Swat Ed is The Phoenix’s biweekly sex education Q & A. We accept all questions and they are kept completely anonymous. If you’re looking for medical advice or a diagnosis for that weird thing on your genitals, get in touch with a medical professional! For everything else, email email@example.com. Today’s subject matter is vaginismus.
My girlfriend and I tried to have sex for the first time a couple of weeks ago. We ended up having to stop because it hurt her too much. Even using my fingers hurt her too much. We tried three times since and it didn’t work at all. I’ve read your other columns and we tried doing a lot of foreplay, using lube, thinking about being relaxed, everything. She’s upset about it and she doesn’t want to try more because it hurt her so much. She said she just doesn’t want to have sex at all. It’s not a big deal to me because I like doing other things, but I do think that she should try to figure out what’s wrong and make it better. I want her to be able to enjoy things and not feel stressed out by all the pain. Based on your other column and some Internet research I think she has vaginismus. How do I talk to her about it?
-Concerned WebMD User
It’s really good that you’re taking the time to think so considerately about how your girlfriend is feeling. I also appreciate that you’re stating clearly that you’re happy doing other sexual things and you aren’t pressuring her to have penetrative sex. It sounds like you’re being a great partner. Your girlfriend’s symptoms are consistent with vaginismus, which is a condition that’s more common than you might think given how little people talk about it. Let’s start by defining the term, and then we can talk about how people go about treating it.
Dyspareunia is the umbrella term for painful intercourse due to medical or psychological reasons. Pain can be more external in the vulva or deeper in the vagina. Vaginismus is included under this term. It specifically describes pain due to involuntary muscle contractions in the pubococcygeus. That essentially means that the muscles in the vagina tighten up reflexively and won’t relax, making penetration extremely uncomfortable. It’s a psychological condition, but it’s important to note that the muscle contractions really are involuntary: it’s not a situation where a person can “just relax” and deal with it that way. Essentially, the body is anticipating pain upon penetration and is contracting in an attempt to keep that from happening.
It’s generally accepted as a ballpark statistic that two in 1000 women experience vaginismus, but the actual percentage is probably much, much higher due to the sense of shame and subsequent underreporting that surrounds this issue. One study estimated that women in the age range 15-24 specifically have a higher rate. Other studies have found rates of painful intercourse in the low teens (note that “painful intercourse” does not differentiate between vaginismus and dyspareunia). The sensation experienced by people with vaginismus include stinging and/or burning pain in the vagina upon penetration. It’s important to note for people that don’t have vaginas that this is not a pain that’s ignorable: it is not only painful, it is also psychologically unbearable in the way that cold on sensitive teeth or the sound of screeching metal is unbearable.
The severity of vaginismus is extremely varied: some people are unable to insert anything at all, others can handle tampons, fingers, or medical exams; others can handle brief PIV penetration before their muscles tighten and pain begins. When vaginismus means that people have never been able to have penetrative sex, it’s classified as primary vaginismus. Secondary vaginismus encapsulates people who develop vaginismus after having already had pain-free penetrative sex. Left untreated, vaginismus tends to grow worse over time because the consistent experience of pain conditions muscles to keep tightening in response The good news is that all degrees of severity are treatable.
The standard treatment for vaginismus involves using a series of dilators (which look a lot like minimalist cylindrical dildoes in varying sizes). The idea is that people can gradually insert increasingly larger dilators until they can comfortably accommodate a penis. A physical therapist or medical professional specializing in dyspareunia can recommend the right products and work with you on their optimal use. There are physical therapists that specialize in treating pelvic pain that can be incredibly helpful, although they can be harder to find than a general PT office. A good place to start is by going to your usual doctor or gynecologist and asking them for assistance or references. Some medical professionals are dismissive of women seeking treatment for pain. If you experience that from your doctor, do not be discouraged –– seek treatment elsewhere. Your local Planned Parenthood clinic is a good place to start –– they can give you referrals and give you a good idea of what you’ll need to do to handle the issue. Some people also benefit from therapy if their condition stems from some sort of trauma. Remember that everyone deserves to engage in whatever sexual activity they like without pain or fear of pain.
It might be the case that your girlfriend doesn’t want to seek medical help. This condition can be a source of a lot of psychological stress and create a feeling of inferiority or brokenness. If she doesn’t want to go, that’s her decision –– just emphasize that you are supportive of her and simply want a mutually enjoyable sex life. If she feels pressured to cure herself fast for your sake, it probably won’t help.