FOR most women, sex is a pleasure-filled experience that they look forward to; for others, sexual encounters can be downright painful and frustrating. One of the possible culprits, according to obstetrician-gynaecologist Dr Robyn Khemlani, may be a female sexual pain disorder, Vaginismus.
“Vaginismus is defined as a recurrent or persistent involuntary spasm of the muscles of the pelvic floor surrounding the vagina, which interferes with sexual intercourse and that can subsequently lead to interpersonal problems and marked distress for the patient and her partner,” Dr Khemlani explained.
She pointed out that the condition, which is both an emotional and pain disorder, affects the muscles of the pelvic floor surrounding the vagina. She said that what happens in the woman is that the vagina tightens up on its own as you try to insert something into it.
“Patients can find it hard to insert a tampon into the vagina and may struggle with vaginal penetration during sex as they will experience pain on vaginal entry. However, for other women, vaginismus is situational and is limited to sexual activity only. As such, the woman is able to tolerate tampons or insertion of fingers, whereas in others it is related to fear of a pelvic examination,” Dr Khemlani explained.
She said that a number of factors can contribute to the condition that affects millions of women globally. However, she notes that the condition remains under-reported, especially since women do not talk about what they are experiencing.
“Many different factors could contribute to this, including anxiety, genital and sexual trauma or abuse, traumatic examination, or it may be linked to certain gynaecological or medical disorders, an infection, or the use of certain of medication. There is no specific test to diagnose this condition, but rather the diagnosis is made based on the patient's history and on examination your doctor may be able to feel the muscles around the opening of your vagina tighten during an exam,” Dr Khemlani advised.
Once diagnosed, the doctor will decide on a multi-faceted therapeutic approach that is tailored to the particular needs of the patient.
“To manage the condition best, professionals such as sex therapists, psychotherapists and physical therapists will all have a role to play. Management of this condition involves desensitisation techniques to give the woman control over muscle tone and relaxation — this process will include encouraging the woman to engage in activities such as kegel exercises, other pelvic floor techniques (physical therapy), and use of dilators,” Dr Khemlani instructed.
With the dilators, she said that the woman will self-insert them; gradually increasing size in and out of the vagina, which will help to teach that control of the muscles of the pelvic floor surrounding the vagina can be voluntary and painless. While using these dilators, numbing medication can be used so they cause less pain.
In the event where the cause of the condition is linked to psychological triggers or if the patient has some history of psychological trauma, for example if she was raped or an attempt was made to rape her, then Dr Khemlani said psychotherapy will be crucial to the treatment plan because it helps the patient emotionally and physically.
Dr Khemlani also recommends that both the woman and her partner should see a sex therapist because it is important that they understand what is happening. A common component of these sessions is relaxation techniques since these will help the woman to relax before sexual intercourse.
Medicinal treatments may also be given for any medical condition that is causing pain, like an infection or skin irritation.
Dr Robyn Khemlani operates from 10A Parkington Plaza/ 129 Pro/ Westminister Medical Center / Oxford Medical Centre, Kingston. She can be contacted at firstname.lastname@example.org.