Help! I’m recently married and we can’t have sex!

I hear this concern at least once a week from young heterosexual women who have been recently married. Women will describe that penile vaginal penetration simply isn’t possible, it feels like “his penis is hitting a wall,” and penetration is incredibly painful. Typically, women in this position have seen several doctors and are told they need a surgery to remove their hymen, or they need to relax, or they just need to keep trying. However, for most of these women, these suggestions and even surgeries (!) haven’t helped. Why haven’t they helped? Because the problem is something called Vaginismus and vaginismus isn’t treated with surgery, it doesn’t just go away the more you try to have sex (it actually gets worse!), and if it was as simple as just relaxing, it wouldn’t be an issue in the first place.

What is vaginismus?

We have 26 muscles that group together in our pelvis to form our pelvic floor (check out this video on the Pelvic Floor by vaginismus expert, Laura Meihofer, DPT: Pelvic Floor Muscles. Vaginismus involves involuntary contractions and tightening of these muscles. Essentially, these muscles are so tight that when anything (a penis, a tampon) attempts to enter the vaginal canal, they clamp shut. This causes that “hitting a wall” experience, because the penis/tampon is hitting a wall of tense, tight muscles.

How do you treat vaginismus?

Vaginismus is very treatable. It’s actually my favorite issue to treat as a sex therapist because it is so treatable. Treatment requires a team of three specialists: 1. Sexual medicine specialist, 2. Pelvic physical therapist, and 3. Sex therapist.

The sexual medicine specialist, typically an MD, officially makes the diagnosis of vaginismus and rules out any other medical issues. One thing the doctor needs to rule out is something called vulvodynia. Often vaginismus and vulvodynia go hand in hand. And if vulvodynia is an issue, it needs to be treated before the vaginismus can be addressed.

Side note: Vulvodynia is pain of the vulva. It’s external pain, whereas vaginismus is internal pain (pain from the tense muscles). Vuldodynia is diagnosed with a “Q-tip test.” Basically, your doctor takes a q-tip and touches different areas of your vulva to assess for pain. If simply being touched by a q-tip is painful, this is a sign that you have vulvodynia. There isn’t much research on the cause of vulvodynia, but we believe it’s an issue with nerves. Imagine the nerves of the vulvar area have an alarm, and it takes the tiniest thing (like a q-tip) to set the alarm off. The nerves are constantly on high alert and easily startled.

The pelvic physical therapist teaches deep breathing, how to relax the body, and exercises to relax and stretch the pelvic floor muscles. They also teach how to use dilators.

Dilators are a series of silicone or acrylic cylinders, that go from small (like the size of your pinky) to large, and are used for vaginal insertion in order to help the pelvic floor muscles relax and stretch. I recommend the dilators made by SoulSource: Silicone Vaginal Dilators. The goal is to be able to vaginally “contain” the dilator that is one size larger than your partner’s penis without any pain.

The sex therapist teaches how to mentally disconnect sex from pain. After so many experiences where sex and pain have gone hand in hand, over time, when you even think about sex, the first thing in your mind is likely pain. Using a type of therapy called Cognitive Behavioral Therapy and exercises called Sensate Focus, the therapist teaches how to separate sex from pain and reduce sexual anxiety. Sex therapy may also include learning accurate sexual health information, increasing comfort with your body image, and learning healthy sexual communication with your partner.

I think I have vaginismus, what do I do?

  1. Stop having/attempting to have painful sex. The more you have painful sex, the more you are strengthening the connection between pain and sex.
  2. Give me a call to schedule an appointment. If you don’t already have a sexual medicine physician or physical therapist, I’ll get you connected to a great team. Then I’ll work with that team to get you started in treatment. Treating vaginismus is not quick. On average, treatment is 6 months to 1 year. However, the results will be worth the hard work!