SUFFERING IN SILENCE: Female Sexual Dysfunction (Part I)

By Rachel Hercman

Rachel Hercman, LCSW is a psychotherapist specializing in relationships.  She works at the Medical Center for Female Sexuality in New York (www.centerforfemalesexuality.com), a center that provides cutting-edge medical and psychological treatment for female sexual dysfunction, where she helps women improve their body image, sexual functioning, and relationship satisfaction.  She can be reached at Rachel@centerforfemalesexuality.com

For a married woman, the ripple effect of vaginismus can exceed beyond just the bedroom.

SUFFERING IN SILENCE: 

Female Sexual Dysfunction 

PART I

Sara* was a beaming, exuberant bride.

After all those hopeless Shidduch dates, meeting Dovid* was the answer to her fervent prayers and she was overwhelmed with gratitude at how much they connected. He was truly worth the wait.

The wedding was everything she dreamed of, plus more. But as Sara and Dovid joyfully left the hall to go to a nearby hotel, some fears started creeping up. Though Kallah classes had been inspiring and her Kallah teacher was open and understanding, Sara had typical wedding night jitters when she thought about developing a sexual relationship. However, she found comfort in knowing that Dovid had a very gentle personality and always had her feelings in mind. Moreover, many of her married friends said they had had similar jitters about the wedding night, and since they became pregnant soon after their weddings Sara presumed that their experiences with the infamous ‘first time’ were a gateway to something better.

Unfortunately, Sara’s ‘first time’ became the start of many attempts to have a ‘first time’. Dovid called his Rav after Sheva Brachos to discuss their inability to consummate the marriage due to feeling like he was ‘hitting a wall’. After an extensive conversation, his Rav surmised that Sara’s vaginal muscles were too tight and he recommended that she take baths, practice relaxation exercises, and drink a glass of wine before intercourse. “Don’t worry”, he kept reassuring Dovid, “plenty of couples have this issue and with time it will correct itself”. But the weeks turned into months, then years, and Sara and Dovid felt like their entire relationship was stunted from reaching its full potential.

Dovid was loving and kind, but Sara felt alone and broken. She didn’t feel comfortable confiding in her mother about her sexual challenges and she was too embarrassed to call her Kallah teacher. After all, she felt like she failed as a student. She was taught that initially sex can be painful, but that with time it would evolve into an enjoyable, spiritual part of her marriage. When that didn’t happen, she began to feel like something was very wrong with her, and it only got worse when she would attend Simchas and feel curious eyes scanning her stomach.

If only she could get over this hurdle, she prayed, she could feel like a normal person…..

*Names and small details have been changed to maintain anonymity

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Meet vaginismus, a type of female sexual dysfunction that contrary to popular belief, is not ‘all in your head’. Vaginismus is a condition in which the vaginal muscles involuntarily contract, making penetration painful and sometimes impossible. In its mildest form, a woman can tolerate penetration for very short periods, but it's unpleasant and painful. Or it can be so severe that she can't even touch herself near her vagina, can't have a gynecological exam, and can't insert a tampon because the pain is so intense and the fear so great.

In cases of primary vaginismus, a woman has never been able to have penetrative sex or experience vaginal penetration without pain. Secondary vaginismus occurs when a woman who has previously been able to achieve penetration develops vaginismus, and this may be due to (but not limited to) physical causes such as childbirth, infection, cancer, or even menopause. In both primary and secondary cases of vaginismus, the physiological and psychological factors are not only relevant but can sometimes play off each other, leading to exacerbation of symptoms. Thus, when a woman suspects that she may be suffering from vaginismus, it is essential that she have a comprehensive assessment that takes into account her emotional and physical symptomology. (For more information on vaginismus and painful intercourse click here.)

Suffering from vaginismus is painful from all perspectives; physically, psychologically, religiously, and socially. Here at the Medical Center for Female Sexuality, we often meet strong, successful women who share the heartbreaking feeling of being “broken”, “defective”, or “less of a woman” because of their vaginismus. As seen in Sara’s case, our patients with vaginismus often reflect on their suffering as casting a dark shadow not only on the marriage, but on their whole self-concept and identity. Feelings of inadequacy, incompetence, and isolation are commonly reported, and with time these feelings often intensify if the vaginismus is not treated.

For a married woman, the ripple effect of vaginismus can exceed beyond just the bedroom. For some husbands, the notion of ‘inflicting’ pain on their wives via intercourse is so upsetting that it can affect their own confidence and sexual functioning, and distance may ensue as both spouses associate their sex life with pain and negativity. Many couples we treat will share that they have become less physically affectionate altogether; the other day a patient tearfully shared that at this point in her marriage, she won’t even hug or kiss her husband and she feels terrible for it. She knows it hurts her husband and makes him feel unwanted and unloved, but she is scared that touching him may send the wrong message that she is interested in having sex. For this couple, as well as so many others we treat, they have adapted to the sexual dysfunction by living like roommates; respectful to each other, set in a familiar routine, but feeling a significant void.

  

Fortunately, there is wonderfully effective treatment for vaginismus, but many women do not end up getting the appropriate help until significant time has passed and the emotional pain is that much greater. Because vaginismus is often a private struggle, many of our patients breathe a sigh of relief upon learning that they are not alone in their suffering, it’s not all in their head, and there is hope in eliminating the pain.

In Sara’s case, a problem that went on for years was able to be rectified in just a few months and she was able to finally enjoy the sexual connection that her marriage had longed for.  While it took some time to adjust to having a sexual relationship after being so accustomed to its absence, Sara felt a surge of unprecedented optimism.  After years of isolation, she felt reinvigorated in her whole outlook on life.  She felt excited about her relationship with Dovid. She could smile as she looked ahead to their hopes and dreams for their future together.  And she could finally feel comfortable with her body and its wonders.

In our next article, we will be exploring some of sociological, cultural, and Halachic factors that come up for frum women suffering from sexual dysfunction.