Q: Why am I too tight for sex?

What you describe could well be vaginismus, which is the involuntary spasm of pelvic floor muscles of the outer (lower) third of the vagina. The resulting interference with intercourse is experienced as "too tight," "he can’t get in," or "it’s like he's hitting a wall."

Because the spasm is involuntary, the cause is sometimes difficult to understand. Pain in the area of the pelvis can be a contributing factor, so the hip pain you describe is likely involved. Beyond interfering with intercourse, vaginismus--those pelvic floor muscles in spasm--can also be experienced as pain in the pelvis, low back, low abdomen, and upper thighs.

It's important to have an exam to better understand what's happening for you, and I'd advise that you have the exam sooner than later. If you have surgery in your future, physical therapy that starts before-hand (and continues after) could help in your recovery, too. Vaginal dilators are often a part of therapy for vaginismus, and that, too, can start now and deliver benefits for your recovery.

Good luck in working through this! With patience and good information, you can do it.

Hitting the Wall with Vaginismus

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!

Pain during Sex? Escape the Cycle

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.

Q: Why am I 'hitting a wall' with sex?

What you describe--feeling like your partner is "hitting a wall" when you attempt intercourse, sounds most consistent with vaginismus. A physical exam can look normal; with careful palpation of the pelvic floor muscles, you can feel them tightening, which is what makes the "wall."

You might go back to your physician with the specific question, "Do my pelvic floor muscles seem too tight?" If that is the case, dilators and/or physical therapy are good solutions. A dilator set will include much smaller sizes--as small as a half-inch--so you can increase your comfort gradually.

Good luck! This is an issue you and your partner can work through.