vaginismus?
Pratima: There are a variety of myths associated with Vaginismus:

1. Vaginismus will simply disappear without therapy
This misconception discourages women from getting help. Remember that spasms are involuntary and that a woman has no control over them. This type of spasm might be caused by psychological or physiological factors.

2. Vaginismus is a condition that affects women whose partners are well endowed
No, having a physically attractive spouse has nothing to do with your vaginismus problems. The vaginal muscles constrict, leaving little room for penetration, which is especially problematic if your partner has a larger shaft size.

3. Pain is typical during sex
We desire pleasure from sex rather than suffering. Sex is not intended to be painful. It's one of the few things in life that should always feel pleasant. So, don't fall for this misconception. If you believe you are suffering from this condition and that no amount of foreplay or relaxation is assisting you in consummating your relationship, reach out to a sexologist.

Why is painful sex normalised for women?
Pratima: Vaginismus carries a lot of stigmas because it is considered a delicate subject. Painful sex for women is becoming more common not only in India but across the world. Women are socialised to believe that they will grow out of unpleasant sex. Women are secretive about their sexual issues. In most circumstances, the spouse is unconcerned about his partner's agony or anguish. Furthermore, it is widely assumed that the male counterpart should be pleased in terms of pleasure.

How can we create awareness about this condition?
Manish: Through discourse and consultation, more awareness can be created on Vaginismus:

Healthy discussion based on sexual conditions
One of the main causes of the lack of understanding regarding vaginismus is the sociocultural normalisation of pain in females during sexual activity. We carry several misunderstandings about sex, and that is the fundamental reason for a dearth of thorough sexual education. Even the discussion of sexuality is frowned upon in our society because of sex. Any person, regardless of gender, has to be made aware of and exposed to sex education. A key step that should be made to raise knowledge of sex and related conditions like vaginismus is sex education in schools.

Consultation and treatment
Vaginismus has been successfully treated with counselling. It entails knowing more about the anatomy of the human body and the changes that take place during sexual activity. Additionally, it could aid in healing from any emotional trauma that might be producing vaginismus.

Pratima: Although vaginismus is curable, those who are unaware of the problem are unaware that it is treated in the same way that any other medical issue is. In our nation, a lack of public understanding about vaginismus, along with shame and fear of social judgement, makes it difficult for people to address it among themselves or with a doctor. Sex education in schools is an important step towards raising understanding about sex and associated problems such as vaginismus. We must commit to being more honest about our bodies and sexual experiences so that individuals do not suffer alone in silence, experiencing the agony and anguish of disorders such as vaginismus. The discussion of sexuality can be solved by mainstreaming it.

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