Many problems arise during the first intercourse. Young women usually do not have enough information rather they are not permitted, even to discuss about their marriage and related problems, by our society.

Men too have little information and the information they get from their friends is usually wrong and instead of helping them create other problems.

In our society women boast that they do not enjoy intercourse and in fact they enjoy it a little. When girls get married they loathe and are afraid of this act because this act is considered bad or this is presumed that only men are interested in it and women do not enjoy it. Apart from this there are many stories rampant about it that the intercourse is very painful and there is bleeding too etc. At the time of marriage mutual love and affection is expected less whereas apprehension and fear of intercourse is more.

Boys have fond anticipation of the sexual act but usually the information, they have about it, is not from any authentic book or person because in our society neither the parents and teachers nor the media, including newspapers, magazines, radio, television etc provide any guidance in this regard. The only source of information available to youngsters is their mutual discussion which is often based on wrong information because it includes notions from ancient books, Hakeems and quacks. This is the reason that instead of correct guidance wrong ideas are propagated. It is necessary that the husband should approach his wife with confidence. He should talk to her with love and affection and should not intend for immediate intercourse rather the amorous talk should lead to touching and when the wife too has no hesitation and starts enjoying the physical contact then the intercourse should be tried. He should tell the wife that maybe in the beginning it is painful but later this act will become enjoyable and in this way after love talk and caressing when the wife is aroused he should first insert one finger, lubricated with oil, in her vagina so that she knows how it feels on insertion of a finger. After one finger can he inserted easily then two fingers, lubricated with oil should be inserted in the vagina. This act should be performed by the husband with love and affection and the wife too should bear it with love and affection even if it is a little painful because later on this act too will become enjoyable.

Both should know that God has exalted the act of mutual love and intercourse between husband and wife to an act of worship and the reward of it equals those of non-mandatory prayers. This is enjoyable and includes benefits in the life here-after too. There are several "Hadees" in which the prophet (P.B.U.H.) has said that the angels keep cursing the wife, who does not cooperate with her husband for intercourse, through-out the night.

When two fingers can be inserted with ease then the penis, lubricated well with oil, should be inserted in the vagina. First time it is better that the wife lies down and the husband kneels on his knees and puts the wife's legs on his shoulders and tries to insert the tip of his organ held in his hand. By this method insertion becomes easy.

It is a must that a person should acquire some necessary information before intending marriage. For this he should consult some authentic book or qualified doctor. If the act can not be completed during the first night it is no cause for worry. The whole life of the husband and wife is there to engage in this act therefore it should be no cause for worry.

Usually, due to inexperience and embarrassment of the bride and groom, the first intercourse may take several days. Therefore if intercourse can not be performed for a week or two it should not be assumed that the husband or wife has some sexual disease or weakness.

In some women there is spasm of vaginal muscles due to fear and embarrassment, so much so that even the insertion of a finger causes un-bearable pain and the finger can not be inserted. If there is such a condition, intercourse should not be tried per force rather the wife be brought to one of our lady doctors who will instruct her how to get rid of this condition. These methods are very effective and enable the wife to perform intercourse in a few days time.

VAGINISMUS

Introduction

In addition to many other shortcomings in our social and educational systems one of the great drawbacks is lack of sex education for youngsters(and this includes both the boys and the girls). Parents, teachers, religious scholars even doctors and lady doctors neglect their important duty in this regard by hiding behind the facade of considerations for politeness, embarrassment, propriety and impropriety and over and above all religious pertinence.

The fact is that by the age of three to four years the child starts being curious about how he was brought in this world and often enquires about it. At this time he is assuaged by narrating baseless stories and this continues till adulthood.

By the advent of adolescence, sex glands become increasingly active due to which evident changes occur in the human body, the sex organs and the psychological inclinations for example curiosity about their own sex organs and the sex organs of the opposite sex and attraction towards the opposite sex etc. Due to this young boys and girls start seeking answers to the questions, relating to sexual organs and sexual acts, which arise in their minds and this is that precarious stage when the void caused by the lack of knowledge of sexual affairs and proper sex education is filled up by improper knowledge imparted by peers and apprehension caused and conveyed by un-authentic publications and pamphlets publicized by quacks.

The evident result, as expected, is that our youngsters inspite of reaching adulthood remain ignorant of correct information due to which, when they reach the stage of getting married, their minds are overwhelmed by the fear of being "unsuccessful" during consumation of marriage. Lack of knowledge about proper method of intercourse also creates difficulties.

Usually it is assumed that performing intercourse is the "need" of the husband and if it can not be performed successfully, only he is held responsible. Even the husband himself too thinks so whereas the fact is somewhat different. Husband and wife are equal partners in marital and sexual relations and the success or failure depends on their mutual cooperation and performance. This means that, as certain factors or illnesses of the husband may be a cause, in the some way, there are certain conditions and illnesses which when affect the wife, may be the cause of unsuccessful intercourse especially the first intercourse.

Spasm of vaginal muscles or "vaginismus" is one of such conditions. Like many other sexual and psychological illnesses, information about this too is very inadequate. Let us tell you some necessary and important facts about this so that you may be able to understand that this is a problem which can be cured quickly and effectively by treatment after which intercourse can be performed successfully.

What is "Vaginismus"?

Severe involuntary spasm of muscles of outer one third of vagina which makes intercourse impossible is termed as vaginismus.

Often this disorder becomes evident, by insertion of finger of the examining lady-doctor or to the instrument of examination but sometimes it is fully manifested only when intercourse is attempted.

Sometimes, if the spasm of vaginal muscles is not so severe, insertion of the male organ into the vagina is possible but only with great difficulty.

Sometimes the wife consciously wishes for successful intercourse but even then psychological factors cause vaginismus.

Causes

Some psychological factors which may cause this disorder are as under:

1. Severe Physical Trauma

Sometimes injuries inflicted on the sex organs during illness, surgery or accidents or even such physical injuries which happened on body parts other than the sexual organs, cause an overwhelming fear in the mind, of some outside object penetrating the body due to which when intercourse is attempted the vaginal muscles contract un-intentionally and intercourse becomes impossible.

2. Psychological and moral conflicts regarding sexual acts and intercourse may also be a cause

3. Sometimes due to lack of proper information, friends of the bride or some other women give exaggerated account of pain due to rupture of hymen during first intercourse due to which she starts thinking of intercourse to be very painful and at the time of intercourse this fear causes spasm of vaginal muscles.

4. Often times, if at all any information is given to young girls about sexual acts especially intercourse it is only that such acts are extremely uncivilized and sinful and these childhood thoughts are engrained so thoroughly in the minds of young girls that they become a part of their psyche so that it is impossible to get rid of these even at the time of intercourse with the husband and become a cause of vaginismus.

Diagnosis

The diagnosis of this disorder is rather difficult for a common lady-doctor or psychologist who is not well versed with the treatment of psychiatric problems . The important fact is that the newly married bride must understand thoroughly that performing intercourse successfully is possible only with the cooperation of husband and wife and whatever the marital problem only the wife or the husband alone can not be held responsible and for treatment both of them should take part and cooperate. For this reason it is necessary that the wife should also come to the hospital alongwith her husband.

Frequently it is observed that women avoid coming to the hospital because they have doubts in their minds as to what will be the procedure of the hospital, how the examination will be carried out, might be the examining doctors and psychiatrists are males and so they do not come to the hospital that is why this disorder can not be diagnosed because as is evident by nature of the disorder, examination of the wife is essential for its diagnosis. In this regard it should be clearly understood that at Karachi Psychiatric Hospital due importance is given to these considerations and patients are treated with due respect for their feelings about privacy, embarrassment, secrecy and chastity and all treatment methods are in accordance with religious principles. Especially when treating marital or psychosexual disorders, for examination and treatment, male patients are referred to male doctors and psychologists and female patients are referred only to lady-doctors and female psychologists and at no stage of treatment the female patient has any direct contact with male therapists or psychologists. They (the female patients) should have no apprehensions in this regard and they should come to the hospital for treatment with full confidence and satisfaction.

Treatment

For treatment of this disorder both the physical and the psychological methods are used.