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An updated version of this post dated December 27, 2020 is available here

A question from a husband:My wife complains of searing vaginal pain upon intercourse and as a result she has been avoiding sex altogether. When I met my wife, she seemed to be so eager and interested in sex that I eventually married her… I am glad I did because we have a good life together – I just miss sex. Help!

Discussion and reply:

Generally speaking, there is no need to end one’s sex life when intercourse is not possible especially because sexual intimacy is the cementing force of any intimate relationship, the vehicle for entering that ‘special zone’ that is not shared by the closest of friendships.

A typical sexual menu will include two main entries:

  • Intercourse: a ‘penis in vagina’ act, lending to the definition of virginity = one who did not have intercourse (male or female).
  • Outercourse: any sexual act that does not involve intercourse: foreplay, oral sex, manual sex, masturbation, humping, rubbing, use of sexual toys on genitals, etc.

Men and women will mix and match intercourse and outercourse as per their sexual preferences. Naturally, there may be other factors which will influence one’s choice, such as a physical limitation, hormonal influence, pregnancy and childbirth, aging, etc.

And then there is the difference between men (male) and women (female)… Whereas a male is easily aroused through his senses (vision, smell, etc.), the female will filter her sexual interest regardless of arousal level, thus being susceptible to ‘killing the mood’ upon a fleeting negative thought. Example: “I am still mad at you for (whatever the reason may be) and you want to have sex????????”

From a psychophysical point of view, men need to be reminded that intercourse is about their penis entering the woman’s body — being the ‘do-er’ to her being ‘done to’ — therefore, they need to be invited and welcomed into her vagina!

Naturally, when intercourse is painful, whether it is vaginismus or dyspareunia, the woman will tend to avoid the act in self-protection. Furthermore, she will often decline outercourse too because she does not want to be reminded of their pain, of disappointing the partner, or because she is worried about his ‘surprise move’ into her vagina during outercourse.

This is when it would be very important for the couple to hold a candid discussion about the situation. The man will need to promise NOT to attempt any vaginal penetration (finger and/or penis) while the woman is being encouraged to enjoy herself as much as she can (remember the ‘filter’ that was mentioned above?) without pressure to orgasm — let it happen if/when it does. Make it fun, friendly, and stress-free!

The goal is to maintain an agreed-upon style of comfortable sexual intimacy and avoid slipping into asexual existence, living like ‘brother and sister,’ which will put quite a bid of pressure on the relationship.

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  • Jessica says:

    Hi, I am new to this and just looking for someone to help me figure out what is going on. I too have a pain either during sex or immediatly following.
    The pain is so bad it is almost crippeling. I have looked up both “causes” that are listed above but neither fit. Its not all the time. I’d say 1 out of 6 times it hurts.
    I have seen a doctor but she basically blamed it on having a child. Its starting to affect my husband and I. I never feel anxious or have had any bad experiences sexually.
    I don’t know if any of you might have any ideas? I’m out of them and don’t know where else to turn.

    • Dr. Katz & Dr. Tabisel says:

      Dear Jessica:
      There may be many reasons for the intermittent painful intercourse, from the above-mentioned to certain intercourse positions that do not agree with you, a tender cervix after childbirth, a sensitive episiotomy repair, how deep/hard the penis is thrusting, the state of the vagina (i.e. dry? Menopausal?), and more.
      Unfortunately, a thorough examination of the problem is beyond the scope of this blog. Discuss with your doctor or contact us directly if you wish to schedule an appointment.

  • Big Girl says:

    Hi. Its big girl again. Of course I would love to come to you gals to treat my anxiety, but Im all the way in South Jersey. Are there any books you would suggest, or maybe programs online? I would love to try and work with my mind first before meds since my anxiety is not terrible. Thanks!

  • womentc says:

    Dear Big Girl:
    Glad to read that your vaginismus is a theme of the past; now it is time to address the panic/anxiety. You may want to consider medication and counseling. As a former patient of ours, we are always available to you so feel free to contact us directly.

  • Big Girl says:

    Does this whole vaginismus thing have to do with generalized anxiety and panic attacks? I was treated by Ditza and Ross a couple of years ago and it worked wonders, but since then (and before) I suffer from panic attacks. I want to cure my panic attacks natuarlly just like the vaginismus. (I’m still somewhat afraid at times…like after I had a baby and didn’t have intercourse for a while…)Any good ideas?

  • Baby G says:

    I had Vaginismus for 3 years before I got treatment and mine and my boyfriend’s sex life was better than most of our friends that had never had vag. We were stronger as a couple because we had communicated with each other on the things we felt comfortable with. I feel it’s important to think of Vaginismus as an excuse to learn each others bodies sexually so that when penatration does happen it’ll be more intense because you trust each other and know what each other likes.