In addition, physiological factors also hamper lubrication. The Bartholyn glands located in the vaginal wall are responsible for secreting lubricating fluid. However, in the presence of infection, they swell up, says Dr Duru Shah, scientific director of Gynaeworld. Treating this fungal or bacterial infection helps ease the pain, says Shah, who tackles at least two cases of painful sex a week.

A deep pain In the case of Vaginusmus, the pain occurs at entry point. Sometimes, women, who do not experience pain at this stage of the act, may reel under debilitating pain during or after the act. In the case of women who are battling endometriosis, the uterus and ovaries are placed close to the vaginal wall. Thrusting may cause friction, leading to pain. The treatment — medical or surgical — would depend on the cause of the condition. “Most women who suffer from deep dyspareunia also live with painful periods,” says Shah.

Enter botox When the cause of pain is psychological, there are doctors who will help you with a Botox jab. Two ml of botulinum toxin is injected into the skin in a non-surgical cosmetic procedure to block muscular nerve signals, which then weakens the muscle so that it can’t contract. Each dosage of two jabs costs Rs 30,000. Dr Sanjay Pandey, consultant urology, andrology and gender reassignment surgeon at Andheri’s Kokilaben Dhirubhai Ambani Hospital, “helps patients relax the muscles of their vaginal wall with a Botox shot, so that they don’t clamp up.”

This, he admits, is reserved for rare cases of Refractory Vaginusmus after counselling and exercises have failed to help and starts showing results in a few weeks. Pandey has offered the treatment to 24 patients in the last six-and-a-half years. The effect of the jab lasts between four to six months, which means women have to come in for ‘follow ups’. “There are no side effects, except that it may not work on some patients at all,” adds Dr Sejal Desai, consultant gynaecologist and director of Saral Hospital in Santacruz. “Although it’s possible in some cases, that the woman dissociates pain from sex and is able to have intercourse normally even after the Botox wears off.”

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