Sexual Health

Your Guide On How To Have Sex When Suffering From Vaginismus

By Dr Claire Giuliano

So you’ve found yourself in some pretty unbearable pain, and the pain is down there…yikes. Don’t worry; experiencing pain during intercourse is more common than you think and more manageable than most people realize. Vaginismus is a condition involving painful penetration of the vaginal opening during sex.

Statistics indicate up to 17% of women experience this inconvenient and often distressing condition.

For most, it may inhibit sexual intimacy altogether - because who wants to anticipate painful sex? However, it doesn’t have to be this way. Some strategies and practices can help you manage your symptoms and alleviate pain. We have collated our pro tips to overcome symptoms of vaginismus, take charge of your body and finally find pleasure between the sheets again. Let’s dive in.

First thing first: what is vaginismus?

Vaginismus is a condition of involuntary tension or contraction of the pelvic floor muscles during vaginal penetration. This not only includes penetrative sex but also occurs during tampon insertion or gynecological exam which can inhibit access to routine health and wellness needs. When the pelvic floor muscles contract, it often renders pain, tearing, or bleeding of the vaginal wall. It is important to emphasize that this is an autonomic response, which means it is not a controlled response and happens involuntarily. This can make things particularly frustrating for the person experiencing this condition and can lead to unwanted abstinence due to fear of pain and judgment from their partner. There are two types of vaginismus:

Primary Vaginismus is when the individual has never been able to tolerate receiving penetration. This is often discovered after one’s first sexual experience or when attempting to use a tampon for the first time.

Secondary Vaginismus is acquired after an individual has a normal sexual function, and penetration suddenly becomes unachievable. This is often due to hormonal changes, sexual trauma, childbirth, or cancer treatment.

Of those living with vaginismus, the majority experience primary vaginismus.

What are the symptoms of vaginismus?

The most prominent symptom of vaginismus is pain with penetrative sex. When penetration occurs, the vaginal wall and pelvic floor muscles involuntarily contract, inhibiting insertion. This can lead to anxiety and fear with any kind of sexual intimacy. For some individuals, these symptoms will only occur with one partner, and may not occur with another. Other times it may only occur with sex, but not with gynecological exams or tampon insertion. This may indicate a psychological or emotional barrier to sex, and working with a counselor may greatly benefit the individual in symptom resolution. Conversely, other conditions may coexist with vaginismus, such as vulvodynia or endometriosis, which may be the root of the autonomic response of tightening and contraction during intercourse.

What causes vaginismus?

There is no known root cause of vaginismus, and the basis is different for every individual. Anxiety and fear around sex can cause vaginismus, but inversely painful sex can cause anxiety and fear to be a part of one’s sexual experience. For many, the most common cause linked to vaginismus is past sexual trauma. Other common causes include hormonal changes, lichen sclerosis, pudendal neuralgia, gynecological cancer recovery, and vulvodynia. All the listed common causes can be conditions independent of vaginismus as well.

Are there treatments for vaginismus?

Thankfully – YES! It may feel like a hopeless journey at times, but there are myriad resources for vaginismus. A pelvic floor therapist is uniquely trained to address and resolve vaginismus. A once rare-to-find therapist is now becoming more common in major cities and some rural areas. Use this directory to find a pelvic floor therapist near you. Treatments your pelvic floor therapist may educate you about include progressive dilator use, self-stretching of the pelvic floor muscles and surrounding structures, and meditation for muscle relaxation. Seeking a sex counselor may also be greatly helpful to process and cope with anxiety or fear around sexual experiences.

How to have sex with vaginismus.

For those suffering from vaginismus, having sex can be a daunting task. We have compiled our best tips for navigating sex with vaginismus so you can reduce pain and increase pleasure.

Foreplay.

The better warmed up your pelvic floor muscles are, the better juices will be flowing and your ability to relax into a sexual experience will help improve muscle spasms or contractions. Optimal foreplay for vaginismus should involve non-penetrative arousal to better warm up the pelvic floor. This includes but is not limited to breast stimulation, kissing, licking of body parts, or sensual massage.

Dilator or Dildo use before penetration.

The Deia or La Wand Grand Bullet are great options for insertional stimulation and muscle stretching to help lengthen things out before penetration. Make sure to use a dildo that is smaller than the circumference of your partner so you can attain a preliminary stretch to your pelvic floor muscles that serve as a warm-up. Starting things off at full-stretch can be uncomfortable if you have a history of vaginismus, and dildo use can help ease into full penetration.

Lube.

Warming things up with extra moisture helps tissue to better lengthen when things are tight, and can help avoid potential tearing of the skin. Explore our lubricant selection, with water-based or silicone-based options per your preference. Water-based lubricant is usually hypoallergenic if you have sensitive skin, but silicone-based lubricant often lasts longer due to its thick molecular nature. Silicone-based lubricant may be your best bet if you are using lube in the shower or bath as it won’t wash away as water-based lubricant will. Always patch-test your lube before using it to make sure you don’t have an adverse reaction.

Meditation.

There is now a solid body of research supporting meditation as an effective relaxation practice. You can do this in the comfort of your home with an app, such as InsightTimer or Calm app. Light candles to improve a peaceful atmosphere. Practicing meditation for three minutes can have a significant impact on your nervous system – anyone can make the time for this in a day. Give this 13-minute pelvic floor relaxation meditation a try.

5. New positions.

Are you trying to work out how to have sex with vaginismus but sick of having to tolerate missionary style? There are countless other positions to try with your partner that could be more appealing and more comfortable. If you need ideas, try the Position of the Day book to get creative with your partner. Consider trying outercourse until you find a comfortable position.

6. Diaphragmatic breathing.

This is known to calm the nervous system, which is of paramount importance when overcoming vaginismus symptoms. Because the spasms of the pelvic floor that occur with vaginismus are automatic, they are much like a “fight or flight” response. This can be largely inhibited with a focus on slow breathing

Living with vaginismus can be exhausting to overcome. Forming enriching connections and prioritizing time for pleasure can be difficult enough with busy schedules, so throwing discomfort into the mix can inhibit your desire to get back in the bedroom. The good news is that the solutions outlined in this article can help you make leaps and bounds in the right direction, back toward a fun, sexy, and fulfilling sex life. Hallelujah.

Claire is a pelvic floor therapist with a distinct specialty certification in pelvic rehabilitation (PRPC). She is the private clinic owner of Rooted Pelvic Health & Hand Therapy in Sun Valley, Idaho. She treats all gender diversities for pelvic floor-related conditions including sexual dysfunction, gynecological cancer recovery, and chronic pelvic pain. Claire's mission is to improve overall function and quality of life with lasting results for her clients. As a contributing writer to Pepper Together, Claire seeks to provide education about a subject that deserves more attention. She hopes that by spreading the word about pelvic floor conditions she can break the stigma about conversations around sex, and provide simple solutions to improve sexual intimacy.