When sex is too painful, or impossible

Involuntary tightening of the muscles around the vagina is referred to as vaginismus.There is usually no physical cause. It is a distressing condition that can potentially stop your sex life, cause relationship problems or even prevent you from starting a family.

The severity of symptoms can vary from woman to woman. At one extreme, some women are unable to insert anything into the vagina, including tampons or having sex. Others may tolerate penetrative sex, but experience burning or stinging sensations. Vaginismus is involuntary, and is triggered by the fear of pain. The vaginal muscles tighten up as a protective mechanism.

In the majority of women, a physical cause for the vaginismus cannot be found. There is usually an association with unpleasant past sexual experiences such as rape or sexual abuse.Memories of clumsy and painful sexual encounters in young age may also trigger vaginismus. Feelings of guilt and shame around sex are also contributory, as may occur with strict upbringing or with cultural and religious taboos. The fear of getting pregnant andother psychological problems have also been associated with vaginismus. Other physical causes of painful sex must be differentiated from vaginismus. These may include infections, vaginal dryness, trauma from childbirth and other disease conditions like endometriosis.Sometimes there are oversensitive nerves at the vaginal opening, a condition called vestibulodynia, which usually presents with severe pain.

Women experiencing vaginismus symptoms should make arrangements to be seen by either their family doctor or a gynecologist. Personal questions may be asked, and if necessary, you can always request to be seen by a female physician. An examination will be necessary to exclude other conditions, and in some cases referral to another specialist may be suggested. It may be helpful to bring your sexual partner along.

Treatment of vaginismus often involves a team of specialists. Self-help techniques may be the starting point. You can be taught how to use graduated vaginal trainers in the privacy of your home. They are useful in helping relax the vaginal muscles, allowing gradual tolerance of penetration.Relaxing and touching techniques with a bath, massage and breathing exercises are a good way of knowing your body. You may require a physiotherapist to teach you pelvic floor exercises that help relieve vaginismus symptoms.If other physical conditions such as infection or vestibulodynia are present, concurrent treatment should be offered.Very few cases of vaginismus require surgery as a treatment option. It may only be useful if another condition amenable to surgery is contributing to the vaginismus.

Referral to psychosexual specialists is often beneficial. Counseling usually helps with underlying psychological issues, fears and anxieties. Cognitive behavioral therapy (CBT) changes any irrational and incorrect beliefs you may have about sex. Patience is often required, as complete cure tends to take several weeks or months.