“When I was in my late teens, I wanted to try tampons, but the thought itself made me clench.” — Revati
“I realized, masturbation wasn't possible for me and it hurt terribly. At that moment, I had just graduated from high school and didn't feel comfortable enough to talk about this difficulty or impossibility with anyone - be it a family member or a doctor.” — Divya Dureja
Revati is happily married and has a young daughter. Divya is a psychologist, a slam poet and a queer activist.
Revati and Divya have never been able to have sex in the traditional sense. They were diagnosed with vaginismus, making any penetration of the vagina unbearably painful.
They are only two among many other women — each with a different story to share about personal discoveries, struggles and most importantly — acceptance.
Dr Mukta Kapila, Director, Obstetrics and Gynecology, Fortis Gurugram, explains the condition.
“A woman with vaginismus experiences sudden contraction in her vaginal muscles when an attempt is made to enter it.”
It becomes difficult for any sort of penetration to take place — intercourse, gynecological exam or even inserting a tampon. The realization, naturally, only strikes when such an attempt is being made.
There are two broad types: primary and secondary. In the former, the person has never been able to experience vaginal penetration, while in the latter, penetration had been possible before, but for reasons that could range from past trauma to some gynecologic surgery, it cannot be achieved now.
Through Divya’s and Revati’s experiences, we try and understand what the condition means to them, the emotional impact, and what they expect out of those around them.
The First Time
“I had irregular menstrual cycles but the thought of getting an internal exam scared me away, so I couldn't even get myself to go see a gynecologist about it. I self-diagnosed myself with vaginismus, googling my symptoms. This was later confirmed by my obstetrician-gynecologist when we were trying to conceive.” - Revati
“Before I had my first intimate romantic relationship in 2010, I had never masturbated or seen porn. He helped me learn about my body and explore it. But I soon realized that masturbation isn’t possible for me.” - Divya
A few years later, Divya realized ‘something felt amiss’ — not because of her inability to have conventional sex, but because she didn’t want to be with men. And with women, the situation is different, she said.
“Each woman experiences pleasure in a unique way - some prefer penetration of some form and some prefer stimulation through oral or other means. However, I still somehow felt ‘less than’ and confided in my sister about my inability to experience penetration of any sort because of the pain. While she didn’t dismiss my concern, she said maybe I’d be up to it when I was mentally prepared, or I could be having a psychological or mental block that’s been holding me back.”Divya Dureja
“I knew that wasn't the case, but I didn't possess an alternative way to voice my concern, so I let that be.”
‘I Couldn’t Put a Name to It, and That Bothered Me’
Divya knew something was wrong, but didn’t know what it was. Just like Revati, she discovered her condition herself, which was later confirmed by doctors. Around three years ago, she came across an article where a woman had described the pain she felt during penetration — “I feel like a wall is blocking the entrance to my vagina. And I feel a shooting unbearable fiery pain when any penetration is attempted.”
Divya knew what it felt like. And she now knew she could be having the same condition as this woman — Vaginismus.
“I felt a rush of emotions — from fear to joy to sadness. I finally had a precise terminology and I could request my sister and mother (both gynecologists) to clinically examine me. They confirmed I have vaginismus. At that moment, I felt like a weight of uncertainty had been lifted off of my shoulders. A diagnosis meant that I wasn’t making it up in my head. It validated my feelings and insecurities of six years.”
To her, the diagnosis was liberating enough. She didn’t seek solutions. “I could feel and give pleasure and consummate the act of love in my own way.”
Guilt, Stress and Hope
What follows after the diagnosis? For Divya, it was relief and liberation. But for Revati, it was different. “I just assumed that someday it would happen for me.”
“Truth be told, I had a lot more guilt due to the typical norms set by society. When you have vaginismus, suddenly your husband becomes the sufferer in everyone’s eyes. I felt really low about it when we were unable to conceive. I later got to know that vaginismus was only one barrier, both my husband and I were also infertile.”Revati
Divya’s experience was different because the ‘performance anxiety and the feeling of not being able to satisfy your partner’, is more or less absent when she engages sexually with a woman. However, her active role in the India Vaginismus Support Community online and her access to Global Vaginismus Support Community have proven to her these feelings are common.
“I often come across narratives shared by females who do experience severe dejection, helplessness, fear and pain at their inability to participate in conventional sex with their male partners. They experience a plethora of psychological as well as physical distress due to this, which they share with the community members confidentially.”Divya Dureja
The Partner’s Role
In a conversation with FIT, Dr Mukta Kapila brings up the importance of a supportive partner. She asserts that patience, consideration, responsibility and gentleness are all expected out of the partner, and an understanding person could help mitigate the psychological consequences in a woman to a great extent.
“The partner most definitely needs to be taken in the picture. At times, we need to sit with him/her and tell what is expected out of them. If the woman wants it to be treated, the partner needs to be explained the need to be gentle, comforting, and very patient.”Dr Mukta Kapila
Revati, out of her own experience, agreed. “Patience and trust along with unending support go a long way in overcoming the issue. It did so in our case.”
“Getting a diagnosis for the condition, seeking a remedy for it (if you decide you need to), and entrusting a partner with that information is big, but essential for you to accept yourselves fully. Assurance, trust, support and patience are all important ingredients which facilitate the individual’s response.”Divya Dureja
Dr Deepa Dureja, Obstetrician and Gynaecologist from Delhi, and Divya’s mother, explains that vaginismus cannot always be put into exclusive categories. In fact, she points that while it is assumed that a past experience or some instilled fear or anxiety causes a woman to get diagnosed with the condition, it is actually also the other way round. The psychological problems may be the result of the pain and inability.
“The cause could be physical, pathological, psychological or anatomical. If needed, multiple doctors could be consulted. The aim is to treat the patient while addressing the root problem.”Dr Deepa Dureja
Another gynaecologist, Dr. Jayati Dureja, traces the research into this condition. “Vaginismus used to be a diagnosis of exclusion, when none of the other problems could be seen. A lot of research was done into the causes of vaginismus, and it came to be associated with a psycho-social-behavioral component. More recent research has shown that the increased tone of the perineal muscles is a major cause.”
In physical problems such as a tight hymen or muscle hypertonicity, dilators and special exercises need to be recommended.
“In mild cases, we start with jelly, advise different positions, tell the partner to be gentle. In more severe cases, dilators are used. If it is a case of fear and anxiety, then a psychologist is involved and a detailed history of the patient is taken. We are even exploring the role of a dermatologist and Botox.”Dr Mukta Kapila
Dr Deepa Dureja also discusses the effectiveness of cold laser therapy, that she has seen to be working in some of her patients, with extremely fast results. She calls for more research in the area.
“The discourse around penal-vaginal penetration distresses anyone who is unable to perform well in that area — be it a male with erectile dysfunction, a woman with vaginismus, vulvodynia, endometriosis or simply finds the act futile. How one views their inability and resolves it is the differentiating factor here.” - Divya
She goes on to say that pleasure and orgasm is important, but what we call ‘love making’ is entirely subjective and unique.
“The important part is that it is consensual, communicative and a positive experience for all involved. At no point should there be any coercion felt or a purposely induced feeling of being ‘less/incomplete’.”
Women can experience pleasure in different ways. Clitoral stimulation, anal penetration, or stimulation in their labia minora. “The key to figuring this out is honest and open communication.”
“In fact, many women don’t even orgasm through traditional sex, if you look at statistics.”Revati
Most importantly, it is important for a woman to know and understand pain. Divya explains, “To know what form of pain is okay and not okay is the key. Our primal instincts of assessing pain do kick in, but sadly, the society has told females to ‘endure’ pain during sex.” It’s time this is redefined.