There were two couples in the waiting room. One was young, in their mid-twenties, shiny new wedding rings showing their newlywed status. The other couple were middle aged. The business suit and neatly pleated sari suggested that they were the ones with the BMW in the car park. The young couple identified themselves as Irene and Sunil and walked into the consultation clinic.
The story was a familiar one. They were both twenty four. They met in second year at university. It was love at first sight. Both from conservative Buddhist Sinhala families, the parents approved of the match. Knowing that they could not get married till he had acceptable employment, they kept their love making to kisses and cuddles, looking forward with great anticipation to their wedding night.
‘I read lots of Mills and Boon books doctor,’ Irene’s eyes lit up. ‘I thought it would be wonderful... and just happen.’ Sunil clasped her hand in his. ‘My parents never talked about it with me. I talked with my friends, but I am the first to get married. They said it would hurt; one had a cousin who went to hospital after the first night. But they were talking about arranged marriages, and I thought it would be alright for us because we were in love.’
Sunil, took over, ‘We had touched and kissed before, even seen each other without clothes, so we were not shy or anything,’ he said in response to my request to tell me what exactly happened on that first night. ‘Irene was happy, she got excited and was... was wet down there,’ he blushed. ‘I was also ready.’ I restrained a smile as he unconsciously gestured an erection with his hand. ‘But when I tried to put it in, Irene screamed and pulled away. I stopped, but she wanted me to keep trying, so I did. But she was in so much in pain’
‘It’s all my fault,’ Irene sobbed.
Having reassured them that sexual difficulties were a couple concern and never one persons fault, I signalled to Sunil to continue. ‘I kept trying, but... but it was like hitting a brick wall!’
‘And,’ Irene cut in, ‘I didn’t bleed. Fortunately Sunil’s parents didn’t expect us to show the blood stained sheet to them. I wouldn’t have been able to prove that I was a virgin.’ I hastened to reassure them that less than fifty percent of girls bleed with first intercourse.
Sunil and Irene didn’t consummate their marriage during their honeymoon. Two weeks of trying to had exhausted them both emotionally and sexually.
What is the problem? And how is it managed?
The condition is called Vaginismus. It is the commonest cause of unconsummated marriages.
In Vaginismus the muscles around the vagina go into involuntary spasm. The spasm closes it to the entry of the penis, or even a finger, often making a vaginal examination impossible.
I confirmed this when I tried to do an examination. Irene was not able to even separate her legs, much less allow me to touch her genitals.
Irene and Sunil are typical of couples I see with Vaginismus. Young virgins with little knowledge of what their genitals look like or how they function. With no formal sex education at home or school, they have picked up information from friends, magazines and sometimes even pornography. Sometimes there is a history of some sort of unhappy or abusive sexual experience. But this was not the case in Irene. Couple this with a loving but uninformed young man – and we have the scenario set.
The best management for Vaginismus is a combination of methods, under the instructions of a therapist, counsellor or doctor.
The first and most important is reassurance that the condition is common and education of the structure and function of the genitals and how the male and female body work when sexually aroused. This way the scene is set for realistic lovemaking, not the unrealistic fantasy of erotic novels or porn.
Management includes:
Sexual pleasuring exercises (also called sensate focus), instructs couples to refrain from intercourse and learn to pleasure each other and communicate – working up to intercourse in a leisurely pace. This transfers the focus from pain to pleasure.
Pelvic muscle training is a mainstay of management of Vaginismus. In this couple I used exercises that made Irene recognise her pelvic muscles and control them.
Plastic or glass dilators come in many sizes, from smaller than the little finger to the size of an erect penis. Irene was able to insert the smallest after her second visit. I also encourage the use of the finger as a dilator.
Above all, the couple need support and understanding that they need to relax and take their time. Counselling is the mainstay.
Irene and Sunil came to see me weekly for six weeks. Their sparkling eyes on the sixth visit told me that they had consummated their marriage.
What of the older couple in the waiting room? That’s for our next episode.
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