Vaginismus: A Psychosomatic Expression of Cultural Stigma

Ayra Chaudhry

cottonbro studio. Mother and Daughter Studying on the Bed. Pexels. 2021.

Insert the plastic applicator and release.

It sounded easy enough. Yet there I stood in my bathroom, attempting this menial task for what could’ve been thirty minutes or so. There was pain, so much pain. My body was rejecting this small plastic tube as if it was an unwanted foreign object. My muscle walls constrict without input, a fortified barrier. I blamed myself; I was probably just using a tampon incorrectly. It wasn’t until I turned nineteen that I realized what the true issue was: vaginismus. A funny, harmless-sounding affliction, but one that would bring much frustration and discomfort to my life.

Growing up in a South Asian immigrant household, sex was never once discussed. There was no birds-and-bees talk. Even at twenty-one, I still feel embarrassed and tense around my family during a slightly suggestive scene in a movie. Sex was only ever alluded to. Discussions of children, married life, and modesty. Don’t wear that shirt, it shows too much of your chest. Cover your skin as much as possible. I became hypersensitive and cautious of my body, never wanting to be perceived physically in any way. Along the way, that brought feelings of shame, and vaginismus was a physical manifestation of that. A psychosomatic effect of my cultural upbringing. My mind learned to associate sex with taboo, shame, moral danger, and the vaginal walls responded, contracting and tightening to retain my purity and innocence, the most prized quality of a premarital woman in my culture.

What is Vaginismus?

Vaginismus is an involuntary spasm of pelvic muscles that partially closes the vagina, causing penetration to be difficult and painful, and in some cases impossible [1]. Due to its interference with intercourse, it is considered a sexual dysfunction and is defined under genito-pelvic pain/penetration disorder (GPPPD) by the DSM-5 [2]. The exact cause of vaginismus remains unclear, with the predominant theory being that fear of painful sex causes automatic tightening of pelvic floor muscles when penetration is attempted [1]. The disorder is complex, with a range of potential causes including sexual assault or abuse, fear of sex, a painful sexual experience, or negative beliefs about sex [3]. Cultural attitudes around sex could potentially explain the stark difference observed in vaginismus prevalence in Eastern countries compared to the West. Worldwide, the clinical prevalence of vaginismus is 5-7% [4]. In the United States specifically, prevalence is around 5-17% [5]. Eastern countries claim much higher rates, with 27% in Iran, 43% in Turkey, and 68% in Ghana [6,7,8]. These figures are likely underestimates due to challenges arising in data collection, diagnosis, as well as cultural stigma, which may hinder how open individuals are about sharing information about their condition [5].

The Crucial Role of Sex Education

Intimacy and sex are often integral to maintaining a healthy romantic relationship, and vaginismus can get in the way of this, causing much distress within couples. In certain Arab and Muslim-majority countries, it is the most frequent disorder accounting for why marriages are unconsummated [9]. Vaginismus is, however, a treatable condition. Treatment consists of a combination of physical pelvic floor therapy, vaginal dilators, and cognitive behavioural therapy (CBT) [1]. So why do prevalences remain so high in certain regions? One reason is that the conservatism around sex in certain cultures can make it difficult to bring up issues in the first place. If sex is never discussed and is associated with guilt and shame, people will continue to internalize problems of sexual dysfunction until it harms relationships and personal well-being. Differences in sexual education also further reinforce this pattern. In the West, sex education is much more focused on starting conversations around sex positivity and pleasure, encouraging questions and exploration. In other cultures, sex education highlights the role of sex in conception, and emphasizes penetration/intercourse as the primary, or sole, mode of sex. Patriarchal values shape expectations of women’s sexual roles. Sex is expected to be painful for them, and little focus is put on sensuality or bodily pleasure [10]. This creates a self-perpetuating cycle: fear of sex due to expectation of pain causes vaginismus, which itself causes pain during sex, confirming expectation. When pain is taught to be inevitable, the problem doesn’t present itself as a problem, and treatment isn’t sought. 

What Can We Take Away From This?

Fear of sex is pushed as a narrative to scare women off of premarital sexual activity, particularly in cultures where virginity is highly valued. If sex is consistently associated with fear or shame, the body may naturally produce a protective response, which may manifest through vaginismus. This is why it’s important to not only treat the outcome of the disorder through physical therapy, but also address the psychological and cultural factors that may shape an individual’s relationship with intimacy. Understanding the broader cultural context of the disorder can further direct clinicians towards more effective interventions. Beyond treatment, this understanding exposes a cycle that must be disrupted. The cultural belief around purity and shame has an effect on women’s bodies, and these ideas are instilled and internalized from a very early age. However, we have the capacity to break away from this pattern. In order to do so, we must replace silence and shame with better education around sex, more open conversation within families, and encourage individuals to live in their bodies without fear. Understanding vaginismus as a cultural inheritance rather than an individual failure allows healing to become not just personal, but generational.

References

1. Cleveland Clinic. Vaginismus [Internet]. Cleveland Clinic. 2015. Available from: https://my.clevelandclinic.org/health/diseases/15723-vaginismus

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013 May 22;5(5).

3. Van Lankveld JJDM, Granot M, Weijmar Schultz WCM, Binik YM, Wesselmann U, Pukall CF, et al. Women’s Sexual Pain Disorders. The Journal of Sexual Medicine. 2010 Jan;7(1):615–31.

4. Arkiath Veettil Raveendran, Peedikakkal Rajini. Vaginismus: Diagnostic Challenges and Proposed Diagnostic Criteria. Balkan Medical Journal [Internet]. 2024 Jan 3;41(1):80–2. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10767778/

5. McEvoy M, McElvaney R, Glover R. Understanding vaginismus: a biopsychosocial perspective. Sexual and Relationship Therapy. 2021 Dec 5;39(3):1–22.

6. Oksuz E, Malhan S. Prevalence and Risk Factors for Female Sexual Dysfunction in Turkish Women. Journal of Urology. 2006 Feb;175(2):654–8.

7. Safarinejad MR. Female sexual dysfunction in a population-based study in Iran: prevalence and associated risk factors. International Journal of Impotence Research. 2006 Jan 5;18(4):382–95.

8. Amidu N, Owiredu WK, Woode E, Addai-Mensah O, Quaye L, Alhassan A, et al. Incidence of sexual dysfunction: a prospective survey in Ghanaian females. Reproductive Biology and Endocrinology. 2010;8(1):106.

9. Zargooshi J. Unconsummated marriage: clarification of aetiology; treatment with intracorporeal injection. BJU International. 2007 Jun 25;86(1):75–9.

10. Zgueb Y, Ouali U, Achour R, Jomli R, Nacef F. Cultural aspects of vaginismus therapy: a case series of Arab-Muslim patients. The Cognitive Behaviour Therapist. 2019;12.

11. cottonbro studio. Mother and Daughter Studying on the Bed. Pexels. 2021.