by Dr Agilan Arjunan
This couple came to see on a busy clinic day on a Saturday.
Since Saturday is a half day clinic, usually the flow of patients are quite quick. They came into the room and we greeted each other. However, I noticed that they appear a bit nervous. “Probably their first visit to a fertility clinic” I thought to myself.
“Hi, good morning . I’m Dr Agilan. How can I help you ?”.
“Doc, we have difficulty having sex for the past 5 years”, said the wife. Husband just looked at me.
I stopped and adjusted my posture. I thought to myself, ” This couple needs help and I am not going to rush them through, even if its a Saturday”.
They have been married for 5 years now. They are both 38 years of age and this a first marriage for both of them. They have been unable to have penetrative sexual intercourse.
“I feel pain during penetration, I become very anxious and tighten up involuntarily. I have tried to relax but I can’t. I tend to push him away without me realising ” she said as she looked at her husband.
They had even seen a psychiatric because those who knows their problem, keep on telling her ” It’s all in your head”.
The rest of the history was unremarkable and it was strikingly clear what is the problem at hand.
I realise that I should start fertility treatment as soon as possible because age is not at their disposal. I then decided to skip the standard sequence of fertility assessments. I decided to tackle the obvious than chasing after the probable.
I told them calmly, ” To get pregnant, we need the egg and the sperm to make an embryo which will implant in the uterus”. I paused and then continued, “In your situation, the embryos are not being made and I am going to teach you how to do just that”.
The wife looked surprised, puzzled and worried at the same time. Since it is only Day 5 of her period cycle and luckily her periods are regular, I asked them to come again in 1 weeks time.
They came 1 week later . I did an ultrasound scan abdominally and noted that her ‘egg’ is probably ready for ovulation. An urine test confirms that she is going to ovulate in the next 24 hours.
“Today you are both going to learn something new” , I told them.
“I need you to produce semen sample today” , I told her husband.
” Then you (looking at the wife) will insert the semen into your vagina using this thin tube” I explained.
“This is called intra-vaginal insemination”.
That’s what exactly they did. Two weeks later , my clinic got a call from the wife told my nurse , “My urine test is positive !”.
I saw the happy couple 2 weeks later and confirmed the pregnancy by scan and again at about 14 weeks into her pregnancy. I discharged her from my clinic to an obstetrician near her home to continue her antenatal care. I advise them to seek long term treatment for vaginismus.
Take home message :
1. A proportion of couple suffers from vaginismus (pain during penetrative sexual activity) which makes it difficult to conceive.
2. Seek treatment early from a fertility specialist.
3. Intravaginal insemination is a simple and very effective treatment for infertility due to vaginismus.
4. However, couple should seek long term solution for vaginismus.
Disclaimer: The stories told in these series are based on writer’s own experience. Appropriate consent has been obtained prior to writing this series and the couples are kept anonymous.