Finding solutions for sexless marriages
There are numerous causes for inability to perform, experts tell Claire Keeton
WHAT happens when the vow to live happily ever after does not include sex? Sexual health physician Dr Elna Rudolph has seen about 300 patients at the Centre for Sexual Health in Pretoria who could not have sex, and Johannesburg sexologist Professor Elna McIntosh has treated more than 1 000 patients with this condition at the Disa Sexual and Reproductive Health Clinic.
“I had a woman the other day who hadn’t had sex ever, and she had been married about 25 years,” said Rudolph. “She had a genetic condition, and within six weeks of treating her she and her husband had consummated their relationship.”
Nearly all the patients at the Pretoria centre where she works are white, educated, in their 20s or 30s, and from Christian or Muslim families.
For McIntosh it is different. “Most of my patients are Indian, both Hindu and Muslim, because I have many patients from India and they are in arranged marriages,” she said. “I have black, white and coloured patients in equal percentages.”
They seek treatment when they want children or because their self-esteem and relationships are taking strain.
An Afrikaans-speaking woman with Christian beliefs from Emalahleni described this painful cycle and her cure.
“We didn’t have sex before marriage, and the first night of our honeymoon, when we attempted it, was weird. In time, I got spasms and it became painful to do anything, so I became more and more reluctant. After a year, I went to the GP, but it didn’t get better. I felt emotional pressure that I was doing something wrong. By the second year, I would try once a month and then I couldn’t take it any more. Last December, I went to Elna [Rudolph].”
Following this consultation, she started physiotherapy and psychotherapy, doing physical and mental exercises and dilator training at home.
“I was determined and I couldn’t believe the progress by the end of one week. In two months, [our sex] life was transformed completely.
“I just want people to know there is help,” said the woman.
Conservative or religious backgrounds were the most common nonmedical reasons for vaginal pain disorders, said the sex therapists. But a family upbringing is not the only factor. Rudolph has seen two sisters, one of whom has a healthy sex life, whereas the other finds the act impossible.
Women with anxiety and obsessivecompulsive disorder tendencies seem more prone to it. Psychosexual therapist Catriona Boffard said she had seen “quite a lot of [women with] OCD and perfectionist tendencies and anxieties” with this condition.
Obsessive-compulsive behaviour was linked to control and “some women feel a deep-seated fear of letting go”, said McIntosh.
Sexologist Babalwa Funda kaMabhoza, based at Medunsa University in Limpopo, said sex education was needed in South Africa. “In the black com-
I got spasms and it became painful to do anything, so I became more and more reluctant
munity, some myths and taboos around sex describe it as painful and dirty.”
She had also heard about vaginal pain connected to traumas such as rape. These women typically experience secondary vaginismus, defined as “tightness, pain or penetration difficulties later in life after previously being able to have normal, pain-free intercourse”.
Primary vaginismus is “an involuntary spasm and tightness around the vaginal opening” — the most common cause of unconsummated relationships from the woman’s side.
“People don’t imagine the pain, and it is not just in the mind,” said Rudolph. “There is muscle and nerve involvement.”
Said McIntosh: “People feel a social pressure that everybody is having sex and they’re not.”