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Sexual Pain in Women: Some women can experience pain when trying to have sexual intercourse. Different kinds of pain have different causes. Sometimes the pain prevents intercourse from being comfortable or, in some women, intercourse can feel impossible. There are many reasons why women experience sexual pain. Starting at the beginning, lots of women will report pain on losing their virginity. Although some find it sore or uncomfortable, this isn t the case for everyone and it can be pleasurable, even if it is a little scary. The hymen is a piece of membrane just inside the vagina. The membrane is thin in the majority of women. It breaks easily when doing certain activities such as riding a bike or horse, jumping a fence or inserting a tampon. When the hymen breaks most women do not even feel it. Breaking the hymen in this manner does not mean you are no longer a virgin. You will remain a virgin until penetration of the vagina occurs. When the hymen breaks there may be some spotting of blood and this can be heavier in some women and less to nothing in others. When intercourse/penetration has occurred once, any discomfort usually goes away. If you find the pain on penetration does not go away after a few attempts, or if you have vaginal pain when you are not having sex, then this should always be checked out by your doctor. There are many causes of vaginal pain, including sexually transmitted infections, yeast and water infections, skin conditions, allergy, gynaecological problems (including menopause) or excessive use of feminine hygiene products. There are also certain psychological problems which can cause pain; the most common of these being VAGINISMUS. is very common and can happen to any woman at any stage in her life, straight or gay, including those who have already enjoyed a successful sex life. What is vaginismus? is often a fearful or phobic response to penetration. generally happens when entry into the vagina is about to occur but in some cases can occur after penetration or insertion has taken place. When this happens, the vagina can feel like it has become blocked or closed (some people describe it as a brick wall ). This anxiety causes the vaginal muscles surrounding the lower third of the vagina to go into spasm, making the vagina feel smaller than it is. This spasm is out of the woman s control. Some women experience this as a burning sensation and others a cramp-like discomfort. The vaginal muscle contraction can occur with a tampon, finger, penis, or anything else that is to be inserted into the vagina (speculum, vibrator, swab etc.). Why does vaginismus occur? The reason why the vagina seems to tighten is because of a strong band of muscle in the first third of the vagina. The vaginal muscle which can be most troublesome in vaginismus is called the pubococcogeus muscle and is part of the pelvic floor. The anticipated pain associated with penetration causes an involuntary tightening of this muscle. Therefore, penetration can be uncomfortable and painful. is very common and can happen to any woman at any stage in her life, straight or gay, including those who have already enjoyed a successful sex life. Effects of vaginismus can be very distressing and often results in women feeling inadequate as a woman and lover; it can destroy her sexual pleasure and strains relationships and limits her ability to seek sexual partners and intimacy. This, ultimately, can undermine her self-esteem and destroy relationships. Women with this condition may avoid smear tests or other gynaecological investigations. 2 3
Beliefs which can trigger vaginismus As vaginismus can occur at any stage in a woman s life, it may be helpful to consider some of the beliefs, attitudes or situations which give rise to a vaginismic response: Thinking the vagina is too small or being told it is Believing stories that first-time sex is painful and heavy bleeding occurs Not being ready to have sex for the first time Not feeling ready to have sex either with a new or existing partner Not being relaxed Being worried about pregnancy or sexually transmitted infection Painful vaginal examination Past issues, such as abuse or trauma Cultural or religious beliefs that sex is wrong, dirty or shameful There are also some medical conditions which can cause vaginismus. If you think your vaginismus is caused by a medical condition, discuss it with your doctor who should be able to help. is usually treated by looking at the underlying causes of the problem while using a slow program of desensitisation with vaginal trainers. How common is vaginismus? is not rare and it is believed that one in ten women experience sexual pain at some point in their lives. For many women sexual discomfort is not recognised as vaginismus. Often the woman believes it is just part of being a woman ( just one of those things to put up with ). Even health care professionals can misunderstand the description of. What can I do about vaginismus? is sometimes temporary and settles down without any help but if the problem continues then it is wise to seek specialist help from someone trained in sex therapy. There may be a specialist service in your area which your doctor could send you to. There are private psychosexual therapists or counsellors usually called sex therapists throughout the country. A list of qualified professionals can be found at www.cosrt.org.uk or you may wish to contact Relate (relationship therapy). Seeking therapy can help reverse the negative feelings often associated with vaginismus. If you, or your relationship, is going through a hard time because of this distressing condition, therapy can help sort through the complicated feelings involved and allow both partners to experience hope for the future. Can it be treated? Yes, often it can be treated very successfully. It is important for women and their partners to appreciate that treatment can take time. Sex therapists treat vaginismus every day and understand the woman s and couple s anxiety and concern. is usually treated by looking at the underlying causes of the problem while using a slow program of desensitisation with vaginal trainers. You will learn to bring the muscles back under your control so you can relax them during penetration. You will have time to develop trust in your therapist when discussing embarrassing and personal issues. You are likely to be shown how to use relaxation to your advantage. 4 5
Skilled assessment Skilled assessment is necessary to identify what the problem is and the best treatment for you. The assessment involves a sex therapist asking a series of questions about the current sexual problem and some background information about you. This means looking at the mind-body link. Sometimes it may be necessary for a doctor to physically examine you but this will be separate to the psychological assessment. An assessment is likely to involve the sex therapist or doctor asking questions about your pain and when it occurs. They will be interested to know: 1. Where the pain is? i.e. at the front of the vagina, or deeper in the vagina 2. When does it happen? i.e. during sex or at other times (smears, tampon use) 3. How long does it last for? i.e. stops soon after sex 4. Is it always the same? i.e. always feel the same 5. How long have you had the pain? i.e. always been there or recently occurred 6. Are there other symptoms? i.e. swelling, discharge, bleeding Sometimes, vaginal pain can be caused by sensitivity in the skin around the lips (vulva) outside the vagina and sometimes by infection. There are other conditions which cause this type of sensitivity and you may wish to look at the Vulval Pain Society website (www.vulvalpainsociety.org). You may feel more comfortable going to your doctor or a sexual health centre (GUM clinic). What can help? Finding ways to feel more comfortable about sexual activity and being able to relax during penetration is likely to help. There are many ways to do this and a skilled therapist will have various techniques to help you. Sometimes having your partner involved in the therapy sessions can be useful as you learn together. Things to ask yourself Has your sexual desire changed? Are you getting aroused? If you are having sex without desire or arousal, could that be the cause of the problem? If your vagina feels dry, lubrication might help. Vaginal lubricants are available from chemists and supermarkets. They are also available on prescription Do you have enough energy for sex? If you feel stressed and tired try to explain this to your partner and look up some stress reduction techniques on the internet Is the balance between Us and Me time right? Try to do things you enjoy without sex being the focus Would some relaxation help? It takes practice so don t give up after trying this for just few times Are you experiencing the sort of sex you would like? Talk to your partner about doing things differently, such as trying other things Are you having penetration too quickly or before you feel ready? Try talking calmly together, after all, two heads are better than one Are there tensions in the relationship? If there is something you are worried or angry about, then look at this with your partner to see if it can be sorted out Do you need to consider professional help such as sex or relationship therapy? 6 7
www.thebrunswickcentre.org.uk Committed to supporting people in our communities Also from The Brunswick Centre are other leaflets in this series: Erectile Dysfunction Premature Ejaculation Sex and Relationships Sexual Functioning Please contact The Brunswick Centre for more details. This series of leaflets have been produced by the Brunswick Centre in conjunction with Andrew Yates, Psychosexual Psychotherapist of Sex Therapy North (info@sextherapynorth.co.uk) and peer reviewed by Roz Ottery, Sexual and Relationship Therapist of Journey Counselling and Therapy (roz@journeycounselling.co.uk) The Brunswick Centre Marten House, Fern Street East, St. Andrew s Road, Huddersfield HD1 6SB Tel: 01484 469 691/01422 341 764 Fax: 01484 480 549 info@thebrunswickcentre.org.uk www.thebrunswickcentre.org.uk Registered charity no. 1015450 Company Registration no. 2764525. Satellite offices in Dewsbury, Halifax and the Upper Valley. The Brunswick Centre is member of the National Council For Voluntary Organisations (NCVO)