The body remembers what the mind forgets. Psychosomatic conditions like vaginismus are evidence of how our thoughts and our beliefs can manifest in our physical functioning and linger like an invisible wound.
The first time I heard about vaginismus was when my friend confided in me and shared her experience of unbearable pain while trying a menstrual cup. After unsuccessful trips to a gynaecologist and a lot of research, she figured that she might have a condition called vaginismus. In a country like India, where menstruation largely still remains taboo, vaginismus is barely acknowledged in conversations about female sexual health.
Hitting a wall
“It felt very much like there was no vaginal opening and that I was hitting a muscular wall. Impenetrable, without a doubt”, says Tanvi Singh, an educator. Vaginismus causes involuntary contractions of the vaginal muscles making penetration of any kind; sexual or otherwise impossible or accompanied by excruciating pain, irrespective of the woman’s desire. “It is simply a protective body response”, says Taru Jindal, a Mumbai-based gynecologist who runs an online vaginismus healing program with Bengaluru-based healthcare platform Proactive for Her.
Vaginismus can be classified into two types – primary and secondary . It is said to be primary when a woman has never been able to engage in penetration of any kind; be it either tampons, menstrual cups, gynaecology exams, or intercourse. It is primarily psychologically driven. We are usually taught “sex is shameful and sex is painful”, says Dr. Jindal. These contribute significantly to primary vaginismus cases. Childhood abuse, sexual trauma, religious upbringing, and sexual ignorance are other contributing factors.
It is said to be secondary when a woman who previously tolerated penetration is suddenly unable to do so. Secondary vaginismus could be due to physical or emotional factors. Repeated painful internal examinations or vaginal infections, traumatic childbirth, radiation and surgery around the vagina, and conflicts within a relationship are the causes of secondary vaginismus.
Vaginismus is estimated to affect 5-17% of individuals in a clinical setting based on studies conducted in the 1990s. The numbers vary across countries. The statistics of women dealing with vaginismus in India are unclear. “I think in a conservative culture, the numbers would be huge”, says Dr. Jindal.
Pain is normal
The general notion that sex is accompanied by pain has been ingrained in women since childhood, in traditional households and many assume that pain is normal. “I used to associate sex with physical pain. I believed that the first time any penetration happened, there’d be some degree of pain. I know now that it is not true”, says Singh.
Sex education occupies the last bench in a corner of the Indian education system which combined with societal silence takes different forms – fear, pain, guilt, shame, and suffering consume Indian women indiscriminately. With no one to guide them, many women suffer in silence. Like heirlooms and folklore, a piece of advice is passed down generationally – it is common, deal with the pain.
This normalisation of pain results in internalisation and acceptance of it. Even more distressing is the fact that most women are told the pain diminishes with time and to just bear it by gynaecologists themselves. “The first doctor [that I met] at a very reputed hospital told me I should just get drunk. It’s in my head”, said Shikha Rao, a corporate employee.
Finding the right doctor is a challenge. Most women on average take around 3 years to get diagnosed with vaginismus.
The right kind of care
According to the National Family Health Survey (NFHS) report 60% of women face problems accessing healthcare. Social determinants like lack of financial autonomy are among the factors which include inadequacies in the healthcare system. The absence of a female health provider was also of concern for 31.2% of women according to the report. Many women also only seek treatment when the pain becomes unbearable.
Many women think twice before approaching a gynaecologist. Many have recounted how they have felt shamed or been given unsolicited advice during consults. Clearly, not all gynaecologists are like that, but such experiences come in the way of accessing healthcare for fear of being judged.
As a gynaecologist with vaginismus, it took Dr. Jindal 7 years to diagnose and heal herself which led her to wonder about the situation of other women. She healed within a month and it led her to create a four-step vaginismus healing program but it was her husband, Dharav Shah, a psychiatrist, who ideated it. It was launched in mid-2020 through Proactive for Her. A program that started with 5 women per batch now has 40 women per batch.
While the few doctors who deal with vaginismus have a single or multi-level approach involving therapy, serial dilators, and pelvic floor exercises, Dr. Jindal’s programme additionally involves support groups for both women and their respective partners and a pleasure coach. Online space ensures privacy and healing from the comfort of one’s home.
The programme begins by addressing one’s emotional ordeal. By pinpointing the source, a therapist guides the woman to reflect on her past and make peace with it. It is necessary for the brain to disassociate pain from penetration. “I think it has to do a lot with my upbringing combined with my anxiety,” says Ms. Rao. “There was a kind of subliminal messaging. It’s not overt, but there is a sense of righteousness.”
Women also bear additional emotional baggage after their failed attempts at penetration. “During attempts at penetration, there is a lot of anxiety, shame, and a sense of being less because the body is unable to do what should have been natural”, says Ms. Singh. This feeling resonates with a lot of women irrespective of their stories.
The women are then introduced to the support group. Turns out the core strength of the program is the women’s support group. “You work as a community and heal as a community but at an individual’s pace”, says Mukta Mohan, who works in an NGO. Questions of self-worth and the sense of isolation disappear when women realise they are not alone and it isn’t their fault.
Apart from healing emotional trauma, learning to relax the mind and listening to the body is crucial. The programme involves the mind and body and pelvic floor relaxation exercises to help relieve tension around the pelvic area. Once women have control over their pelvic floor muscles, vaginal dilators are introduced. There are dilators of different sizes, one starts with the smallest one and proceeds to the largest.
With an increase in the number of participants, Dr. Jindal realised many of them came with different goals – to either get pregnant, save their marriage, or feel accepted. There were hardly any women who came with the intention to ‘heal’ themselves. It was then that a pleasure coach was introduced who focused on teaching women that sex is pleasurable.
The programme also provides partner support groups facilitated by Dr. Shah. It helps them talk about their own frustration, understand what women with vaginismus go through, and realise that other couples are experiencing similar situations, removing the self blame aspect. Support groups offer a sense of community and belonging in such cases.
Holistic approach successful
The integrated approach of the intervention has proved to be a success. “It’s an excellent approach,” says Jayashree Gajaraj, a senior consultant at MGM Healthcare, Chennai, who is not involved with the programme . “Approaching it holistically is important and that is what she [Dr. Jindal] is doing”.
Since its inception, it has evolved, taking feedback from women who healed and incorporating different methods of healing like art and movement therapy in their recent batches. As of September 2023, around 370 women have been a part of the programme and they claim that 217 have healed completely. While most women heal within an average of 6-12 weeks, some continue the process of healing after the programme.
By the end of the course, women not only heal from vaginismus but also experience personal growth. “I was able to accept, with this programme , that I am strong but there is a part of vulnerability also in me”, says Ms. Mohan.
Vaginismus can be treated. Women need to take the first step of reaching out. “They need to understand that there is no need to suffer”, says Dr. Gajaraj, “Sexuality is very much a part of life whatever the age.”
The limited sex education that India entertains is fear-based and centered around reproductive health more than sexual health. Lack of awareness is one reason that vaginismus remains one of the most under-researched female sexual health disorders despite its prevalence. We need to initiate open dialogues around sexual health, inculcate age-specific sex education, and introduce government schemes that explain sexual health in regional languages, experts say.
(The author is a freelance content provider based in Hyderabad)