Case of a woman battling Vaginismus coming in for fertility treatment

A 30-year-old woman presented with the complaint of being unable to achieve vaginal penetration. In addition, she had been unable to have a gynecological pelvic exam. She was extremely fearful of the pain related to penetration. She had been married for five years. She reported that her partner was supportive, and he was present throughout her initial medical examination. Her medical examination revealed no physical abnormalities. The patient had previously enjoyed manual stimulation with her husband but as their relationship progressed and penetration continued to be impossible, she became aversion and withdrew from any kind of sexual contact. She was a home maker, and her husband was a photographer his work demanded him to travel during night. That was also one of the issues couple had. The couple were staying in a joint family which restricted them to explore about themself. The couple were married young and hence the wife was educated in sexual aspects. Even though she was educated she didn’t had much exposure and also, and she didn’t had any right person to share her problem. Through her friends she believed that sexual intercourse will be painful and there will be chances of bleeding. Basically, she didn’t know where the normal penetration occurs. They had come for treatment because of family pressure thinking that IVF can help them in getting conceived.

She hyperventilated during the initial exam and was diagnosed with primary vaginitis. The clinician reported that, “She screamed at one time during the exam; however, she verbalized that she was not in pain. “We initiated our vaginitis protocol and began dilation with the smallest. Although the patient was extremely anxious, she was cooperative when the catheter was inserted. Her husband was present and part of the dilation process and expressed that throughout the process he had become more aware and sensitive to her ability to be penetrated.

As a part of psychological counselling the couple were counselled individually and later together. The plan was to adopt CBT counselling and in the process of counselling we got to know that both husband and wife had a healthy relationship.

Fertility specialist has recommended them to try sexual intercourse for a few months to try to conceive naturally.