This is especially true when the reason for the inability to have intercourse is because the wife has a problem. As it is, she thinks she is a failure because she cannot sexually satisfy her husband. Since having a baby is also traditionally  the woman’s responsibility, the multiplicative effects of the sexual inability and the infertility create a problem which seems to be insurmountable.

While some marriages will break down because of the stress of the inability to have sex, some couples are quite happy to live together happily without having sexual intercourse, because they love one another. However, they will often seek medical help when they want to plan a family.

Medically, the name for the condition which affects a woman's ability to have sexual intercourse is called vaginismus. It also prevents her from inserting tampons and undergoing gynaecological examinations. The reason for this is due to a conditioned muscle reflex in the lower pelvic muscle called the PC ( pubococcygeus) muscle, which clamps shut , making penetration either extremely painful or in many cases, impossible. Wikipedia has excellent information on this condition, which I have reproduced below.  The woman does not choose for vaginismus to happen; it is a learned reflex reaction. A comparison which is often made, is that of the eye shutting when an object comes towards it. This, like vaginismus is a reflex reaction designed to protect our bodies from pain. A woman with vaginismus expects pain to come with penetration and so her mind automatically sends a signal to her PC muscles to clamp shut, thus making penetration either impossible or very painful. The severity of vaginismus varies from woman to woman.

The conditioned reflex creates a vicious circle for vaginismic women. For example, if a teenage girl is told that the first time she has sex it will be very painful ( and this is particularly true in conservative societies like India, where sex education is not provided, and most girls and women acquire their knowledge through overheard conversations and misinformed friends, she may develop vaginismus because she expects pain. If she then attempts to have sexual intercourse, her muscles will spasm and clamp shut which will make sex painful. This then confirms her fear of pain as does each further attempt at intercourse. Every time the fear is confirmed, the brain is being "shown" that sex does hurt and that the reflex reaction of the PC muscles is needed. This is why it is important that if a woman suspects she has vaginismus, she stops attempting to have sexual intercourse. This does not mean women with vaginismus can not partake in other sexual activities, as long as penetration is avoided. It is a common misconception that these women do not want to have sex as a lot of the time, they desperately do.

There is no one reason that a woman may have vaginismus and in fact, there are a variety of factors that can contribute. These may be psychological or physiological and the treatment required will usually depend on the reason why the woman has the condition. Some examples of causes of vaginimus include sexual abuse, strict religious upbringing, being taught that sex is dirty or wrong or simply the fear of pain associated with penetration, and in particular, losing your virginity. These are just some of the reported reasons behind vaginismus and there are many, many more. It is a very personal condition and so each case must be looked at individually as causes and treatment can not be generalised to all women with vaginismus.

Most women who suffer from vaginismus do not realise they have it until they try to insert a tampon or have sex for the first time and so it may come as quite a shock to them. Whether they choose to treat the problem or not is entirely their choice and they should never be led to believe that vaginismus must be treated.  It will not get worse or more serious if left untreated unless the woman is continuing to have sex/use tampons despite feeling pain on penetration.

Primary vaginismus occurs when a woman has never been able to have sexual intercourse or achieve any other kind of penetration. It is commonly discovered in teenagers and women in their early twenties as this is when the majority of women will attempt to use tampons, have sexual intercourse or complete a pap smear for the first time. It can often be very confusing for a woman when she discovers she has vaginismus as we are led to believe that sex is something that comes naturally to us. It can be even more confusing if the woman does not know why she has the condition, as is true for many women.

If a woman suffering from vaginismus desires to treat the problem then she can do so in many different ways. It does not have to be expensive and in fact, many women achieve relief from vaginismus without the help of any health professionals at all (although it is recommended that a proper diagnosis is sought).

If the vaginismus does not have any psychological grounds then physical treatment alone may be enough to fix the problem. This includes sensate focus exercises, exploring the vagina and desensitization involving vaginal dilators. Dilating involves inserting objects (usually mildly resembling a penis in shape), into the vagina. The best dilator is a finger, so there really is no need to spend money on expensive medical dilators. Not only can you control your finger very precisely, it’s much more gentle than an instrument.

It is very important to use a lubricant such as liquid paraffin whilst inserting a finger as it makes insertion a lot easier and less painful. Many women find using a local anesthetic jelly ( such as 2% Xylocaine) also helps, as it numbs the area and reduces sensitivity.

I usually advise my patients to take a stepped care approach in treating themselves. They first need to learn about vaginismus, so they realise that it's " not all in their head" , and that other women have successfully treated themselves . They then learn to pleasure themselves, by learning how to masturbate. Once they are comfortable doing so, the next step is inserting a finger in their own vagina. They can then move onto mutual masturbation. Not only does this help them achieve sexual release, it also helps to cement the relationship. Also, once you can allow your husband to insert his finger into your vagina, nearly half the battle is won ! It's a good idea to invest in sexual toys to make the process more enjoyable - this is a journey of love and discovery.

The process of curing vaginismus is usually a long one and will require patience, will power and determination. However, it is important to know that in 99% of cases, it can be successfully treated. Many people don't take into account the emotional problems associated with vaginismus such as low self esteem, insecurities and often even depression, so it is very important that if women choose to seek the help of professionals, they should try to find someone who is very understanding and who has previous experience with vaginismus. There is no need to suffer in silence !

My only advise is – be kind to yourself. It’s not your fault that you have vaginismus – it’s a disease, like any other, which causes suffering and pain !  You are not “frigid” – and it’s not all in your head !  

The best way of treating the “ infertility” is to treat the underlying vaginismus. However, this is easier said than done ! Because it is a psychological problem, treatment can be time consuming and difficult. Many couples would rather bypass the process  and concentrate on having a baby, without having to worry about having sex. For these couples, artificial insemination is a very effective treatment option. An easier alternative is self insemination, which they can do in the privacy of their own homes.