Does It Hurt to Have Sex?

You may have vaginismus—one of the most underreported and painful disorders a woman can face. Find out what the signs are and how to get help.

| May 13th, 2013

From the time she got her first period, Ashley*, now 29, knew she wasn’t like other girls—at least when it came to using tampons. “I remember how challenging it was to put one in,” she says. “I spent many hours crying in the bathroom and eventually gave up.” She didn’t date anyone in high school and avoided going to the gynecologist since she was afraid of getting an internal exam and the pain it might cause.

MORE: How to Talk to Your Doctor About Sex

Despite her anxiety, she was determined to have sex once she met someone she felt comfortable with.

Four years ago, Ashley’s wish came true. She began seeing a guy and, as the relationship got more serious, she told him she was a virgin. When the couple first tried to have sex, things turned disastrous. “It felt like he was hitting a brick wall,” she says. “I thought there was something physically wrong with me, like I was mis-formed.” The couple tried again and the same thing happened.

That’s when Ashley began researching what might be going on in the hopes of getting some answers. She discovered the Women’s Therapy Center, a sexual health practice in Plainview, N.Y. and booked an appointment with the two therapists there. Ashley had vaginismus—a painful condition in which the pelvic floor muscles tense up in anticipation of penetration, effectively closing off the vagina. After 10 sessions with the therapists, in which Ashley gradually began inserting her finger into her vagina and eventually began using dilators of varying sizes, she was able to have intercourse. “At first it was scary, but my therapists kept telling me that my body was designed to do this,” says Ashley. “They told me this was happening because my pelvic floor was tensing up, and I just needed to train my body not to.”

Like other women who have vaginismus—a condition whose causes aren’t fully known, but it’s been linked to trauma (such as sexual or emotional abuse), anxiety and guilt over having sex—Ashley was unable to have a pelvic exam, use tampons or have sex, until she got help.

MORE: How to Journal Through a Traumatic Event

Vaginismus, which affects one to seven percent of women worldwide, breaks down into two categories—mild and severe. If you have a mild case and find a doctor who is knowledgeable about the condition, you may receive sex counseling and try using dilators, hypnotherapy and physical therapy. Mild cases tend to respond well to a variety of treatments, explains Peter T. Pacik, M.D., a physician in Manchester, N.H., who specializes in vaginismus. “The more severe cases that involve a high level of anxiety about penetration are more difficult to treat,” he says. “I think of it as a protective reflex. The patient believes intercourse will cause her pain and then the body creates a protective mechanism by causing those entry muscles to go into spasm and not permit entry.”

In addition, vaginismus presents in two different categories—complete vaginismus, meaning a woman can’t tolerate any penetration at all, and situational vaginismus, meaning a woman can tolerate a tampon or finger penetration but nothing more. “A woman usually discovers she has vaginismus when she can’t get a tampon in or she can get it in but can’t get it out,” Dr. Pacik explains.

What worries physicians is that there are health consequences to vaginismus since sufferers tend to put off checkups with their gynecologist. “Many women make appointments and find an excuse to cancel,” he says. “This happens year after year so they may go 15 to 20 years without having a Pap smear or pelvic exam.”

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