Vaginal health: Why does your vagina clam up and how does it impact your fertility?

“This is not a freak case, just that it is unreported but affects many young girls, who are routinely dismissed as frigid. This condition is called vaginismus, which is the body’s automatic reaction to the fear of some or all types of vaginal penetration. The vaginal muscles just tighten and clam up on their own and the patient has no control over them. Sometimes the condition can develop even later in life. But the psychological fallout is immense as it prevents the woman from developing intimate relations with anybody,” explains Dr Rodrigues.

So what causes this condition that many patients are still themselves embarrassed to talk about? “There is not one definitive reason but the condition is often reactive and a kind of phobia. It is the result of anxiety disorders, vaginal tears and injuries early on in life, prior surgery, fear or negative feelings about partner intimacy because of past sexual abuse, rape or trauma. In post-menopausal women, vaginal atrophy can happen because the lining of the vagina becomes thinner and drier,” says Dr Rodrigues. “There may be secondary causes like scarring or radiation therapy,” she adds.

Alina had no history of abuse but had psychological barriers and a very low pain threshold that caused her to clam up. “Yet she wanted a baby and her husband, a photographer, decided to approach us. He became her pillar of support and was present throughout her initial medical examination. Her medical examination revealed no physical abnormalities. Slowly, we came to know that she felt alone in a joint family as her husband travelled extensively on job assignments. She withdrew into a shell which complicated her condition further. Yet with her husband around, she seemed open to the idea of physical manipulation by the doctor. So her phobia essentially stemmed from a lack of companionship that didn’t create a conducive atmosphere of trust for initiating physical intimacy even during the brief periods they were together,” says Dr Rodrigues, who had a hard time normalising Alina.

“She hyperventilated during the initial exam and was diagnosed with primary vaginitis. She screamed during the exam. First we began with dilation and tried to reduce the reflex response of her vaginal muscles. Although the patient was extremely anxious, she was cooperative when the catheter was inserted. One good thing came out of this. She became a little less sensitive to the idea of penetration. Then we counselled Alina and her husband, individually and together. We resorted to cognitive behavioural therapy and had the counselor and the gynaecologist work together. Meanwhile the pelvic physiotherapist started to break her fear and help her touch her own body. Slowly, we were able to make progress and now after about a year of therapy and monitoring, we can say that she has conceived naturally,” says Dr Rodrigues.

So what does the therapy involve?

Topical treatments: This involves application of creams and lubricants to begin with,

Pelvic floor physical therapy: This involves a round of exercise where your trainer teaches you muscle relaxation exercises that will help you control your vaginal responses.

Vaginal dilator therapy: This again is a manipulation device to stretch the vaginal muscles and make them more comfortable with the idea of vaginal penetration.

Cognitive behavioral therapy (CBT): This helps in dealing with anxiety, depression and any kind of post-traumatic stress disorder (PTSD) and trains your mind to overcome fear.