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Xinyi Cheong, Tse Yeun Tan, Caroline Shi Ling Chua, Jean-Jasmin Mi-Li Lee, Seng Bin Ang, A Case Report-Primary Vaginismus: Predisposing Factors in Singapore, The Journal of Sexual Medicine, Volume 14, Issue Supplement_4b, May 2017, Page e332, https://doi.org/10.1016/j.jsxm.2017.04.576
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This case report is representative of the typical vaginismus presentation to our multidisciplinary sexual health clinic with predisposing factors identified in the local context. A 36-year old Chinese lady with 6 month-history of unconsummated marriage due to 1°vaginimus presented with the aim of starting a family. The couple were both sexually naïve virgins. Long working hours were cited as a cause of reduced libido.
We employed a multidisciplinary approach by clinician, psychologist and physiotherapist. Treatment addresses sexual knowledge deficiencies, lifestyle and communication issues; and utilises sensate focus, cognitive behavioural relaxation therapy, vaginal muscles training and trigger point release techniques.
Vagina intercourse was achieved after 7-months therapy resulting in spontaneous conception.
Singapore is a multi-ethnic, multi-religion Asian society. Sexual naivety in our married vaginismus patients can be a result of social norms, where pre-martial sex is not socially acceptable and is also due to sexual education programs promoting abstinence until marriage. With more couples getting married later in life due to education and work factors, we observed a trend of late 1°vaginimus presentations after marriage. Presentations are often prompted by desire for procreation rather than sexual fulfillment. Housing considerations also factor in their presentation. In land scarce Singapore, subsidized government housing is made available to newly married couples. However, the long waiting period for housing leads to the phenomenon of couples continuing to reside separately, or together in parental homes after marriage. This living arrangement affects opportunities for sexual intimacy. The Singapore workforce registers one of the highest work hours worldwide leading to poor work-life balance. Fatigue and long work hours impact sexual intimacy and delay couples from seeking earlier treatment. In face of these societal trends which are difficult to modify, educating medical professionals to recognise and treat the condition early as well premarital sexual education maybe a more realistic treatment approach.
