Q: Having sex is painful. What should I do? I first slept with a guy when I was 20 and it was so painful. It happened another three times and was just as bad. I haven't been intimate with anyone since breaking up with him because I fear the pain of being penetrated.
I do want intimacy with a man but I don't know if there will be someone with patience and understanding of this situation - imagine if I find someone and we really have chemistry but I can't go further because of my fear of pain?
A: Vaginismus is a disorder characterised by involuntary muscle contractions of the pelvis and abdomen causing painful penetration, vaginal dryness, emotional distress and anxiety. Sometimes penetration is impossible. It is more common than we realise and can require a multi-disciplinary team of experienced professionals to be successfully managed.
It is not always clear which comes first - the anxiety or the painful sexual experience - but it sounds as if you have what is known as primary vaginismus. This is where a woman has always experienced pain during penetration attempts (secondary vaginismus usually involves an organic cause such as trauma or infection).
For many women, vaginismus is experienced in all situations and with any object. For others it is experienced only during penetrative sex by a penis, or with one partner and not another. You seem to be experiencing the vicious cycle of anxiety about future partner expectations, fear of and anticipation of pain and unsuccessful penetration.
There are techniques you can learn to relax the pelvic muscles. Together with deep breathing exercises and use of a lubricant, you may be able to attempt penetration using objects such as a tampon or vibrator.
There are also vaginal dilators available for home use, but I advise you first to seek help from a general practitioner or gynaecologist; ask a medical professional to perform a basic pelvic exam and check if there are any medical issues that require treatment.
Vaginismus can be managed. It requires time, patience and help to work through the emotional, body-image and self-esteem issues as well as the physical therapy. The idea is to unlearn the defensive reflex response to penetration and manage the anxiety to achieve enjoyment of sex.
• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, DISA Clinic, 011-886-2286, visit safersex.co.za
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