How to Manage Sex and Vaginismus

This cause of pain during sex can be dealt with, but you might need to reframe intimacy.

Vaginismus, a condition that causes a woman's pelvic floor muscles to tighten and contract whenever penetration of the vagina is attempted, can make sex painful if not outright impossible.

Sex should be enjoyable and people's sex lives should be healthy. Unfortunately, uncomfortable sex, medically referred to as dyspareunia in women, is fairly common. Some research suggests that almost 30 percent of women report pain during vaginal sex. Other experts say nearly 3 out of 4 women experience pain during intercourse at some time in their lives.

Dyspareunia can be caused by several factors, such as vaginal dryness, endometriosis and sexually transmitted infections (STIs). Vaginismus can be one of the main causes.

What is vaginismus?

Vaginismus is your body's automatic fear of penetration. It makes any type of penetration—sexual intercourse, inserting a tampon, getting a pelvic exam—painful or difficult.

Although the exact cause is still a mystery, experts believe it can have both physical and psychological causes.

"As vaginismus can cause the vagina to suddenly tighten, penetration can be painful," said Leila Frodsham, Mb.Ch.B., an OB-GYN and consultant gynecologist with Guy's and St. Thomas' Private Healthcare in London and a spokesperson for the Royal College of Obstetricians and Gynaecologists.

"Treatment may include relaxation techniques to help the vaginal muscles to relax, which can help to make sex less painful," she said. "Sometimes vaginismus starts because of sore skin or infection, and it is important to be examined to treat these, too."

Vaginismus can make some people avoid sex altogether and put a strain on romantic relationships, similar to erectile dysfunction (ED) in men. Thankfully, women with vaginismus can have sex as long as they're open to trying new ways of being intimate.

How to have sex with vaginismus

Vaginismus can make sexual intimacy difficult to navigate. Painful intercourse is a common symptom of vaginismus, but it doesn't mean you should sacrifice your sex life because of it. Discover other ways to enjoy sex even if you have vaginismus.

Clitoral stimulation

If vaginal penetration is too painful (or impossible), there are other options. Vaginismus doesn't directly interfere with your ability to become sexually aroused or reach orgasm. Sex can be enjoyed without penetration.

Research shows that more than one-third of women ages 18 to 94 need clitoral stimulation to orgasm, so giving up penetrative sex might not be the sacrifice you think it is. Oral sex (cunnilingus) and clitoral stimulation (with fingers or a sex toy) can be just as pleasurable as penetrative sex.

There is no "right" or "wrong" way to have sex.

'Shallowing'

If your vaginismus isn't too severe and penetration is possible, make sex more enjoyable by using a technique called "shallowing." If you're not familiar with it, shallowing is penetration that doesn't go deeper than the entrance of the vagina.

One survey found 84 percent of women use shallowing to make vaginal penetration more pleasurable. This includes penetration with a penis tip, fingertip, sex toy, tongue or lips.

You can ask your partner to try shallowing when they're on top. Alternatively, you can go on top to control the depth of penetration. Using lubricant can also make penetration easier and more pleasurable.

Sensate focus

Sensate focus is a technique that originated in the 1960s and was made popular by renowned sex researchers William Masters and Virginia Johnson.

Sensate focus therapy is all about removing the "goal" from sex and simply focusing on the physical sensations of touching and being touched. The idea is to use mindfulness to remove any unwanted anxieties or expectations about sex and instead concentrate on how your body responds to stimulation.

A 2019 study published in the journal Clinical Therapeutics suggested that sensate focus can help both sexual anxiety and sexual dysfunction. Many people with vaginismus experience anxiety around sex because they associate it with pain. Sensate focus could help break that connection.

Seek treatment

Treating vaginismus can be challenging but not impossible. A study published in the journal Sexual Medicine found 71 percent of vaginismus patients had pain-free sex after following a treatment program for about five weeks.

Treatment for vaginismus depends on the cause, but common options include therapy using vaginal dilators and pelvic floor exercises. If vaginismus symptoms are affecting your sexual enjoyment and your overall well-being, speak to your doctor or OB-GYN about how to manage your condition.

Don't let fear of talking about pain during sex discourage you from getting help. Telehealth is a low-pressure method of finding a healthcare professional to fit your needs. Video visits are a viable option for most people, which is why more physicians and therapists have added them as a service. Giddy telehealth makes it easy to get connected to a qualified healthcare professional and begin a conversation about a wide variety of conditions.