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Q: I did not realise that I suffer from vaginismus until after my marriage. Sex is almost impossible. However, I was really fortunate to get pregnant and I thought the problem would be solved after a natural birth.
Sex is still so painful that I avoid it. I read that Botox can help, but is it a permanent solution? Are there alternatives?
A: Vaginismus is characterised by an uncontrolled, involuntary contraction of the muscle surrounding the vagina (called the pubococcygeus muscle), which makes intercourse either painful or impossible.
The causes may be psychological - such as previous sexual abuse, strict home upbringing that sex is immoral, fears and misconceptions about sex being painful; or physical - such as genital infection or childbirth injuries.
Treatment may be psychological or physical. Psychotherapy can help the psychological aspects while physical therapy involves vaginal exercises, lubricants and desensitisation with vaginal dilators.
Botox has been used recently with some success, especially when standard treatments fail. Minute amounts of the drug are injected directly into the pubococcygeus muscle (a hammock-like muscle which stretches from the pubic bone to the tail bone, controls urine flow and contracts during orgasm) under anaesthesia to paralyse the muscle, thereby eliminating the pain.
Once the element of pain is gone, psychological fears subside and normal coitus is possible as the brain readjusts to a new situation and feelings.
However, repeat treatment (four to six months) may be necessary and side effects include headache and flu-like symptoms.
As every case of vaginismus is different, an individualised approach by a gynaecologist and a therapist working as a team is the best.
Dr Tan Yew Ghee is an obstetrician and gynaecologist at Raffles Hospital and a senior partner and consultant at Raffles Women's Centre.
This article was first published in Mind Your Body, The Straits Times.
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