“Is it a disease? Does it have a cure?” 

Confusion washes over Esther as she is informed about the reason behind her struggle with sex – a sexual health condition called vaginismus. The protagonist in the Netflix show Unorthodox is unable to consummate her marriage and finds herself under enormous societal pressure. But she has no real information to navigate her inability to perform penetrative vaginal sex.

The character, played by Israeli actress Shira Haas, comes close to Lily, portrayed by Tanya Reynolds in Sex Education. Both are teenagers living in vastly different settings. Both have vaginismus.    

Vaginismus is a psychosomatic condition in which the vaginal wall involuntarily tightens due to fear of penetration, making it impossible or accompanied by unbearable pain. 

Or, as Reynolds explained in an interview: “It’s where your vagina is a couple of steps ahead of your brain, and your brain thinks you want sex, and your vagina is like no, you don’t, and your vagina seizes up and you can’t get anything in. Not a tampon, not a finger, not a penis.” 

Many women describe it as “hitting a wall” or “having no vaginal opening”. 

Today, September 15, is Vaginismus Awareness Day. Let’s look at the reasons, myths and treatments concerning this sexual health condition.

Why does it happen?

Our bodies keep track of both pain and pleasure, never forgetting the experiences. The experiences that seem particularly threatening resurface at the slightest trigger.  

Similar psychological factors cause vaginismus – categorised as primary and secondary vaginismus. 

Primary vaginismus is when a woman has never been able to allow vaginal penetration. The condition persists from the get-go. In secondary vaginismus, a woman who was earlier able to allow vaginal penetration is suddenly unable to do so.

Sociocultural notions around sex are usually linked to sanctity and moral values. For most people, it is also synonymous with pain to the extent that often painful penetration is not questioned and just accepted as a part of sex. These significantly contribute to primary vaginismus cases, apart from sexual abuse, religious upbringing preaching to abstain sex and sexual ignorance. Anxiety, fear and stress also have a huge impact. 

Esther’s case in Unorthodox is an example of primary vaginismus. She is unaware of her own anatomy and suffers from sexual ignorance, having been brought up in an orthodox household. She is ‘educated’ about sex a day before her wedding. Her sexual ignorance combined with anxiety and fear ostensibly becomes the main cause of vaginismus for her.

The triggers for secondary vaginismus could be traumatic childbirth, painful internal examinations, infection, radiation, surgery, or a combination of factors. Each woman with vaginismus has her own reasons and story. But they all suffer from a sense of guilt, question their self-worth, and feel lonely in their journey.

In India, the number of women dealing with vaginismus is largely unknown due to the stigma associated with sex and sexual health conditions. The numbers are difficult to estimate as data depends on women who seek treatment and many remain unaware of vaginismus even if they suffer from it.

Myth of ‘pain is normal’

Sex is often portrayed negatively and associated with pain, fear, and guilt among women. These notions are further exacerbated in conservative societies due to a lack of sexual education and understanding of one’s own body.

For Esther, as the news of her being unable to consummate her marriage reaches her community, a stream of women knock on her door with advice. While all of them tell her about the ways to ‘please’ a man, her words – “it hurts” – fall on deaf ears. The ultimate goal and her only duty seems to be just one, procreation. 

This is not far from the reality faced by many women. Most of them approach gynaecologists for help to save their relationship, or feel accepted, or have a child. They strive to fulfil their duties, but not heal themselves.

Besides the emphasis on duty, a myth that also prompts this behaviour is that ‘pain is normal’. Women are ingrained with the idea that pain related to menstruation, endometriosis, vaginismus or vulvodynia are common, and this keeps them from accessing healthcare.

Meanwhile, a singular common advice on gynaecological issues from family and even some doctors is that ‘marriage and childbirth will solve it’. Such remarks leave women disappointed and discourage them from seeking help.  

Women need to acknowledge their sexual health issues and be open about them, at least with their healthcare providers. However, Indian society has remained far behind in creating a safe space for women to open up without being shamed or judged. 

Lack of awareness in medical community, treatment

With the term ‘vaginismus’ missing from medical textbooks, many gynaecologists remain unaware of the condition and its treatments. While psychologists, psychiatrists, and sexologists are likely to be better equipped to provide the treatment, more women approach a gynaecologist first, and some even end up being ill-advised.  

The lack of awareness about vaginismus in the medical community also leaves women hopping from one doctor to another in search of suitable treatment. Doctors said women with vaginismus take about three years on an average just to get diagnosed, navigating through sexual ignorance and misinformation. 

Vaginismus can be treated through therapy, relaxation exercises, and vaginal dilators. The patient is first advised to speak to a therapist to understand the cause of vaginismus and detach the idea of pain from penetration.  

The relaxation techniques, meanwhile, focus on both body and mind. These include breathing exercises to ease anxiety and relax vaginal muscles and pelvic floor exercises to help gain control of the vaginal muscles. The vaginal dilators further help women to train their minds and vagina to relax and get acquainted with the presence of an object at the vaginal opening. The dilators come in different sizes. The women are advised to use the smallest size first and eventually graduate to the largest.

Botulinum toxin or botox is another treatment option for vaginal muscles. But with vaginismus being a psychosomatic disorder, a multidisciplinary approach to treatment is preferred by most doctors. In over 90 percent of cases, a multimodal approach successfully treats the symptoms, as per a research published in the US government’s National Library of Medicine. Most of the treatments, especially dilators, coupled with patience and persistence, improve the condition.

Sex education beyond schools

Despite being one of the most populous countries in the world, taboo around sex has persisted in India. And the common belief that pain during intercourse is normal for women gives an insight into it.

In the face of backlash from parents, religious organisations and political leaders, even though sex education is now a part of school curriculum, its ambit is usually restricted to contraception and STIs. The concerns related to sexuality, pleasure, and managing sexual dysfunctions are often overlooked, making it crucial to address these aspects of sexual health at home.

A positive and structured approach towards sex education at schools and home is imperative to help future generations understand sexual health and make conscious and informed decisions.

The Science Desk is a collaborative effort between Newslaundry’s subscribers and its editorial team.