Let’s paint a picture here: you are newly married, you’ve never had sex before. Perhaps you’ve never tried to use a tampon before either. You’ve been told a lot of different things like:

• “The first time is going to be really painful!”

• “There is going to be a lot of blood when you lose your virginity!”

• “You need to be relaxed and ready for it!”

Perhaps sex was not really something that you talked about in your household. Perhaps it was kind of built up to be this big thing that happens after you get married. But when the time finally comes, you are met with pain and frustration.

Primary Vaginismus is when you experience these symptoms during your first attempt at vaginal penetration.

Secondary Vaginismus occurs when a person who has previously been able to achieve penetration develops Vaginismus.

We sometimes see this in clients who were in long-term relationships that ended. Perhaps they’ve never experienced this issue before, but when they try to have sex again later in life, they notice it’s now painful.

Another common scenario where we see our clients experience secondary vaginismus is after traumatic events. This could include after sexual trauma, physical trauma such as childbirth, or even as your body starts to enter towards menopause.

The causes of Vaginismus are not fully understood.  It is also not fully understood why certain people experience Vaginismus while others do not.  Or why some people experience pain in certain situations vs. in other situations (ie. with a partner vs. in a medical exam vs. on their own).  Experts do agree that there are both biological factors (ie. trauma, hormonal factors, tissue extensibility), as well as psychosocial factors (ie. anxiety, fear) influence Vaginismus.

Although Vaginismus refers to a physical condition of the pain, blocking, and tension related to attempted penetration, it’s important to gain some insight into why this unintentional spasming is occurring.

It’s important that we think about some of the messages we were given at a very young age.

In many cases (but not always!) conversations about sexuality are interwoven with negative undertones that often result in guilt or shame. Having intercourse, being intimate, and sometimes even showing public affection (especially premaritally) is often viewed as something that is sinful, immoral, and forbidden.

Taking a step back and figuring out what those messages are and how that might be contributing to your painful experience can actually be really helpful in treating Vaginismus.

It’s quite common for clients to have been told by other people, friends, family, and healthcare professionals, things like, “it’s normal for it to be painful, you just need to relax” or “you must have experienced some sort of trauma before”. It is not likely the intention of these individuals to gaslight you, but statements like these can definitely question the validity of what you are experiencing.

I’m here to tell you that your pain is not just “in your head” and what you are feeling is 100% real. There are definitely cases where trauma is a factor in Vaginismus, but on the other side, there are a lot of people who have Vaginismus who have also never experienced trauma, have no anxiety, and feel very comfortable with sexuality.

Vaginismus is experienced differently by individuals. And their experiences, beliefs, and pre-existing histories might also be completely different. This means that the approaches to treat Vaginismus might also vary from person to person.

At a very basic anatomical level we want every single one of our clients with Vaginismus to learn how to relax their muscles to create pain-free penetration.

Most people with Vaginismus will tell us, “I try to relax, I try to do deep breathing, I try to keep my legs open, but it still isn’t working”.

Consider this very simple example: if I had tension in my neck, or was clenching my jaw all the time, I might go all day holding onto this tension and not even realize it! In many cases it’s the same with the pelvic floor muscles. You might be trying really hard to relax, and think that you are relaxed. But until you actually experience what relaxed muscles feel like, you may not be able to translate that to when you are with your partner.

We teach all of our clients how to identify and control their pelvic floor muscles. They are just like any other muscles, but it’s a bit trickier since you can’t really see them! By doing this, you’ll be able to:

• Understand and know what it feels like to carry tension in your pelvic floor
• Relax your pelvic floor muscles to avoid painful intercourse

In many cases, working with a licensed counsellor, Social Worker, or Psychotherapist specifically trained in sexual health, sex therapy, and/or relational counselling can also be helpful to overcome the thoughts and other mental barriers related to Vaginismus.

Vaginismus is a common condition and 99% of the time, there is absolutely nothing “wrong” with you! Every single person will have different anatomy down there and it is rare for things to be “too small”. Vaginal and hymenal tissue is flexible and has the capacity to stretch.

During our physical exam we are assessing:

• What does the vulvar tissue look like? Does it look healthy and age-appropriate? Do we see anything that might indicate a referral to your medical provider?
• Do you experience pain with light touch on the outer labia and vulva?
• Can you differentiate between the left side and right side of your vulva?
• What does the vaginal tissue look like? Does it look healthy and age-appropriate?
• Do we see anything that might indicate a referral to your medical provider?
• Do you experience pain at the vaginal opening?
• Do the pelvic floor muscles clench upon attempted touch?
• Are we able to slowly proceed with a single-finger insertion without pain or burning?

In most cases, the tissue looks normal and age-appropriate. With treatment, we are able to help our clients achieve their goals. And in cases where we think medical treatment may be beneficial to your case, we will of course let you know and let you have a conversation with your healthcare provider.

You’ve heard that sex should be pleasurable and you want sex to be enjoyable. But it may feel like a completely insurmountable goal. Our goals are your goals! We want you to feel connected with your partner. We want you to be able to have enjoyable, pain-free sex and that is 100% achievable.

But taking a step back and looking at some of the complexities around sex and intimacy and having a deeper conversation about this rather than just the physical act of being able to have penetration is often needed as well.

Vaginismus is a complex, chronic pain condition and it’s important to highlight the complexities around treating it. As much as it feels like a purely physical condition, it’s important to also focus on the psychosocial aspects around it as well.

Taking the first step towards treatment will feel like a huge hurdle. Getting comfortable with talking about it, seeking help, and actually tackling this condition often takes years. But it’s a first step that needs to be taken. When you are ready to take the next step towards pain-free intercourse, it’s important that you find a healthcare provider that understands this as well and we would love to help.