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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Hello Doctor. I am asking this question on behalf of

Answered by
Dr.
Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 3119 Questions

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Posted on Wed, 13 Feb 2019 in Sexual Health
Question: Hello Doctor. I am asking this question on behalf of my wife. She is a Rheumatoid Arthritis patient for the past 6 years, flares well kept under control. Her medications include HCQ200 x 2 per day, Prednisolon 2.5mg x 1 per day, Folic Acid supplements. We both are married for past 1.3 years. We tried to have sex, but I am unable to enter her vagina. I tried inserting a tampon and a single finger into her vagina, she feels uncomfortable and if I try to put force she says its painful. We went to a gynecologist and she has said she has mild vaginismus. Her lubrication is lower sometimes. I once ejaculated on her vaginal opening. She then used her finger on the vaginal opening along with my semen as said she was comfortable to touch it. Is there a way to cure her spasm and promote vaginal penetration? Do her Rheumatoid Arthritis medications cause any of these issues? I am really concerned about this issue. Thanks in advance.
doctor
Answered by Dr. Ashok Kumar 2 hours later
Brief Answer:
Consultation

Detailed Answer:
Dear XXXXXXX
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

Vagnismus is a disorder where the psychological component plays major role. Most individuals with the problem have history of excessive moral policing, childhood trauma (physical and/or sexual), Relationship problems, poor sexual knowledge, fear of pregnancy or related issues after child birth among others.


The most important thing here is to unearth the cause as without doing so it becomes difficult to treat the problem. Although gynaecologist are needed to diagnose the problem but psychiatrists are needed to treat the disorder. The other fraternity which can treat this disorder is relationship psychologists or clinical psychologists.

Since she is comfortable to touch herself down there, helping her to explore her own body can help you in understanding the problem and help her in treatment process. This is indicated if she desires to help herself although this can be better achieved with help of psychologist or psychiatrist.

Regarding her medical condition I must inform you that Rheumatoid medications have little role, if any, in causation of vaginismus.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ashok Kumar 22 hours later
Thank you for your detailed response. I have a follow-up question.

I tried to penetrate pushing through her hymen. It's so hard when I tried to push and feels as if like there is tough muscle or a wall. My penis then tends to lose its hardness.

Since we are having sex for the first time, I tend to lose my erection at times. My penis is hard during foreplay or when my wife touches it, but when I tend to penetrate into her vagina it starts to lose its hardness.

Since my wife has to breathe in and relax before I can do a penetration I start losing my previously gained erections after which I am not able to get my erection back. If she excites me, I gain erection soon and once I tried to penetrate, I start losing my erection slowly again as her vagina is tight.

Will I need some treatment or tests to be done, is this a condition to be concerned or will it get better?
doctor
Answered by Dr. Ashok Kumar 7 hours later
Brief Answer:
You does not need any treatment

Detailed Answer:
Dear XXXXXXX
Thanks for follow up.

Being a male it is disadvantage when your partner have a problem. Call it men ego or something else, men tend to believe that there is problem with them and start wandering what need to do.

However when there is vaginismus to the female partner and the male partner is easy to arouse again and again(as in your case), I do not think he needs any form of treatment. You need to keep you confidence with correction of any misplaced beliefs such as since I am men, I must penetrate. It does not always go that way. Sex is something where both partners need to have intact physiological mechanisms and when there is problem with one partner, she needs to get treatment and other need to remain supportive.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar 16 hours later
Thank you, doctor, for your clear explanation and suggestion. I understand as what is really happening.

You are right, it seems to me I am having a wrong conception about penetration and anxiety when I fail to do it.

Regarding the treatment side of vaginismus, you had suggested in your first answer that its more of psychological treatment. Should this approach be done by us visiting a psychologist/psychiatrist as the first step towards a treatment or an examination via gynecologist? Also, is it a psychiatrist or a psychologist who has more control over this issue? Thank you very much.
doctor
Answered by Dr. Ashok Kumar 2 hours later
Brief Answer:
A combined approach is generally better

Detailed Answer:
Dear XXXXXXX
Thanks for follow up.

Although the psychologists have better counselling skills and control over psychological issues but they lack any form of knowledge about medical issues. On the contrast psychiatrist have adequate knowledge about medical as well as psychological issues and they can help you in all domains of vaginismus problem.

Considering these two facts you need to visit a psychiatrist first. In case she/he is comfortable and have enough to devote for individual case can help you all around. However due to lack of time they take the help of psychologist in treatment process and often consider combined approach a better option.

I hope this helps you further.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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