May 2010
• Sexuality has many aspects such as biological,
anatomical, psychological, sociological and cultural and
they all affect the sexual life. Particularly society's wrong
beliefs about sexuality, culture, the concept of sexuality
in the society, local customs, traditions, sexual education
affect the sexual life and have an active part of the
emergence of the sexual problems.
• Vaginismus is a sexual pain disorder, where spasm of musculature
of the outer third of the vagina interferes with intercourse. During the
sexual intercourse not only the vagina muscles but whole body
contracts and there happens something like panic atac.
• Vaginismus is seen quite often in Turkey. According to the recent
surveys it is found that the prevelance of vaginismus is 1 in 10
women in Turkey. %73 of the women apply to sex therapy clinics
because of vaginismus. Vaginismus is not a common problem in
the outher countries. According to the Western sources, it is
estimated that the prevelance of vaginismus is % 1- 6.
Vaginismus is experienced in 2 types such as primary
and secondary vaginismus. Primary means the
experience of vaginismus in the ‘first-time’ intercourse
attempts. Secondary occurs after a traumatic sexual
relationship, child birth or a vaginal infection. Primary
vaginismus is commonly seen in Turkish society.
Nearly all of the vaginismus patients have primary
vaginismus. In a research which is conducted in 50
women who have vaginismus, it is found that % 70 of
them have primary vaginismus. This result shows us
that Turkish men have a lack of sexual knowledge and
they don't know how to treat their partners in the first
sexual relationship.
The possible causes of vaginismus are:
The fear of the first night (the first intercourse)
The hyperbolic importence of hymen in the society (having been taught that sex
is bad, harmful, sin, etc.)
The belief that vagina is so tight and small and penis can never penetrate
Negative thoughts about sexuality
To be a witness of parent's sexual relationship
Traumatic childhood experiences ( to be a victim or witness of sexual abuse)
High- level anxiety
To raise in a religiously or morally rigid family
Fear of getting pregnant
Fear of intimacy
Electra complex
The desire to be countinue being the daddy's good girl
Issues about the partner
To live in the same house with the parent in law.
The possible causes of vaginismus are:
In a study which is conducted on 200 women have vaginismus, it is found that
the most common reason of vaginismus is the fear of first intercourse caused
by inadequate sexual information. According to this study, causes of
vaginismus are:
The fear of first intercourse (%61)
To be forced by the partner during the firts intercourse and feel pain (%18)
Sexual abuse during childhood (%10.5)
To have negative thougts about sexuality (%4.5)
To be a witness of parent's sexual relationship (%2.5)
To be a witness of child birth
To have a pelvic or vaginal trauma ( %1.5)
In a study Sexual Health Institute conducted on 30 women who have
vaginismus, it is seen that the most common reason of vaginismus is the
conversion of the expectance of ''bleeding'' to the fear of first intercourse.
The First Night
Sexuality is still a taboo in Turkish society and the first intercourse
has a great importance. There is a concept called ''the first night''
in Turkish society. This means the first intercourse which has
to happen in the first night of the marriage. Just because of sex
before marriage is not allowable in Turkish society, both bride and
groom are sexually inexperienced. The obligation of having
intercourse at the first night makes the couple feel under pressure
and it usually ends up with failure. Woman usually thinks that it
will hurt and bleeed too much during the first intercourse and she
doesn’t let the intercourse happen and it becomes a habit in the
length of time.
Most common expressions of women who have
vaginismus are:
''I am afraid of feeling an awful pain during sexual intercourse''
''I feel like dying at that moment''
''I become so rigid when my husband touches me and I start
''I don't have a vaginal opening, it is impossible for me to have
''In the childhood it is told me that having intercourse is like to
undergo a lemon into the eye of the needle.''
''If I bleed to much and if it doesn't stop''
''A close friend of mine told me that there something happens like
bomb explosure during the penetration of penis to the vagina.''
''I feel pain even when I touch my vagina.''
''I am afraid if my vaginal muscles clamp down on the penis and if
penis can't get out from the vagina. How can we go to the hospital?''
Most common expressions of women who have
vaginismus are:
These expressions are the proof of why vaginismus is seen in 1 of the
10 women in Turkey. To be raised with the negative feelings and
thoughts since the childhood, to see sex as a painful and fearful action
intead of seeing it as a sharing of love and pleasure with the one you
love makes our women have vaginismus. When the woman expects to
have pain, the pain arises as a ''self fulfilling prophecy.''
Hymen has a great importance in Turkish society and it has to ''bleed''
at the first night. It is believed that bleeding is the proof of virginity.
Hymen must surely bleed and this blood must be too much. And also
there has been a common tradition in some regions of Turkey which is
lessened but not got lost yet. It is called '' bed sheet tradition.'' The
couple has to show their bloody bed shit in the morning aftter the
wedding night. If the couple couldn't achieve the first intercourse, they
has to finf f another solutions to show the bloody bed sheet, usuallt the
groom cuts his hand or arm and drains some blood. Now this tradition
is not common in big cities but it is often seen in the hinterland.
There isn't sexual education in our country and most of our
women don't have any informtion about their sexual organs.
Women who have vaginismus have negative feelings about their
vaginas, they see their vaginas as a dirty part of their body, they
are aimed to think that vagina is to small to take the penis in.
There are women who think that they don't have vaginal
openings. It's just because they don't have accurate information
about their body and sexual organs.
Another cultural reason of vaginismus in our country is to have the first
intercourse in a crowded house full with parents, relatives. Usually in
the hinterland it is common to live with the parent in law. This a
traditional stituation and also the couple may not have enough
materiality to have a seperate home. That's why they have to live in a
crowded house with their parents. To have a healthy sexual life, the
couple has to have a private place to be with eachother. But in these
conditions the couple doesn't have a privacy and the feel under
pressure during the sexual relationship, can't feel comfortable, can
abstain to their voice to be heard by the others. Because women who
have vaginismus usually think that they will shout aloud during the
intercourse and have a fear of people to hear their voices.
Arranged marriage is still common in Turkish society
too. That means men and the women see each other
several times before marriage, sometimes they don't
have a opportunity to have a date and then they get
married without knowing each other well. This type of
marriage can be a reason of sexual problems too.
A Cultural Model of Vaginismus Treatment
Vaginismus is may be the only sexual dysfunction which can be
treated completely. It can be treated successfully in 10 sessions
( this 10 sessions may last 7-10 days).
Teratment should be authentic. They should reflect the society's
points of view, thougts, traditions. Our vaginismus therapy
model is based on ''the expentancy of bleeding'' in the first
intercourse because the most common reason of vaginismus in
Turkey is the fear of bleeding and pain. This therapy model is
particularly avaliable for Muslim patients, but it also can be
adopted to other religions.
A Cultural Model of Vaginismus Treatment
As Sexual Health Instıtute we claim that hymen doesn't bleed if all the
conditions are normal. And sometimes we argue with the gynecologists
about this subject. But until now none of 1354 women who got the
vaginismus treatment in Sexual Health Institute bleed. We think that
this is a proof of our claim. To give accurate information is so important
in the treatment and in some cases it is just enough to tell the couple
that the hymen won't bleed can be the %50 of the treatment. Of
course it is not enough to tell it just to woman, all the sexual information
must be given to the couple together. Because men are so obsessed
about bleeding too and if it doesnt bleed they can blame their wives
with infidelity.
A Cultural Model of Vaginismus Treatment
''First believe, then make believe''
Sex therapist must believe that he/she
will treat the patient herself/himself
first, then can make the patient to
believe that she will overcome
''The importance of using fingers instead of dilators''
Finger dilatation exercises are one of the most important
part of the treatment. In treatment we prefer to use fingers
instead of dilators. Because dilators are unnatural, but
fingers are a part of our body and they are more natural.
Most of the woman who have vaginismus has a great fear
about the finger dilatation exercises and they th,ink that
they can never achieve that. But when they believe
themselves and try again and again they can achieve the
It must be called ‘’brainismus’’, not vaginismus
The vagina muscles do not contract on their own, the
reasons of their contraction are the negative thoughts
and beliefs about sexuality and sexual intercourse.
Brain is responsible of vaginismus,not vagina. That’s
why we believe that the name of this sexual
dysfunction must be brainismus, not vaginismus.
Vaginismus is ‘’a postponement and avoidance illness’’
Women who have vaginismus postpone applying to the therapy
consistently because of their fears about sexual intercourse and
because of this reason vaginismus may last for years. Until now we had
patients who are married for 5, 10 or 15 years. There was a case that
they were married for 22 years but they didn’t come to the therapy.
Because after sometime living without sexual intercourse becomes as a
habit and the couple gets used to live like that. In the first years of the
marriage they believe that vaginismus will go on their own, then years
go by and they start to think that there’s no cure for vaginismus and
there is no hope for them. They go on living with vaginismus.
The Stages of the Vaginismus Treatment
Determining the problem
Taking the sexual history
Giving detailed sexual information
Eleminating the fear and expectation of bleeding with the
congnitive reconstructive techniques
Teaching relaxation exercises
Self knowledge and body knowledge exercises and
sensate focus
Personal and couple finger dilatation exercises
Limited penis insertation and sexual intercourse
Exercises for increase pleasure
Bad Treatments for Vaginismus
 To accept having a sexual problem and apply to a sex
therapist may be so embarrassing for the couple. That’s
why they always postpone the therapy. In Turkish culture
having a child is an important part of the marriage and
people start to ask why they don’t have child. That’s why
couple comes to the therapy usually when they want to
have a child.
 Patients always want ‘’a miracle’’. But there isn’t a miracle
treatment. The couple tries many different ways before sex
Bad Treatments for Vaginismus
 In Turkey first of all they go the hodjas. Then they try short
and fast ways to get rid of vaginismus. One session
treatments, hymenectomy (removal of the hymenal tissue
with an operation), having the sexual intercourse
under anaesthesia in the therapist’s office, sometimes in
front of the therapist, applying anesthetic creams to the
vagina, applying botox to the vagina, applying vapour bath
to the vagina to relax the vaginal muscles, sitting in the
hot water, using tranquillizers and muscle relaxants, etc.
Bad Treatments for Vaginismus
 In an University Hospital in Ankara it s determined that
%50 of the woman who applied there for vaginismus
treatment had hymenectomy. But vaginismus is a
psychological condition and hymenectemy doesn’t solve
the problem but only makes it worse If it is considered that
women who have vaginismus have difficulty to have
gynecological examination, having hymenoctomy may
cause avoidance of sex and malke the situation worse
than before.
Usually in vaginismus treatment it is aimed that to
insert penis to the vagina. But we believe that the
treatment doesn’t end up when penis enters the
vagina. The treatment finishes when the couple has a
healthy and satisfying sexual relationship and woman
starts to get pleasure from the intercourse.
What can be done to prevent Vaginismus in Turkey?
The only way to prevent sexual problems is to
heighten sexual awareness by giving sexual
As Sexual Health Instıtute we offer that Sexual
Education should be made legally compulsory
starting from kindergarten and civil governments
must provide Pre-marriage Sexual Counseling and
Guidance Services to the couples who are about
to marry.
What can be done to prevent Vaginismus in Turkey?
Aslo we have many Turkish patients who live in Germany.
Particularly young girls get married and go to Germany for
living, they can’t speak German, they can’t Express
themselves and also they usually have sexual problems
cause by living wth parents in law. And they can’t know
where to go when they have a sexual problem. We
believe we can do something do something for Turkish
people who live in Germany, we can organize seminars
and educations for giving right sexual information to them.
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