For some women, the thought of sexual intercourse can bring anxiety rather than intimacy. Penetration may be painful, extremely difficult or, in some cases, impossible. Yet many suffer quietly, unsure whether what they are experiencing is normal or even knowing that they can seek help.
One possible explanation for this discomfort is vaginismus, a pelvic health condition in which the muscles around the vagina involuntarily tighten when penetration is attempted.
According to Pauline Ochieng, a pelvic health and lymphedema physiotherapist at Aga Khan University Hospital, the tightening is not something a woman consciously chooses to do.
“The pelvic floor muscles tense and cause involuntary tightening, making penetration painful or impossible,” she explains.
For some women, the condition only becomes apparent when they attempt sexual intercourse. Others may notice it when trying to insert a tampon, while some only discover there is a problem when a doctor has difficulty carrying out a pelvic examination or Pap smear.
When it's painfully tight: Living with vaginismus and how to treat it
The exact cause of vaginismus is not clearly known, but several factors may contribute to it. Pauline says a woman’s experiences and upbringing can sometimes play a role. In some African cultures, children grow up being taught that touching their private parts is wrong or taboo.
“That fear also gets into the mind. So you find that the moment you try to penetrate the vagina, you have that involuntary contraction of the pelvic floor muscles. It is almost like a psychological reflex…”
For other women, vaginismus may develop after a traumatic experience, including sexual assault or rape. Since the causes can vary, treatment may require different forms of support.
Diagnosis is done by a doctor, often a gynaecologist. Once vaginismus has been diagnosed, a woman may be referred to a pelvic health physiotherapist. Where psychological concerns such as trauma are involved, a psychologist may also be part of the treatment team.
Despite the distress it can cause, vaginismus remains a condition many women struggle with privately.
“There’s no sensitisation that there are such conditions. Some women may assume what they are experiencing is normal, while others are simply too embarrassed or afraid to seek help,” she says.
Cultural attitudes towards discussing private parts and sexual health can make that silence even deeper. In some communities, Pauline says, symptoms may even be attributed to witchcraft, which can further discourage women from seeking medical attention.
“The problem is compounded by the fact that pelvic health physiotherapy itself is still relatively new in Kenya, as many people may not know that such specialised help exists. For those who do seek treatment, recovery is a process rather than an overnight solution.”
Physiotherapy does not involve drugs, Pauline explains. Treatment focuses on helping a woman understand and gain better control of her pelvic floor muscles.
“Treatment may include exercises, breathing and relaxation techniques designed to help a woman learn how to relax and coordinate her pelvic floor muscles,” she explains.
“Stretching and lengthening techniques may also be used. Later, devices such as the pelvic floor muscle trainers can be introduced, with some women given exercises to continue at home.”
Patience is important because progress varies from one woman to another. Some may require weeks of treatment, while others may take months.
“Establishing a relationship in which the patient feels comfortable is an important part of treatment, particularly because the experience can be difficult for many women,” she says.
Partners can also be involved in the process so they understand what the woman is experiencing and can offer support.
According to Pauline, vaginismus does not have to be a lifelong condition. While it can make penetration impossible for some women, Pauline says it can be treated completely.
She also points out that vaginismus should not be confused with painful intercourse, since not every woman who experiences pain during sex has the condition.
“Intercourse pain during deep penetration may be associated with conditions such as endometriosis. Pain at initial penetration may, in some cases, be related to a tight muscle that needs to be assessed and treated.”
Women experiencing pain during sex should therefore not assume they have vaginismus. A medical examination can help establish what is causing the pain and guide the appropriate treatment.
“Vaginismus is also not genetic and does not run through family lineage. Neither does having the condition mean that a woman can’t eventually give birth vaginally. These are common misconceptions associated with the condition,” she demystifies.
