What to do if sex hurts and your gynecologist can’t help
Vaginismus
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You’re at the gynecologist’s office. You’re even more uncomfortable than usual because you want to bring up something difficult to talk about: your vagina hurts every time you try to insert a tampon, have sex or during the gyn’s examination.
When your gynecologist finally comes in, you gather all your courage and start talking. You tell them about how much pain you’re in every time you try to have penetrative sex with your sex partner and how it’s hurting your relationship and your own sexual well-being. You tell them that you also can’t get a tampon in because your vagina feels too tight. You say that you think this might not not be normal, and that you really need some help.
In their most dismissive tone, your gynecologist tells you that it’s probably in your head and that you “just need to relax.” You go through the rest of the appointment on autopilot, nodding and smiling while you’re screaming inside. At the same time, you swear to yourself that you will never come back again, avoiding any future gynecological examinations.
Unfortunately, this scenario is all too common. Many gynecologists don’t know much about vaginismus, and their lack of knowledge often leads to a misdiagnosis, meaning that they can’t offer you effective solutions.
Luckily, there are other ways to get the help you need.
Understanding vaginismus
While there are many different reasons why sex might hurt, vaginismus could be one of them. Vaginismus is a fairly common condition among people with vaginas. The pain you’re experiencing happens because the muscles in the vagina and pelvic floor spasm whenever something tries to penetrate your vagina, like when you have a muscle spasm in your back. These painful muscle spasms happen all on their own.
People develop vaginismus for all sorts of reasons. For example, for some, the muscle spasms start after sexual trauma or childhood experiences. Others develop vaginismus after childbirth, gynecological surgery, or menopause. For others, vaginismus is a symptom of another condition like endometriosis. Pressure and expectations from society, negative body image, low self-esteem, fear of giving up control, or relationship problems can also play a role. And for most people, it’s a combination of these different factors that leads to vaginismus.
Vaginismus is both a physical and mental condition. Because penetration hurts, you develop fear, anxiety and negative thoughts around penetration, and your body responds by tensing the vaginal and pelvic floor muscles, which leads again to pain during penetration. It’s basically your body’s way of saying “NOPE” and you might end up wanting to avoid anything that can cause this pain. If you’re stuck in this vicious cycle of pain and fear, we feel you. It’s so frustrating, and it can seem like there aren’t any solutions, especially if your gynecologist is less than helpful. But vaginismus is treatable! You just have to find what works for you.
Additional treatment options for painful sex
The good news is that treating vaginismus doesn’t even have to involve your gynecologist if you don’t want it to. Because vaginismus is both physical and mental, it’s best to address it with a combination of treatments, which may or may not involve health care professionals.
For example, professionals who specialize in pelvic pain can help you out, in person and virtually, as can therapists. They might set you up on a treatment plan that includes dilator therapy, cognitive behavioral therapy, and relaxation exercises, ideally combining different treatment options to one holistic treatment plan.
And if working with someone to address your pain feels too overwhelming right now, that’s okay too! There are multiple ways that you can start to address your vaginismus symptoms on your own. To learn more you can also refer to our blog article on vaginismus self-treatment.
Pelvic floor physical therapy
Pelvic floor physical therapists specialize in treating a variety of conditions that affect the pelvic floor muscles, including vaginismus. Pelvic floor physical therapy involves a combination of breathing exercises, relaxation techniques, and muscular retraining through deep tissue massage and/or vaginal dilators–tube-shaped devices of different sizes that can be slowly inserted into the vagina.
Your physical therapist will start by teaching you some breathing and relaxation techniques that help you relax the muscles in the vagina and pelvic floor. Depending on the severity of your vaginismus and your pain levels, they may focus on these techniques for multiple sessions before they even touch you.
Eventually, your physical therapist will start using massage and/or vaginal dilators to slowly change how your muscles respond to penetration. They may use their fingers to do deep tissue massage on your inner thighs or in your vagina to release tension in the muscles.
During these physical exercises, your pelvic floor physical therapist will coach you through relaxation exercises so you can learn to relax the muscles in your pelvic floor and vagina during penetration. And as penetration becomes less painful through these exercises, your body will learn to stop associating penetration with pain.
Sex therapy
Since vaginismus is both mental and physical, it’s important to uncover and process the mental and emotional aspects of your symptoms. A sex therapist can help you do that. They work specifically with people who’ve experienced sexual trauma, people who experience anxiety about sex, and people who are having issues with their sexual relationships.
If you’ve experienced sexual trauma, a sex therapist can help you process that to reduce anxiety and fear around sex, especially penetration. If you haven’t experienced sexual trauma, a sex therapist can help you identify your beliefs about sex, where they came from, and understand how those beliefs create fear, anxiety, or shame around sex that’s contributing to your symptoms.
Cognitive-behavioral therapy (CBT) and mindfulness techniques
Cognitive Behavioral Therapy, aka CBT, is a therapy style used to treat a wide variety of mental health issues, and research shows it can be an effective tool for treating vaginismus. CBT focuses on breaking the circle of pain of vaginismus by addressing the negative thoughts, feelings and physical behaviors that follow and influence each other. If you’ve been struggling with vaginismus, you’re probably familiar with the cascade of negative thoughts and feelings that start when you think about or attempt vaginal penetration. You might think “I’m never going to be able to have penis in vagina (PIV) sex,” or “My vagina is too tight,” or “I’m broken/weird/wrong for not being able to put anything in my vagina.”
Though your thoughts may be rooted in experience, they’re not entirely true, and believing that they are actually contributes to your vaginismus symptoms. They become self-fulfilling prophecies because your body responds to these thoughts by tensing the muscles in your vagina and pelvic floor, creating pain.
In CBT, you’ll learn mindfulness techniques to help you identify these thoughts, think them through logically, challenge them with facts, and replace them with thoughts that are more helpful like “I can’t tell the future, so I don’t know that penetration will always hurt,” “There’s nothing wrong with me or my body.”, “There’s no pressure. Step by step.” or “I’m allowed to feel pleasure. It just takes patience.”
Changing the way you think about your body and your symptoms and above all to understand what symptoms occur why will help retrain your physical and mental responses to penetration.
Digital therapy: The holistic solution
If working with a pelvic floor physical therapist or sex therapist sounds scary, that’s okay! You can absolutely work at your own pace if that’s more comfortable to you. There are other options that don’t involve seeing a person or having someone touch your body. Digital therapeutics combine at-home treatment techniques with the guidance of a professional, and it’s all accessible on your computer or smartphone.
Programs like HelloGina give you digital access to a professional coach that you can access anywhere, anytime. They’ll guide you through a treatment plan, starting wherever you’re comfortable. They’ll teach you treatment techniques that you can do on your own time, when it’s convenient for you, and you can reach out to your personal coach for help literally any time.
HelloGina, for example, provides all the scientifically proven and effective methods for dealing with vaginal pain and the uncomfortable thoughts and feelings related to that. It combines CBT and educational content with relaxation techniques, pelvic floor training and exercises using vaginal dilators. The program will teach you new ways to handle and reduce the pain and fears related to vaginal penetration, reframing pleasure to improve your sexual well-being. It’s a mind-body approach, like a sex coach, therapist, and physical therapist wrapped in one. Take this assessment to see if this might be for you!
Building a support system
Having vaginismus can feel isolating. Shame about your symptoms, fear of stigmatization or the feeling that nobody will get it may keep you from talking to anyone or seeking help. But talking about vaginismus and how it’s affecting you is actually a crucial part of improving your symptoms.
Communicating with your partner
Talking to your partner about vaginismus probably sounds terrifying, especially if you’ve had negative experiences with penetrative sex or your relationship is already strained because of your sex life. But open, honest communication is the best way to build trust and understanding. It can also give them the opportunity to support you.
First, it's perfectly okay to let your partner know that you'd appreciate setting some time aside for a discussion that embraces openness and empathy. Emphasize the importance of creating an environment free from judgment, as this can have a profound effect on your journey to recovery.
To ensure your partner can fully empathize with your situation, kindly suggest they learn about vaginismus prior to your conversation or offer your support in explaining it to them. This will allow them to approach the discussion with a better understanding and genuine readiness to support you.
During your talk, it's perfectly okay to share your fears, worries, and feelings of anxiety with them. Remember, it's through open communication that you can foster an environment of understanding and mutual support. Let them into your world, show them the steps you're taking to navigate your symptoms, and share how they can contribute positively to your healing journey. After all, you're not alone in this, and having your partner's support can make a world of difference.
If this feels completely overwhelming, we get it! If you think it will help, you can write out what you want to say or even practice the conversation beforehand. For example, you can ask yourself the following questions: What is vaginismus? What contributed to the development of my pain? Why is it important to me that my partner supports me? What would I want from my partner? Though having the conversation is scary, the results will be worth it.
Some of the general tips for good communication can also help here. Remember to:
- Use “I” messages instead of “you” messages, e.g. “I feel frustrated when sex hurts,” not “You’re hurting me during sex and it’s frustrating.”
- Express feelings instead of generalizations, e.g. “I was afraid that…” instead of “You’re always so negative.”
- Stay in the here and now instead of digressing into the past, e.g. “I notice that something is bothering you. Do you want to talk about it” instead of “Back then you couldn’t relax either.”
- Practice active listening, which includes eye contact, non-verbal feedback like nodding, and facing your partner when they’re talking.
- Summarize what you’ve heard and repeat it back to your partner in order to ensure you’re on the same page.
- Ask open questions
- Avoid interruptions
Finding community
If there’s one message we want you to hear loud and clear it’s “you are not alone!” The American College of Obstetricians and Gynecologists says that about 75% of people with vaginas experience painful sex at some point in their lives. But you probably don’t know that because so few people talk about vaginismus. That’s why it is so important to find a community of people who are talking about it.
And where are people talking about it? On social media, of course. Experts and people with vaginismus share their knowledge and experiences all over social media specifically so people like you know that you’re not alone and can find solutions. (For example, HelloGina has great communitie on both TikTok and Instagram!) Check out some of their content, save whatever’s useful, and maybe even send a DM or two. You’d be surprised at the kind of connections you can make.
When to revisit your gynecologist or seek a second opinion
Though self-treatment options can be very effective, sometimes they just aren’t enough to manage vaginismus. Even if the thought of seeing your gynecologist again is almost unbearable, there’s a point when it’s time to seek professional help.
If you’re heading back to the gynecologist who was totally unhelpful the first time around, prepare for the appointment by making a list of all the things you’ve tried on your own to manage your symptoms. It’s possible that your gynecologist will respond differently when they understand nothing you’ve tried has worked.
But it’s also possible they still won’t be helpful, so prepare yourself for that as well. Take some time to research providers and specialists in your area that have experience with vaginismus, and show up at your appointment prepared to ask for a referral.
Living with vaginismus can sometimes feel like you're carrying the world on your shoulders, right? It's physically tough, and mentally? Even tougher. And the worst part? So, if you’re feeling down, that's totally okay. It can be a rough ride and it's completely normal to feel like this.
But remember: You're far from alone in this–and there are solutions out there. It might seem a bit hard to believe right now, but there's always light at the end of the tunnel. Keep your chin up, and remember: You are strong. You’ve got this.
MAKE SPACE FOR PLEASURE
HelloGina is a self-powered digital program for overcoming pain & anxiety during sexual intercourse.
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