When women’s bodies reject the idea of sex

A few months into her marriage, Anjana R., 31, realised that she was unable to have sex with her partner. “My body would not respond. All I could feel was pain. I researched the condition and realised that I may be suffering from vaginismus,” says the Chennai resident.

Vaginismus is one of the lesser-discussed conditions related to women’s sexual health and wellness, where the pelvic floor and the vagina tighten up to avoid penetrative intercourse. It is an uncontrollable muscle spasm, a phobic response to penetration, which has harmful consequences.

Over the next few weeks, she visited three gynaecologists. “They gave me fertility advice. I felt gaslit; they were not ready to address my core issue,” says Anjana.

Taru Jindal, a Mumbai-based gynaecologist, who has helped over 450 women heal their vaginismus through a holistic approach, says that often when women approach gynaecologists complaining about “painful sex,” the doctor suggests surgery to remove the hymen or Botox to paralyse the nerves of the vagina. “They don’t understand that vaginismus is not merely a physical block; it is the woman’s mind saying no as it perceives sex as a threatening activity. It is often linked to trauma or sexual abuse in the past, the portrayal of violence against women in the media, or preconceived notions of sex being painful,” says Dr. Jindal, who suffered from vaginismus for nearly seven years.

High prevalence

While there is no nationwide prevalence study on vaginismus in India, multiple case reports and hospital-specific studies are cited to establish the prevalence of the condition. For instance, the Department of Obstetrics Gynaecology (OBG) Physiotherapy at the Karnataka-based Institute of Physiotherapy run KLE Academy of Higher Education and Research, conducted an observational study in 160 women from 20 to 35 who faced fertility issues and sought treatment. When they were screened for Vaginismus, 58% were found to be suffering from complaints linked to the condition: fear of penetration, painful sex, and tensing of the pelvic floor muscle. 

While researching her condition, Anjana stumbled upon Dr. Jindal’s work at a Bengaluru-based company called Proactive For Her. Their three-month online programme focusses on physical and emotional healing. “Traditionally, vaginismus is not taught in medical school. So, I referred to a lot of western material and designed a step-wise approach, which included psychological support, pelvic floor relaxation exercises, dilation of the vagina, couples therapy, and introduced pleasure components,” she says.

Anjana is middle-class. She enrolled for the three-month programme which cost her a steep ₹30,000. She said the programme was worth it, as it spanned eight weeks and included 24 sessions with multiple experts. Male partners were encouraged to join. “My partner financially supported my situation, so I was okay, but many women are unable to afford these costs. For some, the cost of the programme is their entire monthly salary,” she says. 

Dr. Jindal said that currently she is running the 32nd batch of 60 women, and there are already 35 women on the waitlist to join the next batch. “We now have the largest cohort of women living with vaginismus who have healed. We are in the process of publishing our research findings in an international journal, as historically there is hardly any research, data, or documentation of such cases from India,” she said.

Dr. Jindal said the programme cost has now been reduced from ₹30,000 to 20,000. “We have been receiving enquiries from women who could not afford the fee, so we have brought it down,” she said. 

It is not the case that vaginismus was not present in Indian women of the previous generation. However, in the previous generation, sexual pain was normalised and not questioned. Vaginismus has been described in medical literature since the mid-18th century in the United States. Women who have healed themselves like Petek Tatli from Istanbul and Katrin Maslenkova from Canada are now vaginismus coaches who help women heal world-wide.

Initiatives and start-ups that address lesser known conditions related to women’s sexual health in India are a positive step. “Women today are more empowered, and they are questioning their pain and speaking up,” says Dr. Jindal.

Proactive For Her was founded in 2020, with a business model revolving around OPD healthcare clinics for women. It currently has seven physical clinics in Bangalore and a large offering online. Just like private dental and eye care chains, Achitha Jacob, founder of Proactive For Her, aims to expand to 120 clinics in the top 20 to 25 cities in India. The firm has raised $6.5 million from Nexus Venture Partners and Vertex Investments.

The company is an omni-channel women’s health clinic, offering outpatient treatment for fertility, Polycystic Ovarian Syndrome, preventive cancer screenings, postpartum issues, mental health, pregnancy, and consulting lactation specialists. “As a company, we treat sexual health concerns, but we also look at hormonal, menstrual health, cancer screening and prevention, and pregnancy-related pelvic floor health issues,” Ms. Jacob said. 

Ms. Jacob says that in her twenties, she didn’t get answers to her questions about sexual health. “Healthcare is dismissive of women’s discomfort and pain, so I started a company that puts women at the centre of all of the offerings.” She adds: “There is already a lot of investment in research and development funding for men’s sexual health issues like erectile dysfunction and so on globally, whereas women’s sexual health and dysfunction as a topic is very new. It has just poked its head out in the past five years,” she says.

While currently the patient flow in the clinics is skewed towards women under 40, the company also works with older women. “For instance, we work with menopausal women on addressing their issues like sexual arousal and so on,” she adds.

([email protected])