Ask the Sexpert

Vaginismus: Painful Intercourse

Dear Dr. Kat,

I’m 19 years old and have never been able to have penetrative sex with my boyfriend. Every time I’ve tried vaginally I just lock up. Ik t actually becomes painful to insert anything. For the same reason I’ve been unable to use tampons or get a pelvic exam. What’s wrong with me?

Dear Reader,

What you’re experiencing is a not uncommon condition known as Vaginismus. It involves the involuntary contraction of vaginal muscles. Sometimes the condition is physical in nature, and follows a related surgery such as a hysterectomy, but usually it is related more to psychological issues. Each sexual experience is often met with anxiety and vaginal pain. A powerful contraction of the muscles is usually the result of the body's stress-response system.

It can be very difficult to discuss this problem with anyone else, due to the taboo nature sexuality. And even if you do try, most physicians and mental-health practitioners are either unfamiliar with the condition, or they are uncomfortable with discussing or treating it. This can leave women with this issue feeling alone, ashamed, or defective. It can be quite difficult for the partners of these women, too. Many end up feeling frustrated and rejected and feeling as if that they will never be able have “normal” sex with their loved one.

The first step is to get diagnosed. There are two types of Vaginismus: a) primary -- having never been able to be penetrated, and b) secondary -- you were able to at one time but no longer are. You sound as if you may be a candidate for the primary type. Vaginismus rarely goes away on its own. If left unaddressed, symptoms usually only get worse. The cause can usually be linked to fears developed during childhood in relation to the body or its function, and about the fear of what penetration might be like and the potential “pain” that may be involved . Negative messages about sex or overprotectiveness on the part of parents may play a role in this sexual anxiety. Or, it may simply be a lack of knowledge about how your body works. Trauma is also a common cause of this condition. This may include trauma to the body during childhood illnesses, where the child was repeatedly exposed to treatments; or, more commonly, it may involve physical abuse, rape, and verbal or sexual abuse. The associated emotional stress may range anywhere from a slight apprehension that is easily overcome with explanations and reassurance, to severe panic and/or anxiety attacks. Other physical manifestations may include a reluctance to be touched, legs tightening together, excessive sweating, and rapid heart-beats.

The good news is that this condition is highly treatable with a practitioner who is familiar with the process. The most successful treatments involve psychological work and behavior desensitization (through the use of a range of dildos in graduated sizes). I would suggest finding a good therapist who is well versed in this treatment. Call around and let them know that you think you may have Vaginismus. Then find out how much they know, and if they have worked with this condition before.

I don’t know what you’ve discussed with your boyfriend, but you need to be as up-front as you possibly can with him. Let him know that this is a medical issue, and that it has nothing to do with him. If you’re going to stay together through the treatment, he’ll become an important part of the healing process. I’m sure that, with a little bit of courage and a lot of communication, you’ll have many years of fulfilling sex ahead of you.

~ Dr. Kathleen Van Kirk