How To Overcome Painful Sex and Strengthen Relationships

If you ask anyone you know in a long-term relationship how they make it work, they’ll probably tell you so many things, it’ll make your head spin. But the key in any relationship is work, because, to borrow a metaphor from Violet Bridgerton in Queen Charlotte, no garden grows or even survives when it’s left untended.

But sometimes, unexpected things come up in gardens, and so we have to learn how to tend to those problems as well. In a sexual relationship, one of those events could be learning that you or your partner have vaginismus. One of the best ways to manage anything unexpected is to learn about it, and about the options for how to still make your relationship—or garden—flourish.

So, what is vaginismus exactly?

Vaginismus (vaj-uh-niz-muhs) is a genito-pelvic pain penetration disorder that may cause pain with vaginal penetration. It is thought to be caused by involuntary contraction of the pelvic floor muscles.

If you are suffering from vaginismus, you might hear clinicians or physical therapists describe your pelvic floor as “hypertonic” — or tightly contracted. It means your pelvic floor muscles have a difficult time relaxing.

Vaginismus is often associated with painful intercourse, but it can cause pain or discomfort with any type of vaginal penetration, such as with a finger, speculum, or tampon. Dyspareunia (pronounced dis-puh-roon-ia)— the technical term for any type of pain with sexual intercourse— can also occur due to a variety of other reasons, often without vaginismus.

What do I do if one of us in the relationship experiences painful sex?

If you experience painful sex caused by vaginismus, and neither you nor your partner addresses the issue of painful penetration, it can lead to problems in your relationship. One or both of you may decide just to have less sex since it causes pain, leading to unresolved tension about this issue in your relationship. If you don’t discuss painful intercourse or work together to seek relief from the discomfort or pain, both of you may expect sex to be painful, which can then lead to avoidance of sex altogether. And there’s science to back up the idea that you should communicate with your partner about painful sex.

When looking for data in the Journal of Public Health, researchers found very little information. This lack of research suggested to them that women were not talking to their partners OR their healthcare providers about sexual issues. And of course we always look for [anecdotal data] stories from real people about these kinds of things instead of just medical research. Hello Giggles writer Kelly Gonsalves spoke with several couples about painful intercourse. One couple shared that “open dialogue was a really huge part of our success and the fact that we were both still very sexually active with each other and didn’t go dormant like many relationships that go through this.” So, in this case, communication and maintaining intimacy and sexual activity were both important to their success.

How do I know if I have vaginismus?

What does vaginismus feel like? The exact symptoms of vaginismus vary from person to person. Many describe the sensation of hitting a “wall” when trying to insert anything into the vagina. Others describe burning, stinging or tightening of the vagina, and for many, this manifests as sharp and debilitating pain. These symptoms can cause considerable distress, fear, and difficulty with vaginal penetration.

Although vaginismus is often discovered when attempting penetrative intercourse, painful sex is not a necessary symptom. Individuals suffering from vaginismus often have difficulty using vibrators or self-stimulation during masturbation; struggle with inserting a tampon for menstrual flow; or resist going to the gynecologist because of painful speculum exams.

For years, vaginismus was considered a purely psychological condition or not considered at all. Women suffering from painful intercourse were often told it was “in their head” and rarely examined for an underlying cause. Historically, the diagnostic criteria for vaginismus in the Diagnostic and Statistical Manual of Mental Disorders (DSM) required the presence of muscular spasm to qualify as vaginismus.

However, new data suggests that this spasm-based definition of vaginismus might not capture the diversity of vaginismus symptoms. Therefore, the updated DSM 5 has removed “vaginismus” from its handbook and replaced it with a broader spectrum of conditions termed “genito-pelvic pain/penetration disorders” (GPPPD). This spectrum-based approach emphasizes that there are varying degrees of pain, fear, muscle contraction, and penetration difficulties when it comes to vaginismus-related conditions.

We know this is complicated, but we want to make something clear: whether you call it vaginismus or GPPPD or pelvic floor tightness, these symptoms are not in your head.

If you think you may be affected by vaginismus, or any form of genito-pelvic pain, we recommend discussing your symptoms with your provider to ensure adequate care.

What are some treatment options for vaginismus?

So, you have vaginismus. Now what?

First, take a moment to recognize that you are part of a community of women. There are a growing number of resources aimed at connecting individuals who suffer from vaginismus.

Second, management of vaginismus is tailored to YOU. A big part of learning to overcome the symptoms of vaginismus is getting to know your body and what it needs. If you are someone whose symptoms are mostly spastic, pelvic floor relaxation might be what you need. If you are a survivor of sexual trauma and have an overwhelming fear of sex, you might benefit from desensitization therapy through dilator use coupled with regular talk therapy. Below is a list of the most common approaches to treating vaginismus. See which one or ones might be right for you.

Pelvic floor therapy:

Initial treatment for vaginismus usually begins with techniques to relax your pelvic floor. This involves exercises and breathing techniques that train your pelvic muscles to consciously relax, reducing painful spasms. Most of these exercises can be done in the comfort of your home; however, specially trained physical therapists can help ensure that you are performing the exercises correctly and often accelerate the process.

Therapy:

Treatment for vaginismus often includes different forms of therapy such as sex therapy, cognitive behavioral therapy (CBT), and couple’s therapy.

In sex therapy (or psychosexual therapy), you work with therapists (often called “sex therapists”) to help you address sexual problems. You might learn about sensate focus5, a stepwise approach to non-penetration intimacy with a partner or develop strategies to talk to your partner about your symptoms.

CBT is a form of talk therapy that focuses on breaking thought patterns that cause distress. (Psst…all Rosy Wellness Plans are integrated with CBT methodologies.)

Although each modality is unique, the goal of therapy is the same: to reduce anxiety and fear and improve your confidence, intimacy and sexual health.

Dilators

Another common approach to treating vaginismus is desensitization through vaginal dilators. Just as there is not a one-size fits all solution to treating vaginismus, there is also no one-size fits all dilator. One example is Milli, a unique vaginal dilator tailored to fit your unique vaginismus needs. Milli, the only dynamic vaginal dilator on the market provides an all-in-one, graduated size approach to help you begin dilation therapy. Milli expands or retracts based on your dilation needs, putting you in control so you can gently train your vaginal muscles over time to manage pain during intercourse from vaginismus.

The goal of any dilator is to slowly desensitize your body to increasing degrees of vaginal penetration. Similar to other forms of exposure therapy, dilators help reduce the fear and anxiety associated with vaginal penetration, which can in turn help your pelvic muscles relax and break the cycle of pain.

Botox:

Botox is an emerging treatment for vaginismus, especially for those unable to tolerate dilator therapy. It involves injecting Botox intravaginally under local or general anesthesia to reduce muscle spasms.

The Multimodal approach:

It is important to remember that vaginismus is a psycho-sexual-physical condition. As a result, the best approaches include multiple modalities and techniques. Clinical studies showing the highest treatment success rates employ multiple therapies rather than one alone. We encourage you to talk to your provider about what strategies might work best for you.

No matter what treatment option you pursue, if you begin to experience painful intercourse, the first thing you should do is to open the lines of communication with your partner(s) and your healthcare provider. Then, you can start on your journey to take control of vaginismus causing an unexpected change in your sexual health.