As a psychiatrist I have seen many sad consequences of the negative attitude our society harbours towards sexuality. One such consequence is a disorder which many women & couples suffer helplessly for many years; called Vaginismus.
A woman with this disorder gets intense pain every time she attempts intercourse. Initially both the partners feel that they don’t know the right way to do it and are hopeful that soon they will figure it out. But after few days or weeks of marriage it sinks in that something is majorly wrong.
Ofcourse, with the kind of sexual ignorance prevalent in our society, the couple has no clue of what is the cause of the pain and what is the solution. People they ask for help are equally ignorant. Some of my patients of Vaginismus have been doctors and yet the same story... One of them got advice from her medico friends, “It happens to everyone. It will go away with time. Keep trying.” A senior gynecologist advised another, “Come on. Nothing is wrong with your vagina. You are a doctor yourself. Why are you keeping such an attitude. Just do it!”
The pain is actually because the vaginal muscles involuntarily go in spasm (severe contraction), every time a woman with this problem attempts penetration. Subconsciously, her mind wants to avoid the act. This results in spasm which prevents any penetration. Usually this is seen in women who are from orthodox backgrounds. Consciously, most of them are as excited about sex as other women, at the time of marriage. But the number of negative messages about sex & masturbation they receive during adolescence is so high, that their subconscious gets strongly programmed to regard the act as undesirable; and hence something to be avoided. For some women, stories of how painful sex is or how painful a vaginal examination is leads to the negative conditioning. However, this conditioning is subconscious. Most of them are looking forward to intimate moments with their husband.
This subconscious conditioning can be easily reversed by appropriate counseling and gradual dilatation (by using fingers or vaginal dilators designed for this purpose). However, as most women or people they ask help from are not aware about it, they sincerely continue with the only solution they know – of just doing it. The severe pain which accompanies these sincere attempts further aggravates the negative conditioning. Worse than the physical pain, is the emotional pain of feeling inadequate and insecure. Also there is guilt of not being able to perform their sexual role in marriage. And since the attitudes in our society make them feel uncomfortable in discussing about all this to anyone, their anxiety and stress get bottled up; coming out in all unhealthy ways – blaming others (especially the husband) for various things, irritability over everyone, etc.
With each unsuccessful attempt this stress keeps building up and a belief sets in that this is not solvable. So to avoid any further pain of failure, they start avoiding penetration or attempts to work on this issue. Some tell their husbands, “Accept me as I am unconditionally; otherwise anyways the marriage is not worth it”. Some start treatment but leave it half way, as they find it stressful to think about all this. Some decide to stop treatment as soon as some penetration occurs. By this time, their goal is not sexual enjoyment but just to solve this ‘big problem’. They are eager to get over with it and are happy to take some penetration as a sign of ‘All is well now. No more need to bother about this.’ However, as the conditioning is not reversed adequately pain keeps occurring intermittently and normal sexual intimacy is not established.
Another factor which facilitates avoidance is the cultural belief that sexuality is a ‘cheap’ aspect to our existence (गंदी बात). It is one of the 6 bad qualities of mind which we must strive to overcome. Hence, both the partners often decide to not give Vaginismus too much importance and carry on life as usual. However, frustration soon builds up and unconsciously husband also starts feeling irritated about various aspects of her personality. A volley of accusations and counter-accusations starts: ‘you are not giving enough time’, ‘you are self-centered’, ‘he/ she is very immature’, ‘he/she has no genuine love for me’, etc. In many cases, the couple isn’t even aware that concern about sexual life is the actual reason underlying their frequent fights over trivial issues.
At times husband decides to not bother her as she gets pain and avoids physical intimacy. She feels offended that because there is no sex he doesn’t even want to hug her or kiss her. To express her affection and to feel assured about their bond, she cuddles and kisses. He gets irritated that when they are not going to have sex, why un-necessarily arouse him… Efforts to ignore the issue really don’t help and situation keeps getting complicated.
I also grew up with quite a negative attitude towards sexuality. However, now I have a drastically different view – I regard it to be a gift of God to mankind and all animal species J Certain observations have made me start believing that just as desire to get food or water are biological drives; sexual urge is also a biological drive which is difficult to control beyond a point. A person not getting food doesn’t die. But just as a hungry person may go to any extent to satisfy his desire, a sexually starved person also becomes quite distracted and crazy. When a person with conversion disorder (hysteria) comes to us, the 1st thing we explore for is sexual history… as sexual frustration is one of the most common stressors causing it.
Its interesting to note that many patients of conversion disorder aren’t even aware that they are feeling the sexual frustration. The culturally conditioned mind doesn’t want it; but something within them keeps craving for it badly. For example, there was a saint of a particular religious group who was married; but they were supposed to not get physically intimate as per the rules prescribed for the position he was at in the institution. He used to get severe pain for which he had become dependent on some pain killers. He ofcourse believed that his unexplained pain had nothing to do with his decision of abstinence. Most doctors thought otherwise.
We keep hearing of so many sex scandals involving religious leaders of various religions. How come people who had decided to dedicate their life to society, end up in that situation? In my opinion, that is because most religious traditions have failed to take a balanced attitude to this biological urge. They judged it to be a sin and prescribed rules to suppress it so much that it actually started leading to sins.
Point I wish to make is that you cant expect a person to be at peace if his need for sex is not met. As one of my spiritual gurus said – Sexuality is one of the less important aspects of life but its presence is essential for a happy life; just like many other basic needs eg. food, clothing, shelter, etc. Its said that sexual life has around 20% importance in marriage. But if there is a problem with it, then its influence on marriage become 80%. If a couple tries to ignore the problem in their sexual life, regarding it to be a minor issue, their marriage is bound to fail sooner or later.
In many cases, husband keeps trying to gently encourage her to work on the issue. And she keeps finding reasons why she has no time for it. Avoidance is because of the reasons mentioned above. As extra-marital intimacy is not allowed in our society, he is unable to find any solution to his frustration. His heart yearns to get out of the marriage but can’t as he also understands her struggles and is aware of all her goodness. After few years when the husband can no longer take the avoidance of the issue and talks of separation, she finds it unacceptable that how can he talk of separation over such a trivial thing? She develops a belief that he is just obsessed with sex and doesn’t value all that she has done for him in all these years. This judgement in turn makes the husband develop a belief that she has no value for all the understanding he has shown and for all that he has done for her. Both feel un-understood, rejected and deeply hurt.
Now with a prejudiced mind all the negatives of the other person become intolerable and mind fails to register any positives. Trust leaves the relationship. Over the years their heart is wounded so often that they hesitate to respond to even the friendly initiatives made by the other person. They start fearing other person’s reactions and genuine sharing stops. Being in such an emotionally distanced relationship is at times more painful than separation… and all the blame for this pain is on the partner.
Both develop a view that even if vaginismus gets solved, its not worth living with the other person as the basic personality of the partner itself is not good or that the other person doesn’t love genuinely and can’t be trusted. Usually it requires quite a few therapy sessions to undo the psychological mess which gets created over the years. However, partly because of stigma and partly because therapy is perceived as expensive, most people don’t complete adequate follow up. So in many cases, even after vaginismus is solved the negative beliefs about the other person continue and that prevents harmony & joy from returning back into the relationship.
Thus not addressing vaginismus in time can scar your mind and happiness for a long time. Luckily all studies on this topic have shown that more than 95% of those who complete the full treatment programme, are able to enjoy pain free intercourse. Vaginismus and most other sexual disorders are treatable. Please take professional help in time, before negative prejudices set it.Don’t waste your energy in passing negative judgements on your partner. That will only increase your misery. You getting a disorder is not your fault; but working on it and resolving it is definitely your responsibility. If you don’t like the therapist or if things are not working, change the therapist. But please don’t go in avoidance mode. As we all know ‘a stitch in time saves nine’.
Thanks for reading and wishing you a very satisfying sexual life J
Dr. Dharav Shah
(I shall be very thankful if you share your positive and negative experiences of sexuality with me. Your learnings will help me in guiding young couples struggling with it. I promise to maintain complete confidentiality.)
PS: There is an enlightening ted talk ‘Reclaiming Female Sexual Desire’, on the related topic of lack of sexual desire, by a woman who was herself suffering from that problem, Pam Costa
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