Quote:
"Ms Puva, for instance, learnt relaxation exercises that emphasise stretching, such as yoga and pilates. She also underwent the gradual introduction of fingers and dilators of different sizes to expose her muscles to an object in the vagina and allow them to slowly stretch."
Cases of vaginismus are rising in Singapore, with KK Women's and Children's Hospital's sexual health clinic recording 100 new cases last year.
PHOTO: ISTOCKPHOTO
Amrita Kaur
OCT 12, 2021
SINGAPORE - It was Ms Puva's dream to have a child, but she was unable to consummate her marriage for seven years after getting hitched at 27.
Every time she and her then husband tried to have sex, she ended up crying as she would be in immense pain.
"It felt like something was hitting hard against me," says the 39-year-old senior executive in the healthcare industry, who declined to share her full name.
This caused frequent quarrels between them, which eventually led to a divorce in 2016.
Ms Puva sought help the following year at the sexual health clinic under the women's health and wellness centre at KK Women's and Children's Hospital (KKH), where she was diagnosed with vaginismus.
It is a condition in which the vaginal muscles tighten involuntarily and prevent objects such as the penis from entering the vagina, causing pain and a burning or stinging sensation.
Cases of vaginismus are rising in Singapore, with KKH's sexual health clinic recording 100 new cases last year, a 60 per cent increase from 2017.
Dr Tan Tse Yeun, a consultant at KKH's department of reproductive medicine, says the surge in cases is due to increased awareness among not just the public, but also healthcare providers.
Most women, she says, go to a polyclinic or general practitioner and are then referred to specialists to rule out underlying gynaecological conditions.
The obstetrician or gynaecologist then refers the patient to KKH's sexual health clinic.
"Due to the increased number of referrals, we deduced that more healthcare professionals are now aware of sexual dysfunctions and recognise that they are important health conditions that require appropriate treatment," says Dr Tan.
Over at National University Hospital (NUH), the projected number of vaginismus cases this year is expected to rise by more than 20 per cent compared with last year.
Dr Susan Logan, a senior consultant at NUH's department of obstetrics and gynaecology, says most patients research online to try to diagnose the issue and then seek professional help.
"They are better informed about vaginismus through social media and the Internet," she adds.
Dr Martha Tara Lee, a relationship counsellor and clinical sexologist at Eros Coaching who has been practising for 12 years, estimates that 90 per cent of her clients have vaginismus.
Since her third year of practice, she realised women were seeking help for vaginismus earlier.
"In the beginning, I saw people who had this problem for 10 to 15 years. The time gap from them knowing they had an issue to seeking help shortened to before marriage, three years, one year, one month and even one day," she says.
Vaginismus is often associated with a lack of sexual knowledge and a history of sexual abuse or traumatic sexual experience.
It may also be linked to a strict upbringing or religious or cultural beliefs which interpret sex as wrong or bad. Women who have undergone pelvic surgical operations or childbirth may also be at risk of the condition.
In Ms Puva's case, she had a conservative background and lacked knowledge on sex, which caused anxiety during sexual intimacy. She also had abnormally tightened pelvic muscles - a possible side effect from operations to remove fibroids in her uterus.
Dr Lee, who has clients from other parts of Asia, including India, Malaysia and Indonesia, says vaginismus is an "Asian problem".
"(Women in Asia) do not know much or anything about basic information on sex, like where the vagina is, because they have not been taught this. Even if they received sex education in school, it was limited and biological. The psychological, emotional and relational aspects are missing," she explains.
Most vaginismus patients at KKH's sexual health clinic are women in their 30s who seek help after discovering they are unable to consummate their marriage, or when they want to conceive, says Dr Tan.
At NUH, women also seek help when their husbands threaten annulment or divorce, says Dr Logan.
The severity of the condition varies.
Some women, Dr Tan says, are okay with the insertion of tampons or fingers, but not the penis; others cannot tolerate any form of object entering the vagina. The male partner may also experience "something blocking the entry of the penis and pain during attempted penetration", she adds.
Vaginismus is also associated with an intense fear of and anxiety about pain before or during vaginal penetration.
Ms Cheong Xinyi, a principal psychologist at KKH's psychology service, says these negative emotions perpetuate a vicious circle of pain as they cause the vaginal muscles to tighten further, making future attempts at sexual intercourse or insertion even more painful.
Experts say the condition may cause problems between spouses, leading to communication breakdown, psychological abuse, cheating and divorce.
Tackling vaginismus may involve a multifaceted approach, be it treating medical conditions, sexual education, emotion regulation techniques, pelvic floor muscle rehabilitation or relationship counselling.
Ms Puva, for instance, learnt relaxation exercises that emphasise stretching, such as yoga and pilates.
She also underwent the gradual introduction of fingers and dilators of different sizes to expose her muscles to an object in the vagina and allow them to slowly stretch.
She says: "It was done at a comfortable pace and the breathing techniques that I learnt helped me to calm down when I was in pain."
In 2019, she was able to have sexual intercourse and was discharged from KKH. She is now a single mother with an 11-month-old son.
Statistics from KKH show that 67 per cent to 93 per cent of women achieve successful intercourse within a year of treatment, while 50 per cent of couples achieve pregnancy within the same period.
Noting that many couples keep the problem of vaginismus to themselves, Dr Logan says that while couples no longer need to have sex to have a baby nowadays, treating the condition is crucial.
"It is important for the self-esteem and confidence of the woman and man. Otherwise, it is always the elephant in the room," she says.
Regardless of erection strength, the entrance of the penis is not possible and is even painful. If the male partner persists despite the woman being scared or traumatised, he can develop periodic or persistent difficulties with sustaining an erection around his partner.
Most women, says Dr Martha Tara Lee, a relationship counsellor and clinical sexologist at Eros Coaching, see improvements in their condition in two weeks and overcome vaginismus after six weeks. She has also had clients overcome the condition after seeing her once or twice.
Through proper coaching and counselling, the clinical sexologist can help free a person from the painful circumstances of vaginismus.
Source: Dr Martha Tara Lee, a relationship counsellor and clinical sexologist at Eros Coaching
"Ms Puva, for instance, learnt relaxation exercises that emphasise stretching, such as yoga and pilates. She also underwent the gradual introduction of fingers and dilators of different sizes to expose her muscles to an object in the vagina and allow them to slowly stretch."
When sex hurts: More women in Singapore seek help for vaginismus
Cases of vaginismus are rising in Singapore, with KK Women's and Children's Hospital's sexual health clinic recording 100 new cases last year.
PHOTO: ISTOCKPHOTO
Amrita Kaur
OCT 12, 2021
SINGAPORE - It was Ms Puva's dream to have a child, but she was unable to consummate her marriage for seven years after getting hitched at 27.
Every time she and her then husband tried to have sex, she ended up crying as she would be in immense pain.
"It felt like something was hitting hard against me," says the 39-year-old senior executive in the healthcare industry, who declined to share her full name.
This caused frequent quarrels between them, which eventually led to a divorce in 2016.
Ms Puva sought help the following year at the sexual health clinic under the women's health and wellness centre at KK Women's and Children's Hospital (KKH), where she was diagnosed with vaginismus.
It is a condition in which the vaginal muscles tighten involuntarily and prevent objects such as the penis from entering the vagina, causing pain and a burning or stinging sensation.
Cases of vaginismus are rising in Singapore, with KKH's sexual health clinic recording 100 new cases last year, a 60 per cent increase from 2017.
Dr Tan Tse Yeun, a consultant at KKH's department of reproductive medicine, says the surge in cases is due to increased awareness among not just the public, but also healthcare providers.
Most women, she says, go to a polyclinic or general practitioner and are then referred to specialists to rule out underlying gynaecological conditions.
The obstetrician or gynaecologist then refers the patient to KKH's sexual health clinic.
"Due to the increased number of referrals, we deduced that more healthcare professionals are now aware of sexual dysfunctions and recognise that they are important health conditions that require appropriate treatment," says Dr Tan.
Over at National University Hospital (NUH), the projected number of vaginismus cases this year is expected to rise by more than 20 per cent compared with last year.
Dr Susan Logan, a senior consultant at NUH's department of obstetrics and gynaecology, says most patients research online to try to diagnose the issue and then seek professional help.
"They are better informed about vaginismus through social media and the Internet," she adds.
Dr Martha Tara Lee, a relationship counsellor and clinical sexologist at Eros Coaching who has been practising for 12 years, estimates that 90 per cent of her clients have vaginismus.
Since her third year of practice, she realised women were seeking help for vaginismus earlier.
"In the beginning, I saw people who had this problem for 10 to 15 years. The time gap from them knowing they had an issue to seeking help shortened to before marriage, three years, one year, one month and even one day," she says.
Vaginismus is often associated with a lack of sexual knowledge and a history of sexual abuse or traumatic sexual experience.
It may also be linked to a strict upbringing or religious or cultural beliefs which interpret sex as wrong or bad. Women who have undergone pelvic surgical operations or childbirth may also be at risk of the condition.
In Ms Puva's case, she had a conservative background and lacked knowledge on sex, which caused anxiety during sexual intimacy. She also had abnormally tightened pelvic muscles - a possible side effect from operations to remove fibroids in her uterus.
Dr Lee, who has clients from other parts of Asia, including India, Malaysia and Indonesia, says vaginismus is an "Asian problem".
"(Women in Asia) do not know much or anything about basic information on sex, like where the vagina is, because they have not been taught this. Even if they received sex education in school, it was limited and biological. The psychological, emotional and relational aspects are missing," she explains.
Most vaginismus patients at KKH's sexual health clinic are women in their 30s who seek help after discovering they are unable to consummate their marriage, or when they want to conceive, says Dr Tan.
At NUH, women also seek help when their husbands threaten annulment or divorce, says Dr Logan.
The severity of the condition varies.
Some women, Dr Tan says, are okay with the insertion of tampons or fingers, but not the penis; others cannot tolerate any form of object entering the vagina. The male partner may also experience "something blocking the entry of the penis and pain during attempted penetration", she adds.
Vaginismus is also associated with an intense fear of and anxiety about pain before or during vaginal penetration.
Ms Cheong Xinyi, a principal psychologist at KKH's psychology service, says these negative emotions perpetuate a vicious circle of pain as they cause the vaginal muscles to tighten further, making future attempts at sexual intercourse or insertion even more painful.
Experts say the condition may cause problems between spouses, leading to communication breakdown, psychological abuse, cheating and divorce.
Tackling vaginismus may involve a multifaceted approach, be it treating medical conditions, sexual education, emotion regulation techniques, pelvic floor muscle rehabilitation or relationship counselling.
Ms Puva, for instance, learnt relaxation exercises that emphasise stretching, such as yoga and pilates.
She also underwent the gradual introduction of fingers and dilators of different sizes to expose her muscles to an object in the vagina and allow them to slowly stretch.
She says: "It was done at a comfortable pace and the breathing techniques that I learnt helped me to calm down when I was in pain."
In 2019, she was able to have sexual intercourse and was discharged from KKH. She is now a single mother with an 11-month-old son.
Statistics from KKH show that 67 per cent to 93 per cent of women achieve successful intercourse within a year of treatment, while 50 per cent of couples achieve pregnancy within the same period.
Noting that many couples keep the problem of vaginismus to themselves, Dr Logan says that while couples no longer need to have sex to have a baby nowadays, treating the condition is crucial.
"It is important for the self-esteem and confidence of the woman and man. Otherwise, it is always the elephant in the room," she says.
7 myths about vaginismus
1. A woman with a small vagina is more likely to suffer from vaginismus.
This is not true. Normally, the vagina is flexible enough to expand and accommodate a penis that is fully erect. However, involuntary tightening of the vaginal muscles leads to painful intercourse.2. A woman with vaginismus just needs to relax more.
"Just relax" is one of the most frustrating things patients can hear. If they knew how to, they would. Relaxing is just a small part of what patients need to overcome. Sexuality education and specific exposure therapy exercises can reduce anxiety and difficulties around penetration.3. Penetration will be possible if the penis is hard enough.
Vaginismus happens when the vaginal entrance tenses up so much, penile penetration is difficult or impossible.Regardless of erection strength, the entrance of the penis is not possible and is even painful. If the male partner persists despite the woman being scared or traumatised, he can develop periodic or persistent difficulties with sustaining an erection around his partner.
4. Vaginismus will resolve on its own or if we just try harder, more often or create the right mood.
Trying the same thing many times does not work. Vaginismus needs attention and will not go away without proper treatment. A treatment programme helps prevent the cycle of involuntary tightening of the pelvic floor muscles.5. It will take a long time to overcome vaginismus.
The duration of the treatment programme varies, depending on the approach and technique used. How the woman complies and follows the treatment also affects its duration.Most women, says Dr Martha Tara Lee, a relationship counsellor and clinical sexologist at Eros Coaching, see improvements in their condition in two weeks and overcome vaginismus after six weeks. She has also had clients overcome the condition after seeing her once or twice.
6. A woman who has given birth will not suffer from vaginismus.
This is untrue. There are mothers with vaginismus due to a painful or traumatic experience during the vaginal birth process.7. A clinical sexologist only listens and talks about sex. It is not going to be helpful.
A clinical sexologist is trained to understand a person's behaviour and attitude towards sex, and knows how to deal with patients who have sex issues, including women suffering from vaginismus.Through proper coaching and counselling, the clinical sexologist can help free a person from the painful circumstances of vaginismus.
Source: Dr Martha Tara Lee, a relationship counsellor and clinical sexologist at Eros Coaching
