Vaginismus happens for many reasons.  A woman may be highly nervous about having intercourse, particularly for the first time; she may feel shame or guilt about sex, or she may have performance anxiety.  Or, past trauma such as date rape may be to blame.  Repeat infections, such as yeast infections, or dryness during menopause uncomfortable intercourse can also cause vaginismus.  Finally, treatments for gynecological cancers, such as cervical cancer, can also cause vaginal atrophy.

Because it can be so embarrassing, many women fail to talk to a physician about treatment.  Unfortunately, even women that do mention the problem to a doctor often receive a pat on the knee and advice to “just relax.”  Of course, that is much more easily said than done.  There is much more that can be done to help a woman and her partner overcome vaginismus, including the following steps:

1. Find a physician that specializes in sexual medicine.  This is usually a gynecologist or a urogynecologist (a urologist that specializes in women’s problems).  You can ask your own gynecologist or general physician for a referral.
2. Work with a psychotherapist who specializes in problems of a sexual nature.  This may be a sex therapist, or it may be a marriage therapist who has some training in sexual dysfunction.  Identify what makes you fearful, guilty, or shameful about sex, process it, and let it go.
3. Consider a program of dilator use.  A dilator is a cylinder-shaped object that is inserted into the vagina to desensitize a woman to having something “in there.”  Dilators start with a small size and increase to something comparable to a man’s penis.  The physician or sex therapist can give you guidance on how to use them.
4. Try a program of overall physical relaxation.  You can find many relaxation recordings online.  Or do yoga, meditation, or other form of regular relaxation.  Listening to relaxing music can also be helpful.
5. Learn more about sexual pleasure.  You can learn a lot about your own body through self-massage.  Let your partner know what you do and do not like when it comes to touch.
6. Always use lubricant for any type of genital contact.  Water-based lubricants tend to dry out and need to be reapplied, but they can be used with condoms.
7. Don’t give up on sex altogether.  There are definitely couples that have a rich sex life that just doesn’t include intercourse.  (Often it is the wish to become pregnant that brings them into treatment.)

Women with vaginismus shouldn’t give up on the desire to have “normal” sex with their partner.  It may take some time and lots of encouragement, but with the right assistance most every woman can resolve the problem and enjoy sex.

As stated in the interview, there are treatments for painful sex, and they vary by condition.  What is not stated in the interview is that even if you do find a physician that understands and treats sexual pain disorders, it is sometimes tough to get as good an outcome as hoped.  For example, some women learn that they may have to live with some degree of discomfort.  Other women may be given a course of treatment, such as using graduated dilators, but may have psychological difficulties that preclude them from following the prescribed behavior.

The role of the sex therapist as part of the treatment team is an important one.  Many women that have sexual pain disorders balk at seeing a therapist because of the stigma and because of the lack of understanding of how seeing a sex therapist can be helpful.  Not all women may need the help of a sex therapist, but for those that may benefit, here’s how.

Because sex becomes associated with pain, motivation to stick with a treatment plan can wane.  Also, the woman’s partner can become discouraged and withdraw support.  There may be relationship difficulties that impede progress.  Also, a small percentage of women with these problems have had negative sexual experience such as molest and date rape.

A sex therapist can often spend more time with a woman understanding how the condition developed.  Again, the condition is not in the woman’s head, but there may be psychological factors that contributed to its development.  For example, sometimes a woman is in a bad relationship and has repeated yeast or other chronic infections at the same time.  She then develops vulvodynia, which is pain in the vulvar area surrounding the vagina.  The stress of the infection and the relationship may have simultaneously helped to manifest the vulvodynia.  Understanding and processing this can be very helpful for some women.

Also, sometimes women have developed negative attitudes about sex, or what is called a sexual aversion.  As you might imagine, this can have an impact on a woman’s relationship.  Sometimes, this gets in the way of healing.  A sex therapist can help a woman overcome her aversion and discover, or rediscover, a healthy attitude toward her sexuality and her sexual partner.