health

The hidden condition affecting the sex lives of nearly 1 in 3 women at Mamamia.


 
The day I was told I had been suffering from vaginismus for 14 years, I felt angry. 

I have gone my entire life never being able to use a tampon. I have gone my entire life thinking penetrative sex is excruciatingly painful, and women just pretend to enjoy it. I have gone my entire life being scared of my own body. And according to my physiotherapist, it started the day I began my period. 

Suffering from polycystic ovarian syndrome (PCOS), I was told that due to the lack of estrogen at the entrance of my vagina, my vulva was red and dry when it should be pink, moist and elastic. What annoyed me the most was, if I had been prescribed estrogen cream from the time I was 11, I probably wouldn’t have vaginismus at all. Since using the cream, I can see my skin getting better, but the association of penetration equating to pain still occupies my mind every single day. 

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I self diagnosed a few months ago when I searched ‘why does sex hurt’ on the internet. I went to my GP who specialises in women’s health and told her, ‘I think I have vaginismus’. Initially, she was shocked. She said that I was her first patient to correctly diagnose myself and who knew that vaginismus existed. She told me she had seven patients currently being treated for vaginismus but she believes that number would be much higher if there was more education about the condition. 

Since being diagnosed, I’ve been going to physiotherapy to work on pain reduction and muscle flexibility. I have to do exercises with dilators every day and every day I cry. Not necessarily from pain but from the fact that I can’t believe this is my life. The one thing my vagina is supposed to do, it can’t. Whenever my friends talk about ‘mind-blowing sex’ or even just having a one-night stand, I feel immense rage and jealousy. Something that comes so easily and naturally to them, is something that I have to mentally prepare myself months in advance for and even then, it’s not guaranteed. 

Being single has helped me a lot with my treatment. I was dating someone when I was initially diagnosed and although he didn’t put any pressure on the situation at all, I put a lot of pressure on myself. I believe that knowing I am doing this treatment for myself and not for anyone else has made the experience of being treated 100 per cent better.  

***

The curable condition no one has heard of.

There’s not enough research yet to truly tell us how common vaginismus - or genito-pelvic pain, which is the name we're moving towards - really is. 

If you ask the three experts Mamamia spoke to, it’s absolutely everywhere. But unfortunately, it’s still not being talked about nearly enough, and there are still plenty of GPs sending women away with instructions to ‘just relax’ or ‘have a red wine and a valium’ when they complain about painful sex.

Just look at the Mamamia newsroom. Out of a team of 22, seven of us have suffered with or are still living with vaginismus. We’ve lived with it for years, many of us just thinking there was something ‘wrong’ with us or that we didn’t enjoy sex. 

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Once we had a name for it, everything changed. Because vaginismus is a condition involving a muscle spasm in the pelvic floor and it’s completely curable. 

As Dr Irmina Nahon, a pelvic floor physiotherapist and senior lecturer at Canberra University told Mamamia, “In about 40 per cent of women we never find a cause or origin of the pain. Causes can be physical, emotional or psychological and it’s definitely common in women who have experienced unwanted, violent or painful penetration or sexual experiences.”

To get technical for a moment, your pelvis is hollow. So we need pelvic floor muscles to hold and support all of the organs inside. The pelvic floor is made up of three separate paired muscles, which together literally create the floor of the pelvis. In females there are three ‘tubes’ that pass through the pelvic floor: the urethra, the vagina and the rectum.

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As Dr Anita Elias, from the Sexual Medicine and Therapy clinic at Monash Health explains the pelvic floor contracts (or tenses) when we jump, sneeze, laugh, and cough, and it is important for it to be strong enough to keep us continent. However, we also need the muscles to be able to relax sufficiently in order for anything to ‘go in’ comfortably when we want it to. 

“Those with vaginismus still need their pelvic floor to be strong enough, but also need to learn how to consciously be able to relax and release the tension and tightness in it, in order to have comfortable, pain-free penetration,” she told Mamamia.

Penetration can be sexual, but it also refers to the insertion of tampons or medical procedures like internal ultrasounds and pap smears. 

While vaginismus can be fixed, a physical-only approach to curing the condition rarely works. As Dr Nahon will tell you, it’s as much about the brain as it is about what is happening inside your body. 

When I was in my early teens my mum took me to a urologist because I was leaking urine when I laughed. It had led to me spending my days at school anxiously tensing my pelvic floor to avoid accidents.

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On the day of the appointment I was on my period, so my mum called ahead to check that I wouldn’t be internally examined. I hadn’t shown anyone my vagina before, and the thought of having to do it while bleeding was mortifying for a 13-year-old.

They assured my mum they wouldn't. But once there, the urologist matter-of-factly told me it 'wasn’t a big deal,' as she ushered me into her stirrups. It wouldn’t be until I was 28 that I'd comprehend how much the fear of wetting my pants as a young girl, and that consequent appointment, traumatised me. 

 

When I tried to use a tampon for the first time not long after that medical visit, I remember almost having a panic attack in the bathroom. I physically couldn’t get it in, and I felt so giddy from trying I had to stop and sit on the floor. For the next 15 years I struggled with tampons, and only wore them if I was swimming. Every time, I had to take a mental run-up. 

Fast-forward to my mid-20s and after some unrelated symptoms I spent two years in and out of specialist appointments having invasive internal tests. I would ready my mind and breathe through the stinging sharp pain I felt during every examination, hating every minute. 

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In the years after that, penetrative sex also started to hurt, and that’s how I found myself in a pelvic floor physiotherapist's office in 2020. She told me my pelvic floor looked like a 'W' when it should like a 'U'. I had developed vaginismus from overusing my pelvic floor as a tween and from the trauma I associated with medical examinations. Thanks to an increase in those in recent years, it had started to impact my sex life, too. 

I cried in her office that day. Everything she said made so much sense, and for the next few months, every second night, I did the exercises she prescribed me. She taught me that my pelvic floor needed to be stretched, just like a calf muscle needs to be stretched after a run. That visual made it so much less daunting. Slowly with her guidance I felt the ‘W’ get flatter, until eventually the pain eased. I was advised to see a psychologist alongside my physical treatment to make sure I cured my condition. I opted not too purely because of how much dual appointments would cost me.  

Ever since I was a teenager I remember having a complicated relationship with my vagina. I couldn’t insert a tampon, and when I told people I found it exceptionally painful and most of the time completely impossible, they looked at me like I was crazy. 

It wasn’t until my early 20s that sex became really uncomfortable. It sounds really weird, but basically it felt like I had these muscular… rings… inside my vagina that were super tight, and they couldn’t relax. It’s unlike any other pain I’ve experienced. I dismissed it for many years and just tried to ignore it. Sex was possible, but just not pleasant. 

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Looking back, this seems to have emerged a few months after I was sexually assaulted on the street when walking home one day. Ultimately, I managed to get away, but it was like my body remembered even more than my mind did. 

 

I was diagnosed with vaginismus after getting a particularly painful pap smear probably at around 26. It felt like a bee sting and the process of even inserting anything in there was excruciating. The doctor kept telling me to relax but I couldn’t. It was honestly like a doctor telling you to keep your eye open while they came at it with a needle. It was an involuntary bodily response. 

I’ve worked with a pelvic floor physiotherapist and honestly it was a relief to be told there wasn’t anything physiologically ‘wrong’. The muscles are tight and my mind is doing something it feels it needs to do to protect me. Things have gotten a little better over the years, but it’s not entirely gone. I still don’t really use tampons and find them uncomfortable. It’s nice to know I’m not the only one with this problem.

***

All pain is real.

When it comes to vaginismus, Dr Nahon says the experience of having a threat in a certain area for a period of time can perpetuate the perception of pain. You end up with a subconscious reaction that leaves you already involuntarily tensing up in anticipation of pain, before anything has actually entered you. No matter how much lubricant you use, entry is then painful and so the pain is reinforced. 

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Primary vaginismus is when pain is evident from the very beginning - so the first time you insert a tampon or have sex. Secondary vaginismus is when sex is fine to start with, but then something changes and that leads to pain. 

For some women, secondary vaginismus might come from birth trauma, menopause, or physical conditions like endometriosis or PCOS. But no matter the cause, there’s always a treatment.

Dr Nahon uses dilators to help a patient physically, working in conjunction with a sex therapist to make sure they’re taking a biopsychosocial approach. 

“I use dilators, but I call them trainers, because it’s about training for something fun. Dilation sounds clinical and it sounds like you are forcibly stretching something, and in fact the reverse is true. We want to slowly introduce an object into the vagina. You use the smallest one first when you’re completely relaxed and gradually move to larger and larger ones.” 

If you’re triggered by medical instruments rather than a penis, a dilator is replaced by a less overwhelming thumb. 

Watch: Emily demonstrates how she uses her dilators. Post continues after video.


Video via Instagram @emilyvernem. 

In extreme cases, some patients will need Botox to force their pelvic floor to relax. But as Dr Nahon continues to stress, that only treats half of the problem, and she will always encourage patients to get professional help for their mind, while they're training their body.

I was 18 when I was first diagnosed with vaginismus, but it wasn’t the first time I tried for the diagnosis.

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I first became sexually active at 15 with my boyfriend at the time, and I was always able to find an excuse for the pain that came with it. At first, I assumed it was just getting used to it, and not knowing any better. But the ebbs and flows of severe pain to mild discomfort continued for the duration of our four-year-long relationship.

Vaginismus drove our relationship into the ground. I convinced myself that I had a very low sex drive, when I really just wasn’t interested in sex because of the pain that came with it. When I finally came to terms with needing to get it treated, the first doctor I went to left me humiliated and ashamed. The only explanation for the pain he gave me was that my boyfriend’s ‘penis was too large, and my hole was too small’.

 

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After that experience, I was hesitant to see a doctor again. Someone suggested I try a women’s health clinic, and following my break-up, I decided it was important to fix my pain to avoid future relationship issues. When I called the clinic, extremely nervous of speaking about it again, the receptionist treated me with such compassion that I cried over the phone.

My appointment at the clinic was quick and easy. The doctor assured me that there was nothing physically wrong with me as I feared. I was referred to a physiotherapist and the fix, although tedious, was far less scary and invasive than I had anticipated.

As I left my appointment with the women’s health clinic, I rationalised that despite the cost ($90 for five minutes), having a name for the issue was worth it. But the cost of the recommended appointments with a physiotherapist after that were well out of my budget. Now armed with a diagnosis I sought out the recommended treatment online through articles and videos. Knowing vaginismus was a bodily response as opposed to a physical deformity also alleviated the visualisation I was having each time I went to have sex of a ripping vagina, which surprisingly, really helped.

Nowadays, I take my time with foreplay to ensure I am fully relaxed before having sex and I rarely feel any discomfort. It’s also such a relief to know I don’t hate sex. 

***

Sex should never hurt. Not even the first time. 

As psychosexual and relationship therapist Christine Rafe will tell you, sex should never be painful.

“The myth that sex 'should' hurt the first time is so deeply ingrained in our culture, that young vulva and vagina owners assume that this is part of the process. Sex should never be painful, not even the first time. If it feels painful, you either aren't aroused enough or not relaxed enough. These are both signs to take a step back and either build the arousal, or consider whether that is the right time for penetration for you.”

As Dr Nahon explains, in some cases it only takes one bad experience or one negative headspace to trigger vaginismus. 

“It could be something as simple as where your headspace was the first time you inserted a tampon, or the first time you had intercourse. It doesn’t mean it was unwanted, or not consented to. It was just the emotional environment you were in at that time,” she said. 

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Even though as a society we are getting better at talking about sex in a positive and pleasure-focused way, Rafe says this isn't happening early enough and it’s still not being taught during sex-ed at school in a way that supports consent, safety and pleasure.

The uncomfortable truth is, we still live in a society where young girls accept before they’ve even had intercourse that ‘the first time will hurt’. Where doctors are jokingly asked by male partners to ‘throw another stitch in there for me’ after a woman gives birth. Or as Dr Nahon was once told, “my husband can’t get it up anymore, thank goodness.”

But ‘tightness’ is not something to be celebrated. It’s a sign a woman is not aroused enough and pain is an experience that shouldn’t be associated with sex. None of these statements are okay, and yet they’re not uncommon. In fact, they're an accepted part of our vernacular. 

Sex therapists like Rafe focus on education and exploration around desire and arousal, overcoming negative psychological beliefs as well as relationship dynamics to support successful experiences in the future. As she told Mamamia, her patients with vaginismus have an amazing success rate, and go on to have pain-free pleasurable penetration as part of their sex lives.

For couples in relationships, Dr Nahon often gets her patients to abstain from penetrative sex for three months. When she does encourage heterosexual couples in particular to reintroduce it, she often gets them to do so in a particular way. 

“I get them to play a little game where she gets him aroused and he lies on his back, and she lowers herself onto him. The rule is, he isn’t allowed to move. She is in charge of the situation. The purpose is so she can get to a stage where logically she trusts him and subconsciously and physically her body trusts him too,” she explained. 

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‘I have a tight vagina,’ I shyly said to a male doctor I had never met before. ‘I’m not sure how to pronounce this word, but I did some research and I think I have something called vag-een-ise-mus.’

‘Vag-in-is-mis?’ he clarified.

‘Yes!’

Learning that I had vaginismus felt like a different kind of sexual awakening. Before then, I honestly thought all women had subscribed to an amusing inside joke that sex was enjoyable, but secretly it was mediocre at best.

 

Since I’d lost my virginity, at 15 years old, sex caused discomfort. Slowly and subconsciously, sex became agonising.  

Every sexual partner I’d had said I had a tight vagina. The comment was always said like it was a compliment. But what they didn’t know was that my unusual tightness was not my anatomy but rather a physical manifestation of my fear of sex. 

I never said anything. I waited, unwisely, until the pain was insurmountable. Until every affectionate touch sparked apprehension. Every thrust triggered throbbing. Every night was filled with guilt for not wanting sex. I’d had a partner for over a year when I finally said out loud how unbearable sex had become. So I went to the GP, where I learnt this was a fixable condition. 

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For the next ten weeks, every Wednesday morning at 7:30am, I travelled across the city to see a physiotherapist. The first session I cried, purely from the pain of a pinky-finger slightly pushing against the walls of my vagina. The second and third time, I also cried. But by the fourth, the pain had slightly subsided. It took until about the eighth session for me to feel no pain.

During treatment, I was told not to have sex (for three months). The physiotherapist warned me that this inability to have sex often caused arguments, and even breakups, for many of her clients. My then-boyfriend never seriously pressured me into having sex, but there was certainly a lack of understanding. For him, this was all in my head. But for me, this was a physical condition that was out of my control.  

The other thing the physiotherapist helped me with was understanding and processing why I had vaginismus. When I was 15, I was sexually assaulted and thereafter I felt like what happened to my body was not in my control. And so clenching my vagina was my body’s subconscious defence mechanism. 

I’d love to say that I no longer have vaginismus, but I can still feel it. Thankfully, though, I’m now acutely aware of how to deal with it, and how to relax my body. 

 ***

Right now there are women all over this country internally tormenting themselves. 

Worrying that they can’t do something that should be fun without it being painful.

Terrified that they might not be able to bear children. 

Devastated that their partner can't or won't understand. 

Embarrassed that as a grown woman they can’t insert a tampon. 

Angry that they keep being dismissed by doctors. 

Frustrated that no one seems to understand. 

“Don’t put up with it,” said Dr Nahon, who has had at least two women threaten to name their kids after her after she cured them of years of painful sex.

“Don’t take blasé, throw away answers as the answer. Keep searching for answers for you. And know that there are solutions out there.”

Experts in this field don’t have all the answers yet. Considering the clitoris didn’t appear in anatomy textbooks until the 70s, it’s safe to say we have a long road ahead of us when it comes to women’s health. 

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But know this: painful sex is not normal. A tampon shouldn’t hurt when you insert it. A pap smear should be uncomfortable, not excruciating. 

From 1 in 3 women at Mamamia, we're begging you: don’t put up with it. Promise us? 

You, your sex life and your vagina deserve so much better.

If you live in Canberra, you can find Dr Irmina Nahon here. If you live in Sydney, you can find Christine Rafe's details here. You can read more from Dr Anita Elias here.

Feature Image: Mamamia. 

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