When sex hurts: myth-busting and guidance on vaginismus

If you have a vagina, you have at some point thought something was wrong with it. Whether problems with orgasming, discharge consistency, irregular periods, tightness during sex (and don’t get me started on shape, colour and odour), we have all at some point got out the handheld mirror to have a look at what was going on down there. We said we were gonna be candid, right?

So why do we know so little about why sex hurts, and sometimes just does not work? Perhaps for no apparent reason at all?

Vaginismus is a word that all women should have in their vocabulary. Sadly, this widespread issue is poorly known in the common sexual health vernacular. Elsa* decided to share with us how the condition has affected her sexual and mental health.

Many refer to it as sexual anxiety; too often, less severe cases can be explained as “having a tight pussy” (or “TPP” — Tight Pussy Problems; Candid Orange patent pending).

What is vaginismus?

Vaginismus is a condition where the pelvic floor muscles contract involuntarily on penetration, making something as small as inserting a tampon intensely painful. Affecting sex life as well as personal wellbeing, estimates say that 20% of all women will experience it in their lifetime.

But how many women will know that they have had it?

In truth, doctors know little about the pelvic floor in comparison to other parts of the body due to both its complexity and the centuries-old inequalities in gender-based health. It regulates bodily fluids and is vital for activities like sex, going to the toilet and certain types of exercise. Many refer to it as sexual anxiety; too often, less severe cases can be explained as “having a tight pussy” (or “TPP” — Tight Pussy Problems; Candid Orange patent pending).

The beginning of Elsa’s experience with vaginismus began in her first year of university. “I think it was caused by multiple things. My sex drive became really low from the antidepressants I was taking, and I was stressed so found it really difficult to get aroused. Then, when me and Ben* did have sex, it would chafe because I wasn’t getting wet because of this low sex drive — I think my body then started associating sex with pain.”

There are three different kinds of vaginismus, affecting someone’s sexual health to a varying degree.

  1. The most severe form is when all penetration, whether a tampon or a gynaecological exam, has always been painful. It can manifest during their first attempt at penetrative sex.
  2. The “middling” tier is when pain starts after you become sexually active. It can occur at any stage of life and usually stems from a specific event, such as an untreated STI, a traumatic event, or childbirth.
  3. The least severe is when pain is only experienced during certain incidences of penetration. For example, whereas you may have no trouble during penetrative sex, you cannot insert a tampon.

Vaginismus, as the three forms demonstrate, can range from some discomfort during penetration to a complete inability to have anything inserted in the vagina.

Causes

Little is known about what causes primary and secondary vaginismus and research is sparse, however it can range from “sexual anxiety” and trauma, to a number of physical ailments.

For Elsa, past experiences with sexual trauma exacerbated her vaginismus, although the cause of it remains undiagnosed. There was also no sudden moment when sex became impossible. Due to the cyclical way in which it manifests itself, “the more it hurts, [the more it] reinforces the psychological connection with sex and pain.”

Psychologically and physically traumatic events such as sexual assault and childbirth can cause the condition. Untreated STIs, previously painful sexual experiences, high levels of pressure surrounding penetration and relationship problems can all also constitute causes. Although worsened by a low sex drive, this is often another excuse to easily brush off the main cause, much like supposed vaginal tightness.

Treatment

Luckily, treatments do exist, even with such little understanding of  vaginismus. But it is rarely easy to cure given this foggy nature of diagnosis.

“I googled it and I figured it out,” says Elsa, when asked of her own diagnosis. “I mentioned it to my doctor and he talked about getting dilators online, but they’re roughly £40 and at the time I couldn’t afford that. He gave me numbers of some charities that do psychosexual therapy, but they all told me that I needed a referral. My mental health was low anyway, so jumping through the hoops got old very quickly. I didn’t feel like it was taken all that seriously.”

Psychosexual therapy, the act of determining and easing your mental relationship with the idea and act of penetration and sex, can ease these muscle spasms. Other treatments including pelvic floor exercises are also advised, however, these can in fact worsen muscular tension if performed incorrectly. Vaginal trainers (dilators) can be prescribed to get the muscles more accustomed to penetration — not “stretch” it, as is often the misconception.

Keeping up your sexual and romantic life without vaginismus getting in the way

This is a tough question to broach and an even tougher topic to bring up when you are not in a long-term relationship. Whereas, if in a couple, you can (hopefully) rely on the trust and respect of your partner to understand the problem and work with you on it, single women may have a tougher time. Unlike the well-studied and curable problem of erectile dysfunction, there is yet to be a wonder pill for vaginismus.

Sadly, the idea that heterosexual sex can only be classed as penetration and the male orgasm is in some way ingrained in many of us. This is why, to begin with, both partners may find there is a learning curve to orgasming and making your partner orgasm without any penetrative action.

“I felt useless,” Elsa admitted when I mentioned the difficulties in sex no longer being an option. “Sex is supposed to be a natural, innate thing and my body couldn’t even do that. I cried a lot when me and Ben tried but physically couldn’t, because I felt like I was being a bad girlfriend and hated not being able to ‘satisfy’ him like that.”

Mutual masturbation can allow for both partners to be sexually satisfied without penetration, causing unwanted pain. If you feel uncomfortable, unhappy or ashamed, communication is key to working around vaginismus. Although significantly easier said than done, acknowledging your feelings around your adapted sex life, as well as the current tensions and difficulties with penetration, are the first steps in feeling fulfilled.

My girlfriend has vaginismus. What can I do?

It cannot be stressed enough that vaginismus is entirely involuntary. It is frustrating and you can communicate this, but avoid blaming your partner or making them feel guilty for your lack of sex or non-penetrative sex life.

“We had arguments about it on a level that Ben couldn’t really empathise because obviously he’s never been through it,” Elsa said. “He’d say ‘I’m trying really hard’ but I felt like he didn’t understand that I was trying 1000 times harder. Our relationship became weirdly platonic for a while. We were still in love but I felt like his friend in a horrible way because I couldn’t do this thing that for me is a crucial part of a relationship.”

Patience and communication are needed when dealing with vaginismus. Assuring them that, although frustrated, you understand their pain will avoid provoking feelings of guilt. Remember, they are the one with the condition so don’t revert to making it about yourself. They are probably more upset than you.

The problem with vaginismus

The problem with vaginismus is perhaps not the condition itself, but the level at which it is misunderstood. Rather than enduring painful sex or thinking there is little hope when sex is impossible, those who suffer from the condition should be able to identify it and seek medical help. According to the American College of Obstetricians and Gynecologists, 75% of women will experience painful sex in their life.

The silencing of vaginismus stems from the all hardwired idea that women do not need to enjoy sex, so their pain has been normalised to a certain degree. “There’s shame attached,” revealed Elsa. “I felt so useless when I couldn’t have sex because it’s ingrained in us to believe that it’s part of our duty as a girlfriend to sexually satisfy our partners. I think there’s this unspoken idea that women aren’t meant to have any issues surrounding sex because somehow it’s what they’re made for.”

With this in mind, it is key to end the myth now and forever. Penetration is NOT supposed to be painful. There is no such thing as a penis which is too big. This idea forms part of a male-centred narrative which excuses sexual pain and does little to ascribe the underlying cause of why your sexual experience is painful.

From the time a cisgender girl is in her teenage years, she is exposed to stories about first-time experiences causing pain. It fans the damaging flames of the construct of virginity and perpetuates the anxiety around penetration, even though for many girls the hymen never breaks.

In sum, if sex hurts, seek the advice of a medical professional. Tell them your symptoms and ask for an exam. Most of all, do not be told to “relax.”

*Names have been changed for privacy

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