Thursday, February 18, 2010

Vaginismus-Cause of Infertility

A 34 year old gentleman presented to us with PRIMARY INFERTILITY.The Couple were trying for 5 years for conception.The investigation profile revealed moderate oligospermia.After having tried all medicines (both multivitamins,anti-ostrogens and alternative medicines) there was no fruitful outcome.The couple had almost given up.On presentation to us; we came across a very important finding which was failure of penetration of the male organ on account of vaginal pain (Vaginismus).The husband perse could never deposit semen in the vagina.
The presence of bordrline sperm count had almost driven the focus of attention from this important condition(vaginismus) to treatment of sperm count(? For years).
We were quite surprised as 5 years had elapsed since marriage and the marriage was uncosummated.
In our society majority of the couples entering into arranged marriage are virgins with little knowledge about sexual anatomy of themselves leave apart understanding the anatomy of the partner.No sexual experience and scanty sexual knowledge leads to vast majority of couples presenting to sexologist with inability to consummate.
Many couples are GUIDED by elderly members of the society that ‘things will work out’ especially after first childbirth as the vaginal canal will dilate.Ther poor couple was waiting for the first child to arrive without finishing the first essential formality of proper deposition of the sperms in the vaginal canal.
vaginismus, is a involuntary tightening of the vaginal muscle, which prevents penis-vagina intercourse. If a man pushes hard trying to enter, it can cause the woman intense pain. In other cases, vaginismus is due to a medical condition that causes pain in the vulvar area, inside the vagina, or elsewhere in the pelvic region. Tightening the pelvic muscles is an unconscious reflex effort to prevent further pain.
In some cases, vaginismus is caused by fear or aversion to sex. For women who experienced sexual abuse, rape or other trauma, this may be an effort to protect themselves from further violation or pain. Many women who are fearful or aversive to sex have no history of trauma, but may have heard scary stories about sex, learned negative sexual attitudes, or have frightening images relating to sex.
So basic sex counselling to correct misconceptions,allay the fears and teach the right technique of the intercourse.The lubricating non-spermicidal jellys can be used for decreasing the pain of penetration.All efforts should be focussed towards encouraging interpersonal relationship between husband and the wife.
Any underlying pelvic diseases should be treated with help of gynecologist.If still the problem persist then the women must be taught vaginal self dilatation.Gradually larger dilator can be accomodated and the fear of penetration will decrease.Vaginal self dilatation works in women with a tough hymen also without need of surgical hymenectomy.
One very useful adjust in such cases is pelvic relaxation exercise and Kegels exercise.This can wok wonders with self dilatation at least in 80% cases.


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