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Case Study

Every cloud has a silver lining
Dr M O Mini

Vaginismus is a spasm of the vaginal and levator ani muscles during attempted coitus or attempted PV examination. Vaginismus is of 2 types - primary and secondary. 
1. Primary Vaginismus: There is no anatomical or pathological cause for vaginismus. 
2. Secondary Vaginismus: Spasm may be brought about by painful local lesions such as small-infected lacerations of hymen, vulvitis, vaginal operations etc. The spasm in this case is not unlike that seen in primary vaginismus. Removal of the cause will cure this condition. 

Vaginismus always has a psycho neurotic basis. In most cases there is subconscious dread of sexual intercourse. This is often misinterpreted as frigidity, whereas in actual fact the patient is normally oriented towards coition, if she could overcome her anxiety. 

Case: One of my schoolmates approached me for advice. I knew her quite well but did not know anything about her medical history. She is a young, energetic woman with a loud voice, pushing her ideas in meetings whenever we met. She is thin, tall and dresses in a most attractive way. Her long black hair and blue eyes give her a soft appearance. 

Complaints: - Severe pain in vagina while attempting coition. Screams with pain
- Anxiety and depression for the last 3 months
- Loss of sleep and fatigue

History: She is the only child of rich parents and is suitably pampered and arrogant. She is used to getting whatever she wants. She was excellent in studies and very career oriented. After school she took admission in engineering. She got an attack of depression after one year in engineering. She had constant thoughts of insecurity and death and was taken to a psychiatrist.

Life Situation: With a sad look she explained that her best friend, a senior female student who had completed her studies, had left college and hostel at that time. I enquired whether she could remember having similar attitude in the past. 
She explained "I cannot confide in anybody. I am very short tempered. I have little contact with people and very few friends. During college a female student and a room mate was my best friend. I loved her a lot and she was the only one whom I felt a strong clinging tendency and was very attached to her". With a hesitated and irritated manner she explained that their bonding sometimes changed into lesbian contact. She felt ashamed, but was secretive in order to sustain the relationship. Parting from her beloved friend had brought about her anxiety and depression. She still loves her and dreams about her. With psychiatric treatment she recovered from the illness and completed her engineering course with good grades. At the same time she had a love relationship with her classmate, a strong, handsome young boy. But she does not have any hard feelings about it. 

She had an arranged marriage 6 months earlier. Her husband is also an engineer. During the honeymoon in Ooty, she discovered her vaginismus. She cooperated very well with all the foreplay and even desired lovemaking. But any attempt at coition left her screaming with pain, leaving both disappointed.
I remembered the words of Dr Prakash Kothari, the famous sexologist that teaching the right approach with examples, slides, films and models can cure most sexual problems. I enquried about the possibility. She told me that they had seen many blue films and had read a lot of books about sex, but to no avail. She wanted to make love and was compelled to masturbate. She had no dryness of vagina. 

After 2 months of marriage, she was treated by a gynecologist with some muscle relaxants and sexual exercise. But she did not respond well to the treatment. Her husband took to drinks. Several attempts of forceful attacks on her after drunken bouts became a routine in her life. One day after a forceful, failed attempt, her husband left her room and started to sleep separately. She was shocked. She would often lie awake for hours weeping. She became confused, anxious and totally indecisive about her future and thought it wiser to go to her mother. 

My Assessment: At the end of the case taking, I went through the sexual history she had filled out for me. During college days she was loved by one of her classmates, a smart handsome young boy. Around the same time she got anxiety and depression when her female friend left the college. Even though she enjoyed the lesbian contact she felt ashamed and had a sense of guilt about lesbianism. 

In Synthesis I found the following symptoms for Platina:


Sexual desire violent masturbation driving her to


Sensitiveness vagina


Vaginismus, coition during



Ailments - love lesbian


Anger, weeping alternate




Ailments sexual excess


Forsaken, isolation sensation of




Vaginismus - coition painful


Vaginismus coition preventing



Sleeplessness activity of thoughts from


I gave her Platina 1M /1 dose followed by Placebo to be taken before bed. 

After 2 weeks: she reported that she is doing well. Her anxiety is reduced. She feels better, more confident and able to handle her excitements better. She sleeps better and her fatigue is also less. With a smile she added that she had planned to go back to her husband the next day. She was given Sac-lac for another 2 weeks. After one week she asked me for a new appointment.
She and her husband entered my consulting room with a pleasing smile. With a blush, she explained that after seven long months they have started their honeymoon nights.
After 6 months: She continues to do well with only one dose of Platina 1M. Daily before bed she takes Sac-lac. She is very much afraid to stop the dose. She is now happily into her first pregnancy.