Painful intercourse due to problem in penetration is yet another bothering condition which affects normal sexual life of couples and can affect their relationship. Females have fear of intercourse due to unbearable pain and start avoiding penetrative sex.This condition is called as vaginismus and is often the most common reason for non consummation of married life.
Vaginismus does not prevent arousal but interferes in penetration. There are many reasons for this condition which can be primary or secondary, causes of which are enumerated ahead.
We, at Kalosa, understand the trauma this creates in maintaining normal intimate relationship of the couples , hence treating this condition is our priority.
First let us understand how can vaginismus affect a female.
Apart from imparting deep psychological effect on a female, vaginismus can make penetrative intercourse or tampoon insertion or gynaecological examination, almost impossible.
Pain can vary from person to person from tightness, pain to impossible penetration with partner feeling ‘ like bumping into a wall’.
It should not be confused with dyspareunia which is painful intercourse and could be due to lower pelvic inflammatory disease or vaginal atrophy.
The vaginismus which happens since the time of first intercourse or gynaecological examination or tampoon insertion is the primary vaginismus whereas vaginismus which develops later in life and is not present during initial sexual life is called as secondary vaginismus. It may arise due to infection, childbirth, menopause, radiation or any kind of lower pelvic surgery.
The vaginismus is often categorised as per following grades:
Grade 1 – Patient is able to relax for pelvic examination.
Grade 2 – Patient is unable to relax for pelvic examination.
Grade 3 – Early retreat : patient lifts off the buttocks.
Grade 4 – Generalized retreat – patient retreats, buttocks lifted, thighs closed.
Grade 5 – Generalized retreat plus visceral reaction – sweating, nausea, vomit, trembling, shaking, desire to run or attack the doctor.
Physical stressors, emotional stressors, or both can cause a condition called Vaginismus.
1. Emotional factors –
Fear of intercourse or pregnancy
Past traumatic life events eg rape
Anxiety about performance
2. Physical factors –
Pelvic inflammatory disease
Previous surgery or trauma
Muscles Involved in Vaginismus - Muscles of lower 1/3 of vagina, circumvaginal muscles namely bulbocavernosus, levator ani, pubococcygeus.
Thorough history of the patient is taken and any obvious cause is ruled out before the examination. The aim of treatment is to reduce the automatic tightening of the muscles and the fear of pain.
Treatment of vaginismus involves a combination of various methods with extensive patient counselling, hypnotherapy, progressive dilatation and botox treatment
1. Counselling of the couple – Female should understand that this is a natural process and any fear arising due to this is irrelevant. Female genital anatomy is also explained to the patient.
2. Reducing sensitivity to insertion: A female will be encouraged to touch the area as close as possible to the vaginal opening every day without causing pain, moving closer each day. When the female is able to touch the area around the vagina, she will be encouraged to touch and open the vaginal lips, or labia. The next step will be to insert a finger.
3. Insertion or dilation training: Gradually female is trained to use a dilator. if pain is diminished , female is instructed to have intercourse with her partner. If still pain is there or patient is not able to use dilator, she is instructed to try the next step.
4. Botox Treatment – This treatment involves use of botulinum toxin which is a muscle relaxant that can weaken or stop any muscle from contracting. This property of botulinum has been used to relax vaginal muscles and help in relaxation during intercourse.
Procedure - Muscles which are more prone to contraction are determined by the prior pelvic examination. The treatment can be done under local anaesthesia usually but if the patient is not able tolerate the pricks of the needle, general anaesthesia is given. The dose of the botulinum is decided by the bulk of the target muscles.It is usually injected into a single or all the three major muscles of pelvic floor taking care to avoid the urethra and the rectum so that there is no incontinence.
Contraindications to Treatment - Any medical condition that may put the subject at increased risk with exposure to BOTOX including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other disorder that might interfere with neuromuscular function.
Side Effects – There may be minor complications of mild stress incontinence which resolves after about four months when the Botox is no longer active. Patient may have excessive vaginal dryness, likely due to block of the parasympathetic nerves which govern "letdown". Rarely patients can have blurry vision.
Follow Up - Usually single treatment of botulinum is sufficient to treat vaginismus though effect of botulinum lasts for 2-4 months. Dilators should be continued for a while post treatment. Once a woman experiences sex without pain after Botox, she relaxes and begins to enjoy it, and the muscles learn to relax on their own
Success Rate – Botox treatment has high cure rate of 90%
Team of highly qualified doctors- Dr Deepti Asthana is an internationally trained gynae cosmetic surgeon whereas Dr Ashish Khare is an experienced plastic and cosmetic surgeon.
Well trained staff.
Clinic equipped with latest state of the art technology and equipment with great ambience.
All safety measures for COVID 19 are being followed:
Clinic is being sanitized daily.
Screening of medical staff and patients at the entrance.
Social distancing being strictly followed.
Surgeons are equipped with recommended PPE kits.