What is Vaginal Pain?

Many women know from personal experience how distressing vaginal pain, also known as dyspareunia, can be. In fact, 10-20% of women will experience painful penetration in her lifetime. Vaginal pain and the resulting pain of penetration can get in the way of menstrual hygiene, vaginal health and pleasurable sex by connecting pain and fear with the insertion of tampons, speculum, fingers, toys or penises. Vaginal pain differs from vulvar pain because it’s on the inside (vaginal canal) vs the outside (labial “lips” or clitoris) of your genitals. This is important to know when thinking about treatment.

The most common cause for vaginal pain is anxiety or stress. Ever notice how when you’re feeling stressed your shoulders tend to creep up around your ears? That’s because anxiety causes our muscles to tense and tighten. For women experiencing vaginal pain, anxiety can cause the muscles in the vaginal canal to tense up. That tightness can cause pain, especially when fingers, penises or toys try to press through those clenched muscles. Root causes for anxiety could be connected to your feelings about sex, your body, your partner, or something seemingly unrelated like work or family stressors. Once you begin to associate pain with penetration, anxiety and vaginal pain cause a negative feedback loop – your vaginal muscles will contract involuntarily any time you anticipate something coming towards your vagina, similar to the way your eyes blink if someone tries to poke them.

Fortunately, many women find relief by working with a trained sex therapist. Don’t be overwhelmed! Some things you can expect and steps to take toward treatment for your vaginal pain are below.

Step 1: Ditch the vaginal pain myths

Vaginal pain can be hard to diagnose because of the misinformation women (and some health care providers!) are taught about sex and their bodies. Some of the most common myths and the ways they can inhibit treatment are included here:

  • “It looks normal down there, so nothing’s wrong.”

Many underlying causes of pelvic pain, not just vaginal pain, are hard to see with the naked eye. Health care professionals trained in pelvic pain can recognize things like muscle tension and nerve damage that you or a doctor who doesn’t often encounter vaginal pain might miss.

  • “Sex is supposed to hurt in the beginning.”

This myth has roots in the link between unbroken hymens (the skin around the vaginal opening) and virginity. Many people assume that the first time you have sex the hymen will tear, and this will hurt. In truth, many women stretch or tear their hymens before sex thanks to sports and biology. Additionally lubrication – created by your body during foreplay or bought at the store – can usually prevent pain. In short: sex can hurt but it doesn’t have to!

  • “Once you hit menopause, you can just expect sex to be painful.”

While menopause can shrink or dry out vaginal tissue and create pain during penetration, not all women experience this. More importantly,- massage, estrogen-based and other creams can rejuvenate vaginal tissue and reduce pain.

All of this is to say: don’t doubt your pain, and if you feel dismissed by a health care professional, get a second opinion!

Step 2: Get a physical exam from a gynecologist.

If you can, try to find someone who has experience with pelvic pain (a broader term for vaginal and vulvar pain.)

The doctor will want to examine the inside and outside of your vagina. They’ll likely ask to insert either a speculum or their fingers. Sharing the answers to the questions below with your doctor can help them to better understand your needs.

  • Where do you feel pain? On the outside? On the inside? How far inside? On one side or all over?
  • What is the quality of your pain? Is it burning, stabbing, throbbing, tingling, etc?
  • When do you feel pain? All the time? In certain sex positions? During any sexual contact? During insertion?

Once your doctor has assessed your pain, they will likely make a referral to a sex therapist that is trained in vaginal pain issues. This is handy because step 3 is…

Step 3: Make an appointment with a sex therapist

Sex therapists like those at The Center for Growth are trained to talk you through your anxiety and help you manage triggers for vaginal pain. They also will provide you with exercises to do alone or with a partner to relax and stretch your vaginal muscles. These exercises may involve massage or the use of dilators (small plastic or silicone tubes of increasing sizes.) If you have difficulty with them, your therapist can refer you to a trained pelvic floor therapist.

With patience and persistence, you can overcome your vaginal pain. Questions? Call the Center for Growth today for an assessment. The Center for Growth offers therapy in Philadelphia, PA with a wide range of professional counseling services.

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About Ferland Manuel

Dr, Manuel Ferland is health care specialist,