Vaginismus: Women Who Can't Have Intercourse

Mary, age 25, has been married for one year. While she and her husband are very much in love, they share a secret they have told no one. Despite numerous attempts, they have been unable to have sexual intercourse. She has also never been able to insert a tampon or finger into her vagina.

Betsey, age 32, confides in her gynecologist that while she is able to have a pelvic exam, she and her boyfriend have been unsuccessful in having sexual intercourse. Upon further questioning, her doctor learns that Betsey is still a virgin.

What Mary and Betsey have in common is a condition called vaginismus. Vaginismus is an involuntary spasm of the muscles surrounding the vaginal opening which occurs whenever an attempt is made to penetrate the vagina. For some women, such as Mary, any attempt to insert anything into the vagina is unsuccessful. For other women, such as Betsey, certain types of penetration can occur without pain or discomfort, such as putting in a tampon or undergoing a pelvic exam, however, when intercourse is attempted, penetration is impossible.

What causes this to occur? In most cases, this is not due to a physical deformity or disorder. Instead, it is an emotional condition that occurs because of psychological reasons but manifests itself in a physical response. The majority of women with vaginismus believe that intercourse will be very painful; often thinking that their vagina is too small to accommodate the penis and therefore, their vagina will be ripped or stretched too far. Consequently, they develop a phobic response to the penis; associating it with pain. Other women have indeed experienced some type of trauma to the vagina or genital region, such as rape, sexual abuse, or surgery, which then leads to a fear of intercourse. And, unfortunately, for some women, it is their first pelvic examination that causes them to be fearful. Lack of sensitivity on the physician's part, or neglecting to adequately inform the patient what she can expect, has sometimes contributed to the pelvic exam being a negative experience for women; causing them to fear sexual intercourse.

Sometimes the type of relationship a woman has with her partner or the feelings she has about the relationship interfere with her ability to have intercourse. Women who do not feel physically or emotionally safe with their partner may "shut down" via their bodies. In these cases, vaginismus is not a conscious decision but is a consequence of a desire to protect their bodies and themselves.

Some women who have been brought up to believe that sexual intercourse is wrong to engage in before marriage, or have conflict regarding sexuality and behaving sexually may also find themselves having difficulty with intercourse. Not having intercourse protects these women from doing something they feel wrong doing. For some women, it is the possible consequences of intercourse (pregnancy, childbirth, or sexually transmitted diseases), that make them fearful.

However, in a small number of cases, physical factors (such as the presence of a rigid hymen, or deformities of the vagina) can make penetration of the vagina impossible. Additionally, although physical conditions, such as endometriosis, vaginal infections, or an episiotomy are not directly responsible for a woman experiencing vaginismus, they may, through association, contribute to vaginismus indirectly through conditioning. What this means is if a woman experiences pain upon intercourse, or with a pelvic exam, this may lead to a self-protecting tightening of the vaginal muscles the next time she attempts to have intercourse.

Many women who suffer from vaginismus believe this problem is unique to them. There is a tremendous sense of shame and embarrassment at not being able to do something that is perceived as being simple and natural. A large number of women who eventually seek help admit they have never confided in anyone for fear of being ridiculed and humiliated. In their relationships with their partners, women with vaginismus often experience feelings of guilt and inadequacy. Over time, if they continue to fail in their attempts to have intercourse, many couples eventually decide to stop trying. The inability to be successful and establish a full sexual relationship usually places significant strain on the relationship as a whole.

It is important to know that there is help available for overcoming vaginismus. A key factor, however, is knowing where to get help. Unfortunately, there are still some physicians and gynecologists who may not be very sensitive to a woman's concerns or see the problem as simply one of "needing to relax" or "not worrying." If this is your experience, seek out another physician or gynecologist who understands what vaginismus is. Even if he or she does not treat vaginismus, they should be able to refer you to someone who does, such as a sex therapist. A sex therapist may be a psychologist, social worker, psychiatrist, or nurse who specializes in problems dealing with sexuality and sexual functioning. If your doctor does not know of someone like this, you may want to check with major hospitals and/or medical schools to see if they offer sex therapy services. You can also contact the American Association of Sex Educators, Counselors and Therapists in Chicago at 312-644-0828 for a listing of certified sex therapists in your state.

Treatment for vaginismus consists of a combination of relaxation training and various behavioral exercises in helping the woman overcome her fear of intercourse. The husband or partner's participation in treatment and his emotional support are considered very important to the success of treatment. Sometimes, in addition to the above treatments, individual and/or couples therapy is recommended as well. In the majority of cases, treatment is successful and couples are able to move on to develop and enjoy a sexual relationship that is satisfying to them.

SOURCES: LoPiccolo, Joseph, & Schoen, Mark. Treating Vaginismus. (Videotape). Available through Focus International. (1-800-843-0305). Valins, L. (1992). When A Woman's Body Says No To Sex: Understanding and Overcoming Vaginismus. New York: Penguin.