Pakistan: Karachi When Laiba*, a 29-year-old Karachi resident, visited a seasoned and well-respected gynecologist, she was informed, “Your husband is going to leave you,” or “mark my words.” Those words are still fresh in Laiba’s mind, now 34. The choice of words did not have a profound impact; It was her tone, her complete lack of compassion for me, and the shame she intended for me to feel. Laiba relates how she remained frozen and unable to express her worries.
“Jo aurat apna basic kam nah ker paye” means “a woman who is unable to fulfill her basic responsibilities.” I recommend that you mature and stop acting like a silly schoolgirl.
Laiba had to mentally prepare for another appointment with a gynecologist for almost another two years. She says, “My mother kept reassuring me that my husband would do no such thing as I sobbed in the waiting room and then in the car on the way home,” as she recalls leaving the clinic in tears. Although I was aware that my husband would not leave me, I was unable to convince my mother that he was not the problem. To tell you the truth, it had taken me a whole year to find the strength to talk about something that made me feel so ashamed. Before seeing another gynecologist, she waited another two years. I recall enquiring about her kindness from a friend who had met her. What do you think? That is the bare minimum that I had anticipated.
After listening to Laiba’s story about her life since her marriage, the second doctor examined her and diagnosed her with vaginismus. I felt such relief. I mean, it’s strange to hear someone relieved when they find out they have a serious medical condition; however, “I felt so alone and I finally received validation that there was a term for what I had and I wasn’t alone in it,” Laiba reminisces, bursting into tears of joy.
So, exactly what condition was Laiba given? The NHS defines vaginismus as a condition in which the vagina suddenly tightens when you try to insert something. It can be treated, though it may be distressing and painful. Women in their late teens to early 30s are most likely to experience vaginismus, but anyone with a vagina can experience it.
A comprehensive explanation of this condition is provided by consultant obstetrician and gynecologist Dr. Mala Jitendra Shahani, who practices at Karachi’s Altamash General Hospital. Dr. Shahani claims that vaginismus manifests itself as an automatic and uncontrollable response to attempts at penetration. The woman has no conscious control over the tightening or spasm of the muscles around the vagina. This completely involuntary reaction only occurs when something is inserted during sexual activity.
Dr. Shahani notes that she frequently sees women in her practice who employ a variety of approaches to managing this condition. They don’t have any problems using menstrual cups, tampons, or other devices. However, the involuntary muscle contractions continue during sexual activity or other forms of penetration. This condition, known as vaginismus, is characterized by reflexive, unintentional muscle spasms that make the experience of penetration more difficult.
Why does this occur?
Dr. Shahani defines vaginismus as a psychosomatic response, or mind-body interaction. The vaginal muscles contract and spasm as the body anticipates pain upon penetration. This can occur for a variety of physical and psychological reasons, but it is mostly psychological and frequently stems from societal stigma regarding sex.
Sex and having sex are taboo subjects in many cultures. Dr. Shahani explains that many girls’ first impression of sex is of something unpleasant and painful. Our mothers, grandmothers, sisters, and other relatives frequently discuss this subject in a very negative light, which psychologically embeds discomfort and pain in the first impressions of intercourse that many young girls have of it.
“Almost every woman, to some extent, experiences this, but some overcome it while [for] others [it] persists,” according to Dr. Omema Akhtar, a consultant gynecologist at the Jinnah Postgraduate Medical Centre in Karachi. She explains that “roughly speaking, in every two clinics, one patient presents with a history of vaginismus,” despite the absence of statistical data. The doctor emphasizes that effective treatment is not particularly difficult.
She thinks about vaginismus to erectile brokenness — neither of these circumstances are in the control of the individual experiencing it. Dr. Akhtar adds, “If someone struggles to overcome this problem, there is nothing to be ashamed of.” This is not the woman’s fault because it was unintentional and out of her control at the time.
A study that was published in the Journal of the South Asian Federation of Obstetrics and Gynecology estimates that between one and seven percent of people worldwide suffer from vaginismus. The current prevalence of vaginismus in the US population ranges from five to 17 percent in clinical settings. 20 percent of Egyptian women exhibit vaginismus, according to studies. According to the study, no prior research on vaginismus had been done in India. It surveyed 160 married women in Karnataka, India, and found that 30 percent had secondary vaginismus and 28 percent had primary vaginismus.
Dr. Akhtar estimates, based on her own experience, that approximately one in twenty Pakistani women suffers from vaginismus. There is no official data on the number of women affected by the condition outside of a few limited studies.
In Pakistan, sex and pleasure discussions are rarely healthy. Sex is frequently depicted as filthy, taboo, and associated with tearing, bleeding, and pain. Fear and apprehension regarding sexual experiences can result from this negative portrayal.
“Cultural and religious backgrounds contribute to the development of vaginismus,” says Samia Khan, a licensed professional counselor, licensed marriage and family therapist, and certified sex therapist with her own practice in Wisconsin, USA, called the Whole Hearted Wellness. The basic idea is that our mind and body are inextricably linked, especially when it comes to feelings and physical sensations. We internalize the belief that intimacy is something we should either avoid or not engage in when society communicates messages that make it taboo. Because of these ingrained perceptions, when we are married and ready to be intimate with our partner, we may struggle.
She goes on to explain that our minds have been conditioned to think that intimacy is bad, dirty, or inappropriate for girls, which is why our bodies say “no.” Consequently, our body physically resists these internalized beliefs, resulting in pain and muscle spasms that prevent penetration. She thinks that these things can definitely make vaginismus worse.
In the meantime, Dr. Shahani points out that this fear can be significantly exacerbated by previous trauma from sexual assault or rape.
Misha*, 36, says, “I grew up in an environment where the burden of sexual abuse was placed on the victim.” She reflects on the sexual abuse she experienced as a child. I chose to ignore the trauma despite the fact that I knew deep down that it wasn’t my fault. Intimacy was a struggle for me after my marriage; Every time there was a breach between us, my husband had the impression that there was a barrier he couldn’t break through. After consulting with a surgeon, I was informed that I had vaginismus. At first, I thought I had a physical defect. Misha is grateful that she was able to relocate to the United States following her marriage because her diagnosis was made there. She is aware that she probably would have received little to no support if she had remained in her hometown of Gujranwala.
However, despite the fact that sexual assault or abuse can exacerbate the condition, it is not the only cause.
Anum*, 27, recalls her gynecologist’s dismissal of her vaginismus diagnosis. She insisted that I had been sexually abused as a child, but I had either denied or repressed it. I didn’t, but she wouldn’t buy it, so I switched doctors until I found someone who knew this wasn’t something I could control and wasn’t a result of abuse.
However, how does one find out that they have a condition about which no one wants to talk? We search everything online, don’t we? Everything, from making pancakes to repairing the geyser. Therefore, this was very natural,” recollects Ayesha*, a teacher of algebra. All I had to do was type in “fear of penetration,” and I was shown not only the term vaginismus but also a whole community that was eager to help. However, I had a hard time culturally connecting with these white people who were surprised that I had lost my virginity at the age of 25 and had never explored my body in any way.
That’s when Ayesha realized she needed people who could talk to her in a language and culture where she wouldn’t have to struggle nearly as much and understood her problems. It is a privilege for me to be able to Google everything, even things about which I would be ashamed and wouldn’t even tell my husband. My sympathies go out to our mothers who had to deal with life without this extremely useful tool.
The road to recovery Penetration-related anxiety can exacerbate the condition. Physical therapy to relax the pelvic floor muscles and psychotherapy to address any underlying anxiety or fear are frequently used in vaginismus treatment options.
Counselor Khan believes that by working to relax and exercise the pelvic muscles, a physical therapist who specializes in pelvic floor therapy can assist with the treatment of vaginismus. When psychological effects or past traumas, like sexual abuse as a child, cause muscle spasms and physical blockages, this can be especially helpful. We can better manage the guilt and shame that are common in our culture by making these treatments more common and making more resources like these available.
Dr. Shahani clarifies, “In medical terms, when physical factors are involved, we refer to it as dyspareunia, not vaginismus,” when considering whether vaginismus is psychological or physical. Vaginismus is primarily characterized by muscle contraction. When physical factors are present, the term “dyspareunia” is used to describe pain during sexual activity. Vaginismus, on the other hand, is primarily psychological, with psychological causes frequently at the root.
Discomfort and pain can be caused by physical factors like previous childbirth or conditions like vaginal lesions, tumors, atrophy, or narrowing, but these are usually secondary to the primary psychological causes. During an attempt to penetrate, vaginismus may cause muscle spasms, and occasionally hymenoid abnormalities may also be involved.
Dr. Shahani uses a multidisciplinary approach to treat vaginismus that sometimes includes pain management from a neurosurgeon, sex therapist, psychologist, and physiotherapist. Topical gels can numb the pain, while muscle relaxants in the form of an ointment or Botox injections can relax the muscles. Depending on the patient’s history and condition, anti-anxiety medications prescribed by a psychiatrist may also be beneficial.
Khan is also of the opinion that there is no one treatment for the condition. Psychotherapy or talk therapy might not be enough on their own. Both the mental and physical aspects of these conditions can be addressed through its combination with pelvic floor physical therapy.
The goal of pelvic floor therapy, in contrast to talk therapy, is pain management and muscle relaxation. According to research, vaginismus is not just psychological; It involves genuine physical pain and muscle spasms that require mental and physical treatment.
Dr. Shahani uses vaginal dilators, starting with the smallest size, as part of his physical treatment plan. In the clinic, she often tells the patient’s partner to help with dilation because some patients feel more at ease with their partner’s support.
Because candles come in a variety of sizes and the wax is typically gentle on the skin, Dr. Shahani suggests using candle sticks instead of costly silicone dilators.
She emphasizes the importance of having a partner who is supportive in overcoming vaginismus. The doctor has noticed that, if the condition is not treated well, some couples may split up or divorce. It can take up to three years for some couples to successfully manage penetration, so patience is essential.
Dr. Akhtar concurs: The treatment of vaginismus can be hard if there is no partner who can help. I’ve seen patients whose partners had no idea what was going on. After coming to us for vaginitis treatment, these women were able to insert dilators on their own. But when their partners came up to them, they couldn’t let it.
When there is no mental or emotional understanding, how can they? How can a woman feel ready to allow her partner to be intimate when their relationship lacks fire? Because of this, treatment for vaginismus frequently involves both partners; it is a treatment for a couple. After treating vaginismus, couples counseling and participation are highly recommended by doctors.
Hamnah*, who is now 33, divorced when she was 21 years old. I divorced at a young age. I was married to a family friend who was 11 years older than me. I had never spoken to a boy, let alone had any idea of physical intimacy, prior to my wedding night. I wasn’t used to people of the opposite gender, so I wasn’t sure what to expect.
He coerced me the night of the wedding. I broke my hymen in the most painful way possible, and I was so traumatized that I refused to let him touch me after that. I would start shaking and crying whenever he would get close to me, to the point where my in-laws got involved. He dropped me off at my parents’ house after this ordeal lasted for six months and sent me divorce papers before I turned 22. Hamnah hasn’t married again.
There is still a lot to learn about women’s bodies, particularly in the areas of reproductive health and female genitalia. Doctors have long dismissed symptoms associated with menopause and menstruation. Don’t forget about the medical fascination with female hysteria in the 19th and 20th centuries, which kept women with likely mental health issues out of society. Gender bias has harmed research for far too long, with studies focusing first on male participants and then on female ones.
About vaginismus and the physical and psychological effects it has on women, there is still a lot to learn. Many suffer in silence and shame in a nation where mental health care is considered a privilege for a select few.
Vaginismus is a frightening and lonely condition. It isolates sufferers, and when they seek assistance, they frequently encounter shame and silence. It comes as no surprise that we are burdened with trauma and unspoken emotions in a culture that restricts women’s bodies to roles of enduring pain and delivering pleasure. We are unsure of how to let go of these feelings that build up in the tucked-away spaces between our hips. Qurat, 31, who is 31 years old, says, “I have been in clinical and physical therapy both.” I felt invincible after getting a pap smear a month ago. However, I was unable to obtain an internal ultrasound a week later. I have witnessed individuals “curing” vaginismus, but I suppose everyone is on their own journey. My relationship has gone through a lot of ups and downs, but I just need to keep reminding myself that this doesn’t make me a bad partner or woman. No one else will be kind to me if I don’t treat myself well.
