When Sex Is a Pain
Vaginismus and Dyspareunia
Pain in places and at times when we hope that there will be pleasure is more common than many of us think. Because sex is not discussed, many feel alone in their painful sex lives. And so often shame and embarrassment arises because we think that we are deficient or there is something wrong with our sexuality. Furthermore, many religious and moral messages have seeped into Canadian mainstream culture, asserting that sex is for procreation, a duty, to be endured for the good of a relationship and that pleasure is unnecessary or even leads to bad consequences. Sex education is limited in schools where pain is rarely addressed. Many do not feel comfortable discussing their sex lives with their parents, who are often also uneducated anyhow. Finally, many people will not bring up sexual issues with a medical professional unless asked and even then, may not respond honestly out of shame.
The reality however is that dyspareunia, or painful sexual contact, is relatively common. This covers a range of experiences from external to internal pain, from infections, cysts or lesions, to cancer or anatomic variations. It can also be triggered by hormonal changes, especially during menopause or hormonal disruption, where the lining of the vagina thins, the vaginal walls atrophy and lubrication decreases. Some have a tight pelvic floor (kegel or Pubococcygeus or PC muscles) where anything entering the vagina is met with resistance and hence pain with any force to penetrate. A pelvic physiotherapist is a good resource to help diagnose which muscles are tight and to teach you how to train these muscles to relax. They may also notice that there are adjacent muscles that need to be stretched in order to relax the whole area. Our muscles, bones and ligaments are all very interconnected.
A medical professional is the first place to go when painful sex occurs. If you feel anxious about speaking to your medical doctor about this, remember that many women experience this type of pain and that your doctor has heard it before, will not judge you and is there to help. Moreover, just because it is a pain in a sexual part of the body does not mean that it is any less important or valid than a pain anywhere else in your body.
One resource I cannot recommend highly enough is When Sex Hurts by Goldstein, Pukall, and Goldstein. They break down pelvic pain into many specific and distinct conditions that might help you better understand your condition and might even have information that could be useful to pass onto your MD.
One type of dyspareunia pain that is quite common is vaginismus: involuntary tightening of the vagina during anticipated or actual penetration. What often happens is that the vagina does not trust that anything coming towards it will feel pleasurable or even neutral. It almost has a mind of its own: no matter how much a woman might will her vagina to relax, it makes up its own mind. If she fears that touch will be painful, she will tense in order to keep anything out. And following a painful experience, where it was unexpected or where she forced herself to endure the pain, her vagina will tighten even more the subsequent time, as if to say, “no way are you going to get in here to hurt me again”. This pattern can lead to a downward spiral where the pain continues to increase and it feels like there is no way out.
Fortunately, there can be a way out, which requires some effort, but only 15 minutes to a half hour a day. Some people respond well to a gradual training of learning how to contract and relax the muscles as well as regaining the vagina’s trust. The simple process begins with a finger or thin dildo or soft dilator with gradual insertion. This should be done by the woman herself first, as her vagina will trust her own hand’s movements more than a partner’s.
Start with inserting just a little, very slowly. As soon as there is any pain, leave the finger/ toy in place without moving in or out. Take a deep breath, clench the vagina for 5 seconds and then relax while breathing out. The vagina should be more relaxed, similar to the common Progressive Muscle Relaxation Technique where muscle groups are tensed and relaxed in progression. What this process does is consciously tightening the muscles (which are slightly or highly tensed) so that when released, they are even more relaxed. Then move inwards again slowly and stop when you feel pain again, breathing, squeezing and releasing. Repeat this process with your finger/ dildo for 10-15 minutes. The first time you may only move it in and out a couple of times over a 15-minute session as you keep stopping to squeeze and breathe. That is ok. It can take a few sessions before your vagina starts to trust and relaxes more. The most important thing is to NOT endure the pain. Forcing yourself to endure any pain takes your vagina a step backwards in trust. This means that you may have to refrain from internal sexual stimulation with a partner for a couple of months. Take advantage of the opportunity to explore other types of external pleasure in the meantime.
Once a finger or toy can be inserted with a regular in-and-out rhythm without pain, then you can progress to two fingers or a larger dilator/ toy. Follow the same process with increasing speed and size, stopping, breathing and squeezing when there is pain. Once you feel comfortable involving a partner, ask them to hold it while you squat down onto the toy, controlling the depth and speed yourself. Squatting is a good position to start in as it is harder to contract your pelvic floor in that position. When you are ready to progress to the next step, you can ask your partner to move their finger or the toy, building up trust between your vagina and your partner.
Of course, this is a very rough outline of how to proceed. Remember that a medical professional and pelvic physiotherapist are the best place to start to rule out any physical reasons or complications to your pain. Try to see your vagina as your friend who needs some coaching rather than your enemy who is preventing you from intimacy and pleasure. And don’t force your vagina to endure any pain. It will respond much more favourably if you seduce it and help it regain your trust.
Carlyle Jansen is the founder of Good For Her, a sexuality shop and workshop centre in Toronto. If you have questions or comments, email firstname.lastname@example.org or go online to goodforher.com