Pain during sex? Escape the Cycle

Pain during sex? Escape the Cycle
Vaginismus, a vaginal muscle spasm that prevents penetration, can be part of a vicious cycle of pain and response. If you experience painful intercourse, your natural desire to avoid the pain may be a psychological trigger for vaginismus, which occurs involuntarily.

How do you know whether it’s time to talk to your doctor? The keys are frequency and persistence, but I hate to tell women they need to endure pain for any specific length of time before they talk to me about it. If pain is recurring or persistent, if you take note of it, if it affects your ability to enjoy intimacy, I’d recommend that you talk to your health care practitioner.

Maybe you’ve been avoiding going to the doctor because you’re afraid the exam will be painful, and that’s very understandable. And you’re not alone, believe me! Pelvic exams cause anxiety in most women—even without the added complication of suspected vaginismus. But a trusted gynecologist or menopause practitioner will be very familiar with vaginismus and related conditions and will know how to approach the exam.

If you’re uncomfortable talking about what you’re experiencing with your doctor, consider printing out this post and taking them with you to get the discussion started. Write down your exact symptoms—where it hurts and when—so you can describe what’s happening. You can also read more about vaginismus; learning about it will help you ask your doctor more specific questions, like, “Do my pelvic floor muscles seem too tight?”

Treatment requires the right combination of physical and cognitive therapies, especially if your condition is psychologically induced vaginismus. In that case, retraining the body and the mind to accept vaginal penetration is part of the treatment. Other techniques may include:

• The use of a dilator, which can increase your comfort gradually
• Botox injections
• Exercise, such as Kegel, and/or pelvic muscle therapy
• Pain management techniques
• Relaxation training

It’s also worth noting that vaginismus is common among women who force themselves to have sex when sex is painful. I hope you’re not one of them! If you are having pain during intercourse, please go to your doctor and let the healing begin. Then you—and your partner—can get back to enjoying sex again.

Your partner in midlife wellness,
Dr. Barb

Barb DePree, MD

Barb DePree, MD

Recipient of North American Menopause Society’s 2013 Certified Menopause Practitioner of the Year for her exceptional contributions to menopause care, Barb DePree, MD, specializes in menopausal medicine, hormone replacement therapy and sexual health. With nearly 25 years in women’s health, Dr. Barb has comfortably answered all the uncomfortable questions of sexual health and the changes that occur as we age.

After completing her Master's in Medical Management, Dr. Barb launched her own website,, that connects with people across the country and provides additional advice and products for patients. Dr. DePree obtained her Clinical Cancer Genomics Community of Practice Certification through the City of Hope. In addition to being a provider at Holland Hospital Women's Specialty Care, Dr. DePree is also part of the Holland Hospital Breast Care team, seeing patients at Holland Hospital's High Risk Breast Clinic. 

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