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Hitting the Wall with Vaginismus

by Dr. Barb DePree MD

As we’ve discussed before, experiencing pain during intercourse is not unusual for post-menopausal women. The general medical term for it, dyspareunia, is defined as “recurrent or persistent genital pain associated with sexual intercourse in either the male or the female.”

And it’s nothing new; “difficulty mating” was mentioned in Egyptian scrolls nearly 4,000 years ago! But just because dyspareunia is a common problem doesn’t mean it’s normal or that you have to live with it. Sex should never hurt. So it’s important to acknowledge and address any pain issues as soon as you notice them. And the sooner you tell your doctor what’s going on—with as much specific description as possible—the better: Early intervention can prevent a bad situation's getting worse.

What causes the pain? It varies. It might be simple dryness or vaginal atrophy. Or it could be another condition called vaginismus, which is a little more complex.

Vaginismus occurs when the muscles of the vagina go into an involuntary spasm. The resulting tightness prevents or limits penetration and can be so severe that even a vaginal exam or inserting a tampon is impossible. Some women describe it as “hitting a wall.”

The causes of vaginal spasms can be physical or psychological or both. Physically, loss of lubrication and elasticity in the vagina can contribute to it.

The psychological causes are more problematic. What happens is this: Once you experience any kind of pain with intercourse, you’re afraid it will happen again. Your brain reacts accordingly and the anticipation of that pain creates a fear that can actually trigger the spasm. So it’s really out of your control.

The spasms may also be a protective measure brought about by trauma; women with vaginismus may be survivors of rape or abuse. (Well-known sex therapists Masters and Johnson identified this as a psychosomatic illness back in the 1970s.)

The ultimate result is that you want to avoid sex altogether. And that can create a vicious cycle that can wreak havoc not only in your sex life, but in your relationship, too. You no longer want or enjoy sex because of the pain associated with it, and your partner feels rejected and maybe even a little resentful or angry. You feel guilty and you’re both left frustrated, unsatisfied, and unhappy.

The good news is, vaginismus is very treatable, once it’s recognized and diagnosed. In the next post, I’ll tell you what to look for and what to do if you suspect you might have it. In the meantime, if you are having pain, share this information, so your partner knows that what you’re experiencing is real. And that you’re determined to find a solution!


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