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Pain during Sex? Escape the Cycle

by Dr. Barb DePree MD

Vaginismus, a vaginal muscle spasm that prevents penetration, can be part of a vicious cycle of pain and response. If you experience painful intercourse, your natural desire to avoid the pain may be a psychological trigger for vaginismus, which occurs involuntarily.

How do you know whether it’s time to talk to your doctor? The keys are frequency and persistence, but I hate to tell women they need to endure pain for any specific length of time before they talk to me about it. If pain is recurring or persistent, if you take note of it, if it affects your ability to enjoy intimacy, I’d recommend that you talk to your health care practitioner.

Maybe you’ve been avoiding going to the doctor because you’re afraid the exam will be painful, and that’s very understandable. And you’re not alone, believe me! Pelvic exams cause anxiety in most women—even without the added complication of suspected vaginismus. But a trusted gynecologist or menopause practitioner will be very familiar with vaginismus and related conditions and will know how to approach the exam.

A river cuts through a rock not because of its strength but because of its persistence.If you’re uncomfortable talking about what you’re experiencing with your doctor, consider printing out this post (and the previous one) and taking them with you to get the discussion started. Write down your exact symptoms—where it hurts and when—so you can describe what's happening. You can also read more about vaginismus; learning about it will help you ask your doctor more specific questions, like, "Do my pelvic floor muscles seem too tight?"

Treatment requires the right combination of physical and cognitive therapies, especially if your condition is psychologically induced vaginismus. In that case, retraining the body and the mind to accept vaginal penetration is part of the treatment. Other techniques may include:

  • The use of a dilator, which can increase your comfort gradually
  • Botox injections
  • Exercise, such as Kegel, and/or pelvic muscle therapy
  • Pain management techniques
  • Relaxation training
It’s also worth noting that vaginismus is common among women who force themselves to have sex when sex is painful. I hope you’re not one of them! If you are having pain during intercourse, please go to your doctor and let the healing begin. Then you—and your partner—can get back to enjoying sex again.


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