4. Problem with the male partner – erectile dysfunction and micropenis
5. Sexual inexperience from both partners
For the purpose of today’s discussion, I am going to focus on vaginismus as one the commonest reasons why your husband or boyfriend can’t penetrate you.
Vaginismus makes sexual intercourse difficult or impossible (the vagina can completely close up) & it can be so so painful
It is reflexive tightening around the vagina when vaginal entry is attempted or completed (eg, using a penis, finger, or dildo) despite women’s expressed desire for penetration and despite the absence of any structural or other physical abnormalities.
Types of vaginismus:
• Primary vaginismus is when u have never been able to have sex because of the condition.
• Secondary vaginismus is when u have previously been able to have sex but now find it difficult or impossible.
Primary and Secondary Vaginismus image
• Global vaginismus is when you are unable to place anything in the vagina
• Situational vaginismus is when you are able to use tampons and can tolerate pelvic examination but cannot have intercourse.
Vaginismus can strike any woman at any time at any age.
Symptoms of vaginismus include the following:
• difficult or impossible penetration of the vagina, because the muscles in the vagina have tightened
• burning or stinging pain & tightness of the vagina if penetrated by a tampon, finger or penis
This is the cycle of pain as depicted by Dr Rajeev below.. .
• loss of sexual desire if penetration is attempted
• Some women are unable to insert anything into their vagina.
• Some women can insert a tampon & complete a gynaecological exam, but intercourse isn’t possible.
• Other women can try to have intercourse, but it is very painful.
* Another important symptom though rare, is penis captivus.
Causes of Vaginismus
• Pelvic pain due to a medical condition, infection, physical trauma or assault, age-related changes, or painful physical events such as childbirth.
• Emotional distress, anxiety, fear, relational difficulties, or other similar emotions that relate to
sex, intimacy, past trauma, or relationships.
• You are affected by cultural or religious taboos around sex.
• Previous surgery to the genital area
• vaginal dryness, which can occur after the menopause
• lack of sexual arousal
• side effects of some medicine
* Inadequate foreplay
* infections like UTI and candidiasis
If you have symptoms of vaginismus, see your doctor who may need to ask some personal and intimacy history questions to find out more about your condition. Thereafter, she may do a pelvic examination on your to ascertain the extent of your complaints.
Treatment modalities are then instituted as below:
(1) Progressive desensitization
• The woman first touches herself daily as close to the introitus as possible, separating the labia with her fingers.
• Once her fear and anxiety due to introital self-touch has diminished, the woman will be more able to tolerate the physical examination.
• The next stage is to insert her finger past her hymen; pushing or bearing down during insertion enlarges the opening and eases entry.
• Once finger insertion causes no discomfort, vaginal cones in gradually increasing sizes are inserted progressively; leaving a cone inside for 10 to 15 min helps perivaginal muscles become accustomed to gently increasing pressure without reflex contraction. The woman first inserts a cone herself; when comfortable with the cone, she then allows her partner to help her insert one during a sexual encounter to confirm that it can go in comfortably when she is sexually excited.
• Once insertion in this context is comfortable, the couple should include penile vulvar stimulation during sexual play so that the woman becomes accustomed to feeling the penis on her vulva.
Ultimately, the woman inserts her partner’s penis partially or fully, holding it like an insert.
She may feel more confident in the woman superior position.
These methods can also be used if the above method is not working;