I first published this piece in Metropole Magazine
He [is] on top of me… And then he is thrusting in. It hurts, it hurts so much. It’s almost like I am being torn apart from the inside. I look into his face… those sweet eyes that start to look at me with worry. “Am I hurting you?” he asks. His voice is full of honest concern…
From movies to books to music videos, it is hard to escape it. Two people. A connection- anything from instinctive attraction to money. Clothes coming off. Intense physical pleasure, two persons ravishing each other lost in their passions, their bodies taking over, speaking pleasant things to each other. For the most part, and for many people, this is true. But for women like Mary, whose words open this article, the exact opposite is the case.
“In my last relationship I first hoped that it wouldn't hurt again. But it did. Then each time I thought: "It will hurt. You have to relax. It's gonna hurt anyway. So how can I pretend to my partner that everything is fine? I don’t want him to become anxious too."”
The subject is one that causes Mary visible discomfort. It is easier for her to write out her pain than say it. So she writes, about a condition that has affected every relationship she has had, for years.
The website vaginismus.com describes vaginismus as “vaginal tightness causing discomfort, burning, pain, penetration problems, or complete inability to have intercourse.”
Vaginismus is characterized by involuntary spasms of the pubococcygeus (PC) muscle- the lower pelvic muscle around the vagina- which contracts tightly making penetration of the vagina selectively or completely impossible or extremely painful. (The PC muscle is the same muscle used when trying to suppress the flow of urine). For some women, this makes things even as routine as using tampons or doing medical examinations like pap smears extremely painful or even impossible. How acute these spasms or reflexes are varies from woman to woman. For some diagnosed with the condition like Mary however, all but penile penetration is possible. In simple terms, everything is fine until a penis is involved in penetration. With Mary, although she had had sex which started with “little pain that didn't last long”, in the last seven years at least, “the pain has been too much to get past.”
The reflexes which cause the closure or contraction of the vagina are similar to those which make us instinctively duck when an object which may not even be close enough to hit us, whizzes past, the sudden jerk when pricked by a sharp object, or the involuntary shutting of the eye when a foreign object comes close. That is our body’s way of protecting us from harm.
According to the Mumbai based Malpani Infertility Clinic website, drmalpani.com, the causes of this condition range “from the physiological to the psychological”. Some of the known causes of vaginismus include strict religious upbringing making it hard to lose the association of sex with ‘sin’, insufficient or faulty sex education, the physical pain associated with losing virginity, physical trauma, witnessing or experiencing sexual or domestic abuse, the fear of not being completely healed following childbirth or other medical procedures, and urinary tract and other infections. Sometimes however, there is no known or identifiable cause.
The prevalence of this condition in Nigeria is hard to tell, because as Dr. S, an experienced Abuja-based gynecologist agrees, many issues of sexual health remain unreported. The culture of silence regarding sex and sexual health, albeit varying according to culture or social class, makes it harder for women living with this condition to seek professional help or even in some cases discuss it with their partners. She finds that couples in the “middle to upper classes” are more likely to seek sexual health treatment together.
Dr. S further explains that in her experience, this occurs a lot with young virgin brides or post-operative patients who have had some work done around the vagina following childbirth or other procedures. She calls it a vicious cycle, explaining that when pain is anticipated by a woman during sexual intercourse, messages are sent to the brain which in turn triggers these conditioned reflexes and spasms which either close up the vagina completely or make intercourse extremely painful for the woman. The physical pain, once associated with intercourse, reinforces these reflexes, causing the whole cycle to happen again.
“It's hard to relax when experience has taught you that the next thing that you will feel is likely to be pain,” writes Mary.
Women with vaginismus may decide to avoid intercourse altogether, sometimes adversely affecting their relationship with any partner they may have.
Most cases of this condition are fully treatable with things like therapy and muscle exercises like the Kegel exercise which help relax and control the PC muscles. It is up to a patient however to seek professional help.
While this may be a condition affecting only women, male partners, especially husbands, need to be involved in at least some parts of the treatment process of vaginismus.
For one thing, it is important for men to think beyond themselves and their own pleasures and be sensitive to the needs and comfort of their partners. Sometimes, just being observant and unselfish during sexual intercourse can reveal that a woman is experiencing pain, in spite of her desire to participate in that activity. The more partners learn about each other’s bodies, the easier it is to provide support when one partner is experiencing discomfort or pain during intercourse. Men can help by joining their partners during hospital consultation or even during treatment like exercises or therapy.
In a publication by the UK’s National Health Service titled “Difficulties With Penetration or Painful Sex? For Women and Their Partners” it is advised that “it is important that you give your body time to react to sexual stimulation …, so that you don’t feel any discomfort during sexual experience.” It goes further to state that “it is also important that your sexual partners understand this, and that they respond to your feedback about how turned on you feel.”
Male partners may also need to keep an open mind to things like lubricants. Mary found this a challenge with her partner who “refused to try lubricants, even though he knew the sex was painful”. Attempting to have sex without vaginal intercourse may help to ease things a bit for the woman and put her body in a better state to attempt penile penetration at a later time.
The connection between sexual health and other aspects of a relationship is not very hard to see. Where there is silence about sexual frustrations, this triggers other frustrations which put a strain on relationships sometimes leading even to the total breakdown of a marriage. Especially in more conservative cultures, women may be discouraged from ‘seeking enjoyment from sex’ by the negative attitudes about sexual rights. If a man considers his wife a partner in a relationship instead of a subordinate or mere bearer of his children, it may be easier for him to assist her get over vaginismus. Mary for example thinks that instead of expecting a woman to get over it, a more helpful attitude might be trying to “get over it together”.
Although she has seen doctors, Mary still struggles with this condition. Because of the negative reaction she has sometimes gotten, Mary has wondered “whether to mention it at all” to prospective partners or “just endure it” quietly. However, this has not done anything to dampen her enthusiasm for the latest treatment suggestion she has received which involves exercises. “It is promising,” she says.
Perhaps the more open we are-- men especially-- with discussing sexual health, the less pressure there will be on women to just quietly endure the kind of treatable pain that vaginismus causes.
*Because of the personal and sensitive nature of the details in this piece, I have changed the names of those I interviewed.