Vaginismus is a condition where the muscle walls of the vagina contract in response to attempted penetration.
The involuntary muscle contraction can be mildly uncomfortable or it may cause searing or tearing pain.
"The female partner may have tremendous involuntary spasm in the outer one third of vagina at the attempt at penetration or sometimes even by anticipation of penetration.
Because of the fear of pain, she may come up with excuses to evade sex," says Dr Prakash Kothari, sexologist.
The problem is not between the legs, but between the ears, he says.
Vaginismus occurs mainly due to fear and anxiety.
The woman would have heard stories of pain and bleeding during intercourse that make her fear the act.
So, when the man makes the attempt, she has involuntary spasms in the outer part of the vagina.
"Vaginismus is intuitive and involuntary.
Despite her willingness, a woman could be unable to encompass intercourse," adds Prakash.
A couple's inability to engage in sex is considered to be one of the major problems among married couples.
A study conducted by Dr Promodu's Institute of Sexual and Marital Health in Kochi from January 31, 2006 to January 31, 2010, says that vaginismus is the second largest cause of unconsummated marriages globally.
The study was conducted on 4003 cases of which 770 were due to infertility and vaginismus accounted for 17%.
The unusually high prevalence of vaginismus has been reported by western studies, too.
According to a study conducted at State University of New York Health Science Center, the vaginismus incidence rate is 40%.
Women having vaginismus may have severe pain during sexual intercourse without any apparent reason.
Penetrative sex will be impossible due to the tightness of thighs and the pelvic area.
They may even refuse to undergo a checkup by a gynecologist.
Vaginismus is more common than previously thought.
One needs to use common sense to resolve it, says Prakash.
"The most important thing a girl should remember is that vagina is an elastic organ.
When a doctor puts a finger for examination, it expands that much.
When the baby comes out, it dilates so much.
Vagina can accommodate any variety of penis, big or small.
If you remember this, most of the anxiety gets over," he says.
Pelvic inflammatory diseases, ovarian cysts, lack of lubrication, inflammation or infection in the vagina, endometriosis and Bartholin's cyst are some of the reasons that could cause vaginismus.
Women with happy sex lives can also develop vaginismus later on, known as secondary vaginismus.
Prakash recommends Kegel's exercise to patients with vaginismus.
It is a simple exercise wherein one has to hold the urine midstream and then release it.
Then after emptying the bladder, lie on your back, tighten the pelvic muscles, hold the tightening for five seconds and then relax.
It helps strengthen the pelvic floor muscles, which support the vagina and uterus.
"When you indulge in Kegel's exercise, the involuntary muscles become voluntary," says Prakash.
Then there are vaginal dilators to treat vaginismus.
"Shaped like a penis, they are available in various sizes.
Once a woman becomes comfortable using a dilator, it is easy to convince her that a penis of the same size can go in, too.
Usually, she accepts it and a normal sexual intercourse is possible," he says.
Prakash does not use any drug while treating vaginismus.
"It takes just 5-6 sessions and the problem is resolved to the partner's satisfaction," he says.
"Supportive psychotherapy and behavior modification also help treat vaginismus," he adds.
However, Prakash does not recommend dilators for patients with vaginismus.
The wounds vaginismus leaves in the mind need to be healed first, he says.
"I think sex therapy including cognitive behavioral therapies and counseling sessions work better than dilators.
Patients with vaginismus may have a lot of psychological problems including fears and deep seated aversion of sex.
There could be relationship problems as well.
We help the patient overcome them through psychological treatment.
In the last phase, sexual problems are corrected," he says.