This was the only question that had been a permanent guest inside Reena’s head. With her mental make-up at best a shadow of its former self, Reena was hoping that Dr. Samatha would be able to give answers to evict this unwanted question from her thought system. Even as Reena was keeping her fingers crossed, Dr. Samatha, a firm believer of being open and connected with her patients, thought it would be best to keep Reena on the same page as her.
Therefore, Dr. Samatha told Reena that she suspected it to be a case of Vaginismus, but before the name of the condition could cause any more distress than Reena was already undergoing, Dr. Samatha found it necessary to explain what the condition was.
As evident in Reena’s case, Vaginismus is primarily defined by the tightening of the vaginal muscles as there is an attempt to insert a foreign body inside the vagina. These foreign objects could be a tampon, penis, medical instruments and even the patient’s own fingers. Coupled with the involuntary tightening of muscles, the patient could also experience pain, burning or stinging sensation. While these are the physical symptoms of the condition, there are also psychological symptoms like fear and loss of emotional control when an insertion or attempt of insertion happens.
With this part explained clearly to Reena, Dr. Samatha gave her some time to absorb all the information and have clarity in understanding if this was the case with her. After much thought, when Dr. Samatha asked her if she was ready to answer a few questions, Reena felt she was in a place to answer her better.
The first thing that Dr. Samatha wanted clarity on, was whether Reena has experienced any form of sexual abuse. This could be in the form of molestation or a forced attempt to penetrate. Considering that this type of abuse isn’t uncommon at all and that many girls and women bury it in the deepest chambers of their conscience, never opening up about it, Dr. Samatha wanted this information to make her diagnosis accurate. Any form of sexual abuse, whether during childhood or as an adult, can have an intense psychological impact, triggering the vaginal muscles to become the first line of defense, the tightening becoming the initial resistance to any attempt of penetration.
Then of course, any victim of sexual abuse will have the whole incident played and replayed inside their heads, making the act of inserting anything inside their vagina a very traumatic event. The fear takes control of the whole body, making an act as harmless as inserting a tampon or consensual sexual relationship very scary, thereby making the vaginal muscles tighten even further. Apart from this, lack of sexual awareness, or improper sex education can cause vaginismus. Psychological factors like fear could also contribute. In many cases, there could be no specific cause or trigger for this condition.
The other causes of vaginismus could be any surgery in the vaginal area, such as a vaginoplasty or hymenoplasty, causing the vaginal muscles to become abnormally tight, the after effects of childbirth, or even menopause, when a woman produces less estrogen, leading to less lubrication, contributing to pain and dryness during sex.
Now, vaginismus comes in two forms: primary and secondary.
Primary Vaginismus is when the patient has never had non-painful sexual intercourse, as in the case of Reena and Secondary Vaginismus is when a patient has had non-painful intercourse before, but has started experiencing pain and discomfort recently. While primary vaginismus could be a result of sexual abuse, lack of sex education or simply fear, the secondary type could be a result of surgery, childbirth or menopause.
When it was clear to Dr. Samatha that Reena had no history of sexual abuse and could be experiencing primary vaginismus, the next step for her was to make a diagnosis.
In order to take the appropriate steps forward, it’s important to determine whether the patient has that particular condition, or whether it’s something else altogether. In the case of vaginismus, the first step is to conduct a pelvic exam to determine the exact cause of the problem.
Wait, a pelvic exam?
The moment Dr. Samatha revealed her course of action, she immediately spotted the worry creases between Reena brows. When Reena asked her what a pelvic examination would entail, her worst fears came true. She immediately expressed her concerns, the same feeling of fear taking over her, but here’s where the difference between a good doctor and an extraordinary one clearly shows. Sensing Reena’s discomfort and anxiety, Dr Samatha first comforted her and then took her through how it would happen.
A pelvic exam is critical in determining whether a patient has vaginismus or not. To ensure that Reena would not have a panic attack, Dr. Samatha calmed her down, making her understand why this step would be important in resolving the complications that had arisen in Reena’s life. Obviously, Reena did want to understand the root cause of the problem which is why when Dr. Samatha explained that the pelvic exam would actually be a good thing for Reena, she understood and put her fears aside to understand how it would work.
Keeping her tone calm as to not trigger worry in Reena, Dr. Samatha explained to her that she would be asked to dress in a hospital-provided, sanitized robe for the ease of examination. Then, she would be asked to lie down on her back, comfortably. “It’s that easy,” continued Dr. Samatha, carefully observing Reena’s facial expressions, taking mental notes of her psychological state. Again, this is the thin line defines the calibre of a doctor. While most doctors just proceed with the pelvic exam, the ones with credibility like Dr. Samatha are the ones who take note of every minute detail in the attempt of making the procedure as comfortable for their patients as possible.
Next, Dr. Samatha continued, she would visually inspect Reena’s genital region for structural abnormalities, explaining that it would definitely cause no physical discomfort, managing to coax a slight giggle from Reena. Now confident that Reena was a bit more relaxed, Dr. Samatha cautiously treads the path that causes to bring anxiety right back. The upcoming steps would be more intrusive, entailing the insertion of the doctor’s fingers to check for the health of Reena’s reproductive organs.
Dr. Samatha said the experience wouldn’t be anything as scary and she promised to be as gentle as she possibly could be. With an earnest and heart-felt assurance to be careful and not cause pain, Reena’s anxiety was lowered as she agreed to try a pelvic exam.
So, how did Reena do in her pelvic exam? Did she even get past the first stage? Keep watching this space for the next part of Reena’s journey with Dr. Samatha Kumar
