Sex, Sex, Sex, Sex – we are invited constantly in our society to pay attention to or get directly involved in sex.  There are numerous social messages in our advertising, our magazine articles, our TV/movie screens and in our social media encouraging us and instructing us on the optimum performance or experience.   If only those messages were all sex positive but as with most things in life there is a variety of messages presented to us which can confuse us, pressure us or sit at odds with our own values which can trouble us even further.

Even when sex positive messaging can be inspiring, it can also be distressing for those of us who do not experience sex as positive.  Sex can be the ultimate bond and expression of love and is meant to be pleasurable and pain-free.  However there are thousands of women who have discovered that intercourse is not pleasurable – in fact is very painful or impossible to achieve.   “I feel like a failure,” “I never thought it would be this way”,  “Why can’t I have sex?”,” The doctor has ruled out anything physically wrong” are some of the ways we hear about this. 

Although many women report they are sexually responsive, their bodies will not allow penetration to pleasurably happen if at all.  For some this means that their marriage is left unconsummated, and/or their relationship strains or breaks down which often leaves their self-esteem shattered.  The hurt and pain can be intense.  Many couples feel very alone with their problem.  This is not what society says should happen and there is no place it seems to talk openly about it. 

Rest assured whilst silencing on this topic may be mainstream, the actual prevalence of painful sex means it is an experience many women share across the world. You are not alone and there are ways to get help for this issue.  Raising it with specialist nurse practitioner or gynaecologist can get the ball rolling.  Contacting a specialist sex therapist is another avenue where talking about this issue can be respectfully shared and the process of change can begin.

It can take years for some women to find out that they have a condition called vaginismus.  Vaginismus is not due to a physical abnormality, nor to having a vagina which is too small to fit a penis into. It is caused by muscles surrounding the entrance to the vagina, making penetration impossible and/or painful.  The primary muscle group involved is called the pubococcygeus, or PC muscle group. Most women with vaginismus are sexually responsive and deeply desire to make love, so it is very frustrating not to be able to engage in sexual intercourse.  

 Primary vaginismus occurs when a woman has never at any time been able to have pain free intercourse due to pelvic floor muscle spasm.  It can be triggered by any attempted entry to the vagina such as a tampon, a doctor’s finger or even your own fingers. There can also be related spasm in other body muscle groups and even halted breathing. 

Secondary vaginismus occurs when a woman who has previously enjoyed intercourse without pain develops the vaginismus condition later, possibly following some trauma, relationship issues, or surgery.    

Recovery from this condition will require sharing intimate personal information, and can be terrifying for some.  Ideally, therapeutic treatment will be a collaborative event between doctor, sex therapist and physiotherapist. The process will involve unravelling its impact, and then retraining the mind and the body in order to feel free of any negative inhibitions towards sex or any unhealthy messages that the mind may be subconsciously holding.

It is important to seek specialist help so that a proper diagnosis can be made.  A sex therapist will address the psychological issues, while a physiotherapist will require experience with women’s pelvic floor pain and other problems.  When appropriate, it helps if both partners are involved.

Many women are uninformed (and uncomfortable!) about their bodies, so you will learn about your own sexual body parts and their role in sexual activity, including the changes during arousal and orgasm.   Initial education will also include learning the terminology of vaginismus and some simple relaxation techniques. Your physiotherapist will help you to locate and exercise your PC muscle group, and identify the kind of pain or discomfort you may be experiencing.  

Alongside this gradual retraining comes challenging the mind and emotions. Many women find that old fears from earlier experiences begin to surface. For example, pain and complications from surgery may cause an involuntary, subconscious reflex, making the PC muscles spasm.  Vaginismus can also be linked to having experienced unwanted sexual experiences or body trauma.  The fear of being trapped often accompanies this experience. 

Exposure to inhibiting moral or religious attitudes to sex while you were growing up can also prevent you from developing trust in your partner.  Many women have been taught that after marriage, sex would lose all these sinful and nasty connotations and would miraculously become a joyful experience. 

Additional experiences which can impede a woman’s ability to be sexually free include fear of pregnancy, high anxiety, exposure to shocking sexual imagery in childhood, violence in the home, fear of commitment, or an abusive partner – all of which will need to be discovered and worked through, because somewhere along the line your PC muscles have developed a muscle memory that penetration is not desirable and in fact should not be allowed.

Often the cause is not one single thing but rather the result of many experiences and emotions. Fortunately, there is a way forward and completely understanding the cause is not always necessary in order to overcome vaginismus and reclaim your choice to enjoy pleasurable sexual experiences.

Paula Dennan and Helen Mounsey