Painful penetration?

Dear Help!,

It is great that you are taking charge of your health and know that you have a healthy vagina! Since you say that you have already consulted various gynecologists and have ruled out a medical problem (a great place to start), there may be other non-medical reasons for your pain during penetration. One type of painful penetration not caused by a specific medical issue is referred to as vaginismus, and is experienced as a strong, involuntary tightening or contraction of your vaginal muscles. More specifically it is a spasm of the outer third of your vagina, which makes entrance by a finger, tampon, speculum, sex toy, or penis acutely painful. As you mention in your question, Kegel exercises may be one of several ways to address this painful problem (more on that in a bit).

Noticing pain during penetration is something many people with a healthy vagina may experience at one point or another due to different levels of lubrication, inflammation, hormone changes (especially for those post-menopause) or other factors. Vaginismus could have many different psychological or emotional causes: the result of a previous painful sexual experience or a painful GYN exam; a history of sexual abuse; or stem from anxiety, depression, or relationship issues. Sometimes there is not a clear cause.

Whatever the cause, determining which scenarios produce painful penetration may assist in finding a possible solution. A little self-exploration may be helpful in this type of situation. You may want to ask yourself:

• Have you experienced similar pain when inserting a tampon?
• How about during a gynecological exam?
• Have you tried inserting a finger or two (yours or your partner's) to investigate the response?
• How about trying penetration with a vibrator or dildo?

Vaginismus can be treated successfully by a variety of methods, including psychotherapy, hypnotherapy, and sex therapy, either alone or with a partner. These types of therapy may help you get a better understanding of why this might be happening. One technique a sex therapist might recommend is Kegel exercises, which are done by alternately contracting and relaxing the pelvic floor muscles. By consciously exercising these muscles, people with vaginismus can learn to make the muscles around the vagina relax voluntarily so that penetration may occur more easily. A therapist can tell you exactly how to adapt Kegels for your use. Because vaginismus can stem from emotional rather than medical causes, improving self-awareness and communication with any partner(s) may also help.

If sex is in any way painful, there is no need to grin and bear it. Until the problem is solved, try to be creative and figure out ways to be sexual without vaginal penetration — or with a less intense form of penetration. That way, you can still give and receive pleasure while you are working things out. For more ideas about experiencing pleasure with and without penetration and communicating with your partner, consider reading No orgasm with intercourse (female).

Because associating penetration with pain can further increase the likelihood of a vaginismus response, it may help to seek assistance sooner rather than later. Consider talking with a sex therapist, reading about the condition, and trying to make changes that feel good for you. To find a sex therapist in your area, you might visit American Association of Sexuality Educators, Counselors, and Therapists (AASECT). Wishing you pleasurable exploration ahead!