The Vagina Monologues: We need to talk more about sexual wellness

Meera (not her real name, and nobody in this piece is using theirs) had been married for fourteen months when we first spoke. The first thing she wanted to share with me was that she and her husband had never had sex. For most of those fourteen months, she was convinced there was something wrong with her, but she couldn’t quite put her finger on what it was.

She was 29 years old and worked as a software engineer in Bengaluru. Her wedding had been a traditional affair: two days of celebrations, a mehendi ceremony, and relatives who cried on cue. But when it came to the bedroom, things didn’t go as planned. The rose petals on the sheets and kesar doodh on the side table, which neither ended up drinking, seemed like a cruel joke. When they tried to have sex, it was painful, and Meera described the feeling as if her body was missing a door, like it was impossible to access.

They had laughed about it at first, but as time went on, the joke started to wear off. Her mother-in-law began asking about “good news” every Sunday at lunch, and Meera found herself scheduling work trips to avoid those conversations. As the months went by, Meera saw a couple of gynaecologists, spent a lot of money on pregnancy tests she didn’t need, and read a lot of stories from other women online. She started to think there was something wrong with her.

Nothing in her was faulty, and she was not rare either. She had vaginismus. In the five years I have spent as a pleasure and intimacy coach, I have worked with more than 5,000 women having it, and I can count on one hand the ones who arrived already knowing the word.

Vaginismus is when the muscles around the vagina get really tight without even trying. This makes it painful or even impossible to put anything inside—a penis, finger, tampon, or even a doctor’s tool during a check-up. It’s involuntary. That’s why people who deal with the issue hate hearing “just relax”. What’s really going on is that you have learned to see penetration as a threat, so the vagina tenses up before anything even happens. When you try to insert something, it hurts because the muscles are all clenched. And because it hurts, your body thinks it was right to tense up, so it gets even tighter next time. It’s a vicious cycle of fear, stress and pain.

These muscles are also connected to bladder and bowel control, so problems in the pelvic floor rarely stay confined to the bedroom. Many women with pelvic pain also experience a range of symptoms, including constipation, straining, a feeling of incomplete emptying of the bladder and a persistent urge to pee. I’ve also come across women who have been treated repeatedly for years for UTIs, or told they have sensitive stomachs, only to discover they had tensed pelvic floors all along.

Since 2013, the DSM-5 has grouped vaginismus with painful intercourse under a new category, Genito-Pelvic Pain/Penetration Disorder. But here’s the thing: the numbers we have, between 5 and 17 per cent of people who seek help for sexual issues, might not be telling the whole story. That’s because many of us would rather discuss our neighbour’s second cousin’s divorce than admit to a doctor that sex is painful. So the real number of people struggling with this is likely much higher. Some people experience primary vaginismus, where penetration has never been possible or has always been extremely painful. Others develop it after a significant life event, like childbirth, surgery, or menopause. And then there are those who have a frightening experience that changes everything.

It’s not just married women who deal with this; unmarried women, queer women, trans and non-binary individuals with vaginas, and people with disabilities or chronic illnesses are all affected. The healthcare system often fails to acknowledge these individuals have sex lives, making it even harder for them to speak up. However, the silence around this issue becomes most pronounced in marriages.

We grow up without learning about our own bodies, and instead, we are often taught about the reproductive systems of animals like frogs. This leaves a huge gap in our knowledge, which is filled by movies, rumours and old stories about what happens on the wedding night. These stories often portray sex as something done to a woman, rather than something she participates in.

Some, like the Kanjarbhat community of Maharashtra, take this idea to an extreme. A white sheet is given to the newlywed couple, and the community leaders inspect it the next morning for blood. Young people from the community have been speaking out against this practice since 2018. Even though none of my clients are from this community, many describe their first night in a way that makes it sound like they are waiting for someone to come and inspect them as well.

Our bodies respond to the same pattern we have anticipated in the past. A body that expects sex to be painful will tighten up. A body that has been informed a woman’s pleasure does not matter will not progress to arousal. The clitoris is made from the same tissue as the penis and becomes enlarged in a similar manner during sexual arousal. The vagina is only three to four inches long when unaroused but can lengthen and become extremely lubricated within twenty to thirty minutes as arousal builds. Many of my clients report their partner is ready within seconds while they feel they are taking forever. It feels this way because we have been taught that penetration is the end of sex and everything before that is just waiting in line. A woman who believes that sex equals penetration will attempt sex cold (without arousal), and when it hurts she will already know whose fault she has been told it is.

Gynaecologists are not the bad guys here. They are just another product of our same culture, holding the same misinformed perspectives and taboos; their years of training to earn a medical degree do not erase the years of stereotypes they have grown up with. Referring clients to gynaecologists every week, I’ve met some great ones, but also some not-so-great ones.

Take the case of Noor, a teacher from Lucknow, who took two whole years to muster up the courage to tell her gynaecologist that she and her husband were having trouble having sex. What did the doctor do? She laughed it off, told Noor she was just nervous, and suggested a holiday and some wine. Noor didn’t give up. She went to another gynaecologist, who tried to do an internal examination. But Noor’s body just wouldn’t cooperate; her knees locked together and wouldn’t budge. The doctor’s response? To tell her to stop being childish. The third gynaecologist was no better. He told her that her hymen was too thick and that she needed surgery to cut it. There are actually some rare cases where such surgery might be necessary but vaginismus isn’t one of them. The problem is that the muscles are responding to fear, not that there is something physically in the way. Cutting through tissue isn’t going to solve anything. But Noor was desperate and went ahead with the surgery. She ended up with the same condition, plus a new wound to heal and even more reason to be frightened.

Sexual medicine is barely covered in a gynaecologist’s training. This means patients may receive the same sort of advice their aunt might offer them, just with a different label. Gynaecologists also deal with a huge workload, seeing up to 60 patients a day. The patient ends up going home without any real help, and some couples, feeling pressure from their families, might even end up at fertility clinics without ever having had penetrative sex. It’s shocking to know specialists in this field have seen couples going through expensive and invasive procedures like IUI or IVF without anyone stopping to ask if they are even having sex, or if it’s painful for them.

A physical condition’s weight can be crushing—not just the condition itself, but the guilt of failing a partner’s expectations and the fear of being found out. Partners carry their own burden too: some are supportive, others pushy, mistaking persistence for romance; still others are simply terrified of hurting their wives, convinced every other couple has it easier. Over months of trying and failing, many lose interest in sex or struggle with erections altogether. It’s a lonely, isolating experience.

Vaginismus is one of the easiest sexual issues to treat. Back in 1970, Masters and Johnson saw great results with a gradual approach that lets the patient take the lead. Since then, most research has shown that people can get better with the right kind of care. I’ve seen it happen in my own practice: people who couldn’t even insert a small object, like the tip of an earbud, were able to have the sex life they wanted. In some cases, people went on to have penetrative sex; in others they discovered they still didn’t care for it. But for all of them, sex had ceased to be something that their body refused to do. This mattered more than the act of sex itself.

There’s no single solution, and the first session often matters most—that's when I show clients an anatomy diagram explaining where the vaginal opening is relative to the urethra. I've had clients with Master's degrees who didn't know, and had been attempting sex in the wrong opening for over a year. Then there's pelvic floor physiotherapy: the pelvic floor is a muscle that can be taught to relax, though most people don't even know it’s one. Psychosexual therapy addresses the underlying fear, shame and trauma, while sensate focus—touching without attempting sex—slowly rebuilds connection. Some doctors also suggest Botox injections. But there's no quick fix for the deeper issue: feeling that your body is your own. It’s a process, but the right approach helps people feel in control again—and that’s powerful.

Dilators offer a practical solution—made of medical-grade plastic or silicone, they come in a set ranging in width from the tip of a little finger to that of an erect penis. Start with the smallest dilator, regardless of how small it looks to you. You lie on your back with your knees up to your chest and a pillow under your hip/ lower back, and use plenty of lubricant. Before you even begin to insert the first dilator, take a few deep breaths into your belly and practise a gentle “drop” of your pelvic floor muscles, just as you would before you begin to pee after having held it for hours while seated in a long meeting. Slowly, and on an exhalation, insert the dilator to the point of resistance and then stop applying pressure. Take a few deep breaths and allow the muscles to release and soften around the dilator. Leave it in for a few minutes and then add some gentle movement, in and out and side to side. You continue this practice for 10 to 15 minutes on a daily basis, and you progress to the next size only when you feel that you have become bored with the current dilator. Remember that stretchy discomfort is okay to feel, but sharp pain means stop immediately.

Progress isn’t linear—many clients regress after a stressful week or around their period and fear they have undone their work, but they haven’t. Eventually a partner can hold the dilator, then use their fingers, then graduate to penetration; by then the body has had hundreds of safe experiences to draw on.

What often changes things is realising that sex isn’t just one act. I’ve seen this with couples like Jennifer and Ankit, who came to me after three years of marriage, feeling drained and barely intimate. Once they stopped fixating on the one thing they couldn’t do, they explored kissing, oral sex and touch—and Jennifer had her first orgasm at 36, well before penetrative sex became possible. She said they had forgotten they were allowed to simply enjoy each other.

Meera finally experienced painless penetration about seven months after our initial conversation. The message she sent me wasn’t about finally achieving her goal, but about something more profound. She mentioned that around week six, she stopped feeling like a broken person, while intimacy with her partner came much later, almost as an added benefit. And she didn’t tell me about that night first. She told me about the Sunday lunch after, when her mother-in-law asked about good news yet again and Meera said, “Mummy, we’re enjoying ourselves,” and then went back to her rajma chawal.