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When Sex Hurts

For thousands of women, intercourse is physically painful. Now there's help.

Amanda and Randy had been married almost four months. Their honeymoon was great, except for the "main event." No matter how hard they tried, it just wasn't happening. With great embarrassment Amanda finally went to her gynecologist, thinking there was something wrong with her.

Amanda's issue represents the experience of thousands of couples. Their frustration is incredible—they can't consummate their oneness, and they don't know where to turn for help. One husband put it this way: "We were virgins when we married. Four years later we were still not 'one.' It was terrible. We went to three different counselors, and they were nice but really didn't know what to do or say to us."

After running some tests, Amanda's physician informed her that she was normal, but she had vaginismus.

Vaginismus is a condition in which the muscles in the lower third of the vagina—the pubococcygeus or pc muscles—involuntarily constrict so tightly that they're unable to allow penetration, or they at least make penetration incredibly painful.

The result is that a couple is either unable to engage in intercourse at all (commonly referred to as primary vaginismus), or is able to do so only with tremendous difficulty (secondary vaginismus). As one wife battling secondary vaginismus put it, "We were able to have intercourse, but it was unbearably painful. It never seemed to get any better. About six months after we were married, we just stopped trying."

The physical, emotional, and spiritual toll this takes on a marriage can be devastating.

Studies have shown that up to 47 percent of women experience general pain during sex, and between 6 and 10 percent suffer with either primary or secondary vaginismus. Several physiological issues can be contributing factors, including vaginal yeast or bacterial infections, urinary tract infections, physical damage from childbirth, and sexually transmitted diseases. Even allergic reactions to medications, latex in condoms, lubricants, or spermicides can lead to secondary vaginismus. 

But psychological factors also play a central role, whether or not there are physical problems. Fears resulting from rape or molestation, insensitive gynecological exams, negative messages about sex being dirty or wrong, or fear of pregnancy can create these involuntary spasms, even when a woman isn't fully conscious of such fears. Feelings of disgust about genitalia, or even imagined or anticipated fear because of stories from other women or scenes from a movie, can create the reaction. And certainly fear of re-experiencing pain after unsuccessful attempts at intercourse can quickly set up a self-perpetuating cycle, creating a greater likelihood of painful penetration, which creates more fear. 

It's not "all in your head"

It's important to understand that this problem isn't "all in your head." This isn't merely a "mind over matter" issue. Countless women have been told—or have told themselves—that and have tried to force themselves to complete the act in spite of excruciating pain. This only exacerbates the problem. The key is to recognize that for some reason the woman has established an involuntary pattern that operates in the same way as a simple phobia (such as a fear of the dark). But the good news is that with treatment it's nearly 100 percent curable!

If you are struggling with painful intercourse, the first thing to do is have a thorough gynecological exam to diagnose and address any physiological disorders. Next, meet with a licensed Christian psychotherapist, preferably one certified in sex therapy (visit sexualwholeness.com to find one in your area), to identify and address any unresolved emotional trauma from experiences such as rape or molestation, abuse, negative mental conditioning from childhood, or oppressive religious beliefs about sex.

Once you and your physician and therapist have addressed all physiological and psychological problems, the final step is to reprogram your central nervous system (cns). This often requires a woman to become more familiar with her body, particularly her genitalia, and with her pleasure zones, discovering what is most pleasing and arousing for her. It may require creating greater feelings of trust and safety within the marriage, especially if there have been angry conflicts over her inability to allow penetration.

How your body responds

In addition to these crucial steps, you'll need to engage in a process called systematic desensitization—desensitizing the central nervous system to its conditioned response. It's similar to when we get something in our eye and our eye reacts immediately (and largely involuntarily) by closing or blinking and tearing up. It's a self-protective, central nervous system-based, muscular response. As anyone who wears contacts knows, however, you can reprogram those involuntary responses to the point that you can move your contact around on the surface of your eye or insert drops without any of the near-panicky blinking responses you'd normally have made.

To overcome vaginismus, the goal is to "teach" the cns that its automatic responses aren't necessary and are, in fact, not desired, to send the cns the repeated message that it's safe and has no need to react in a protective manner. As you reinforce this message through sensory exercises, positive mental rehearsal, and consistent prayer, your body will eventually "unlearn" its unconscious reaction in order to enjoy full intercourse.

Here's one exercise to commit to on a near-daily basis, for several weeks or months if necessary.

Giving yourself at least an hour of uninterrupted time, make a cup of hot chamomile tea or another drink that will relax you. Lock yourself in the bathroom and draw a warm bath. Add scented oils such as lavender and light a scented candle. Put on a cd of relaxing music at a low volume. Cover your time in prayer as you begin to disrobe, and spend some time becoming more familiar with the body God gave you.

Settling into the bath, let the warm water relax your muscles, continuing in prayer and asking for the gift of the ability to be joined as one with your husband. While still in the bath, place a finger at the opening of the vagina and notice any reaction. If the muscles spasm, simply leave the finger there and do some deep breathing, mentally reassuring yourself that all is well and you are safe, and wait until the muscles relax. This may be sufficient for several days. Eventually, try slightly inserting your finger. 

Repeat this same process, gradually inserting deeper and/or adding a second finger. Don't try to move in and out—all you're working for is containment. You're allowing the nerves to become desensitized to having something inside the vagina. When this is no longer painful, try pressing against the pelvic floor (the lower part of the vagina, toward the rectum.) This will stretch the pc muscles, but again, stop and allow the muscles to relax any time you sense them tightening. 

Many women prefer to use plastic dilators of varying diameters instead of their fingers. If you'd be more comfortable with that, go to vaginismus.com to purchase one. Whether you use dilators or your fingers, work for containment each time for at least 5 to 20 minutes. Eventually, you'll want to invite your husband to your exercises, and you may move from the bathroom to the bedroom, but don't attempt intercourse yet. You'll need to educate him on what you've learned about your body's responses, and ask him to be patient as you increase your level of vulnerability by engaging in mutual exploration and stimulation, without the goal of consummation. 

If you remain diligent in your exercises, you'll eventually find your involuntary reactions greatly decreasing and your comfort with (and desire for!) attempting intercourse increasing. Use all your sensory cues for relaxing your cns and then, applying ample lubrication to your husband's penis, begin trying gentle penetration and containment. You'll eventually be able to progress from containment to gentle thrusting, and before long, you'll both be enjoying pain-free sexual oneness as God intended it.

Is it worth all the effort?

Over the years we've had the joy of receiving photographs of babies who would never have been born if not for their parents' commitment to working through vaginismus. These couples would readily affirm that all the effort and frustration and tears now seem a small price to have paid for the gift of their children. 

But even if children are never a result, the couples who work together to get to the other side of vaginismus express a much deeper and richer sense of connection. After working with one couple, the wife told me (Chris), "We finally got home about 3 a.m. on New Year's Eve. We were tired, but that didn't matter. We dimmed the lights and made love. This time it was beyond magical, it was heavenly. We weren't just having sex or doing our exercises—we were truly making love. I've never felt so connected to my husband—and to God! It was an amazing feeling. We took it slow and easy and just really enjoyed each other. I can't even find words to explain how wonderful it was!"

If vaginismus is your secret struggle, take heart. There are answers, and the benefits of finding those answers together can cement your marriage far more strongly than the challenging times may ever have threatened to tear it apart.

Christopher and Rachel McCluskey are co-authors of When Two Become One: Enhancing Sexual Intimacy in Marriage (Revell). www.whentwobecomeone.net

Read more articles that highlight writing by Christian women at ChristianityToday.com/Women

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Intimacy; Marriage; Pain; Sex
Today's Christian Woman, Summer, 2008
Posted September 12, 2008

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