Signed,
Help!

Dear Help!,

Since you say that you have already consulted various gynecologists and have ruled out a medical problem, we can look at other reasons for your pain during penetration. Painful penetration is often called vaginismus, and is experienced as a strong, involuntary tightening of your vaginal muscles &mdash a spasm of the outer third of your vagina, which makes entrance by a finger, tampon, speculum or penis acutely painful. Vaginismus can have many different non-medical causes: it may be your body's defense against a sexual stimulation you can't handle or situation you don't want to be in; the result of a bad sexual experience, such as rape or childhood sexual abuse; or stem from anxiety or relationship issues.

Vaginismus can be treated successfully by a variety of methods, including psychotherapy, hypnotherapy, and sex therapy, either alone or with your partner. One technique a sex therapist might recommend is Kegel exercises, which are done by alternately contracting and relaxing the pelvic floor (PC) muscles. By consciously exercising these muscles, women with vaginismus can learn to make the muscles around the vagina relax voluntarily so that penetration can occur more easily. (For more on how to identify these muscles and perform Kegel exercises, see Kegel technique in Alice's archive.) The therapist can tell you exactly how to adapt Kegels for your use and may have you do the exercises while using vaginal dilators (plastic rods inserted at gradually larger sizes to help widen the vagina). More general educational treatment, as well as improving self-awareness and communication, can also help.

Whatever the cause, if lovemaking is at all painful, don't be a martyr, trying to bear with it. Because associating penetration with pain can further increase the likelihood of a vaginismus response, it's important to seek help as soon as possible. Take an active stance in your own sexual pleasure by talking with a sex therapist, reading about the condition, and trying to make changes. Until the problem is solved, be creative and figure out ways to make love without penetration. That way, you can still give and receive pleasure while you are working things out.

Try reading more about vaginismus in When a Woman's Body Says No to Sex: Understanding and Overcoming Vaginismus, by Linda Valins (New York: Viking Penguin, 1992), and in The New Sex Therapy, by Helen S. Kaplan (New York: Brunner-Mazel, 1974). To find a sex therapist in your area, visit the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) web site and click on the "Locate a Professional" link.

Alice

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