FOXSexpert: Access Denied -- When Sex Is Too Painful

Access denied. For some couples, vaginismus — a rare and frustrating vaginal reflex barrier — can make sexual intercourse impossible.

Attempts to break through the barricade, if remotely successful, only result in extreme pain. In many cases, filled with longing, she feels surprised, powerless, and out of control. Her partner, sore, emotionally speaking, finds little comfort in sharing his own grief with his lover.

While there is no good data on the prevalence of this sexual disorder, vaginismus is the most common reason for unconsummated marriages. It rarely goes away on its own. If left unaddressed, the symptoms only get worse. The relationship suffers as well, with lovers desperate to know: Can lovemaking overcome this kind of lockdown?

This condition is characterized by a strong involuntary contraction of the vaginal muscles — mostly of the outer third of the vagina — which occurs prior to sexual intercourse. For some women, this has been a lifelong problem (primary condition). For others, “normal” sexual functioning has been disrupted by a specific trigger (secondary condition).

In either case, this is not a conscious effort. Just as a blink protects the eye, these so-called “blinks” protect a woman from unwanted sex or sexual advances she can’t handle.

The irony is that the body’s reaction to avoid pain causes pain itself. The woman then comes to anticipate pain, which increases the likelihood that sex will be painful. This becomes a cycle.

Fearful and anxious, the body’s stress-response system is activated. A woman may notice a dry mouth, accelerated breathing, excessive sweating and an elevated heart.

What Causes Vaginismus?

While this sexual dysfunction is linked to pain disorders or medical conditions, including vaginal infection or hysterectomy, it is usually related to psychological issues. The sex phobia can affect females of all sexual orientations, and those fully capable of arousal and orgasm.

It may be due to:

— previous unwanted sexual experiences, e.g., rape or childhood sexual abuse;

— trauma to the body from the treatment of childhood illness;

— physical abuse;

— discomfort with a sexual situation;

— fear of penetration and the potential pain involved;

— relationship issues, including lack of trust in one’s partner;

— negative messages about sex growing up;

— coming from a restrictive culture, especially one that puts a high value on virginity;

— need to maintain control in the relationship;

— lack of sexual knowledge, experience and skills.

In some cases, couples bring this condition upon themselves. An article in the "National Vulvodynia Association" newsletter by sex therapists Dr. Stephanie Buehler and Christine Seeberger featured a couple who, on their wedding night, literally walked out of the taxi, into their hotel room, and attempted first-time sex without foreplay. This resulted in a year of painful attempts and emotional strain.

Regardless of the cause, lovers need to get help. This fear of intimacy can have her feeling alone, ashamed, and defective. Her partner may feel rejected and frustrated. Both are distressed that they’ll never have “normal” sex. The good news is that they can.

Your Treatment Options

Once a gynecologist has ruled out any medical problems, treatment for this type of sexual anxiety is dependent upon the degree of emotional stress. A woman who is slightly apprehensive may more readily grant entry with information, self-awareness, communication skills, and reassurances.

A woman grappling with severe panic and/or anxiety attacks will require more work. The treatment goals for any sufferer are to overcome fears of penetration and to reverse her response. A program, tailored to her needs by a competent sex therapist, may include:

— Education, for example, learning about the importance of foreplay;

— Desensitization, such as, examining herself in a mirror;

— Physical therapy to retrain pelvic muscles, for example, Kegel exercises or manual therapy that involves stretching for greater flexibility;

— Individual psychotherapy (including hypnotherapy) and/or couples therapy for dealing with emotional and relationship issues;

— Medications;

— Pelvic floor biofeedback, where a sensor reads vaginal muscle activity in an effort to relax, strengthen and control the pelvic floor muscles;

— Behavioral therapy.

Individuals and couples are given “homework,” which heavily emphasizes training the vaginal muscles to open and relax during sex.

The work is slow, but the payoffs are well worth sticking to it. In the meantime, couples should strive for other ways to express their “love” till permission is granted.

*To find a certified sex therapist in your area, visit

Dr. Yvonne K. Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, "Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots."

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