Painful sex/ vaginismus

Uncomfortable? ... explore your body

IF it hurts to make love, then I hope to help. There's no doubt about it, it's very difficult to imagine happy and pleasurable intercourse until you have enjoyed it. 

It can be particularly difficult for girls. To start with, their sexual parts are hidden away from their gaze, whereas a boy's are mostly very much in view, and he is familiar with them from his earliest infancy. 

If their mother was fairly anxious about potty training and cleanliness, girls may early have learned to think of that area of their body as being "dirty". 

Later, parents anxious to "protect" their daughters, may have made the whole subject of sex one clouded by guilt, doubts - more or less taboo. 

All this conditioning can make it almost impossible for a woman to respond to her body's sexual signals, or to think of future sexual activity with anything but dread. 

Fuller knowledge of how your body works can relieve some of that anxiety. To start with, get to know your own body, in particular the genital area. 

Get a mirror, lie down and part the outer lips of the vulva, the outer sexual organs, so that you can see what lies hidden behind. At the top is the clitoris, a little peak of tissue hidden or partly hidden by a hood. 

Below those are the labia minora, the inner lips, covering the urinary opening, and below that the opening of the vagina. This may be partly covered by the hymen or maidenhead, which has many myths attached to it. 

The hymen is a membrane, usually half moon shaped, covering the lower half of the opening to the vagina. It usually gets stretched by the first act of intercourse. 

Provided this is gentle and loving, and the woman is properly aroused, this is usually uncomfortable rather than painful, and accompanied by very little loss of blood and often none at all. 

It may help you understand what part is what to see a clear diagram, and you can find one in good sex guides - I give details later. 

The vagina is surrounded by very strong muscles which keep it collapsed, rather like a used toothpaste tube, most of the time. 

However, when a woman is sexually aroused, the muscles at the entrance to the vagina relax and the vagina balloons out. 

No penis can ever be too broad, nor any vagina too small for successful intercourse. 

The vagina can expand to allow a baby's head to pass through, so there's no question of it being too narrow to allow a penis to enter. 

When couples think that it is a physical mismatch which is preventing them having pleasurable sex, the problem is almost invariably a psychological one. 

If the woman is afraid of intercourse, or not fully aroused when the man attempts penetration, then her vagina may not be sufficiently lubricated - for when a woman begins to be aroused her vagina produces lubrication without her necessarily realising - the muscles around the vagina may still be in a tight ring, and intercourse will either be painful or impossible. 

The man may find himself bumping up against a wall of muscle refusing him entry. 

 Perhaps you're not ready

 Girls may be afraid of sex for all sorts of reasons. It may be the conditioning that I mentioned earlier. They may have a very loving partner, they may be married, and still can't overcome their fears. More advice for them later. 

However, a girl may be afraid of sex simply because she is not ready for it or she is not with the right partner. A girl may feel pressured into sex, because friends say they are having sex, or a boyfriend is trying to talk her into it. 

Well, to start with, those friends may be exaggerating or, if they are having sex, they may not be enjoying it as much as they pretend. 

For the overwhelming majority of women, sex is not pleasurable unless it is part of a deep, loving and mature relationship. 

It is illegal in this country to have intercourse with a young person under 16, but most girls are not emotionally ready for sex, nor have they formed the right type of relationship until some time after that. No girl should ever feel she should have sex because her friends are. 

If the pressure is coming from her boyfriend, she should remember that no boy or man who really loves her will try to persuade her to have sex until she really wants to. 

If he tries to blackmail her into having sex by saying that he will leave her if she doesn't, then she can take that as a definite sign that he doesn't love her or care about her deeply. 

If any of that seems to apply to you, then don't feel that you have a problem because you don't want sex at the moment. The chances are that you will, when you are emotionally mature enough and when you have the right loving partner. 

However, even though you would be most unwise to start practical experiments before you are ready for them, it might help relieve some of your anxiety about sex to read a good and responsible guide.

Worth Talking About (0800 28 29 30, www.nhs.uk/worthtalkingabout) is a free confidential phoneline which offers help and advice to young people (under 19) about sex and personal relationships. 

And please, when you feel you are ready to have sex, don't even start until you have sorted out a reliable means of contraception, will you? See your family planning clinic and, if you have any difficulty, write to me again. 

Sexual Abuse 

Women who have been sexually abused often have difficulty establishing happy sexual relationships. If you are a victim you might like to read my leaflets Abused as a child? or Have you been raped? which explain how to get the understanding help you need. 

Vaginismus

If you know that your relationship is right, that you do care for one another deeply - perhaps you're even married - though you're in love you can't make love, then you may be suffering from vaginismus. As explained before, it is not that your vagina is too small, or your partner's penis too big, but that the wall of muscle around your vagina stays clamped shut in a firm No. 

It could be that your partner's knowledge of what turns a woman on is more limited than he realises.

Some men still think that a woman's sexuality is centred in her vagina, but this actually has few nerve endings compared with the clitoris. It usually takes a woman something like four or five times as long as a man to get sexually aroused. He should not attempt to penetrate unless he is sure that you are ready. 

This is usually after some time, caressing the clitoris (the centre of a woman's sexuality and very sensitive) or the area around it or wherever else you find particularly pleasing, having moved on to that from other parts of the body. If you think the problem could be the way you make love rather than your fear of it, send for my leaflet called How to have great sex. 

If you now think the problem is your fear, then these sensate focus exercises should help you begin to get in touch with your body's signals of sexual pleasure. First you both accept the rule that there will be no intercourse - at least for a while so that you feel free to enjoy the sensation without pressure. 

Exercise One

Stroke yourself all over. Experiment with soft stroking or firmer massage. It is important that you do not chafe your skin, so use soap - in the bath - or cream or body lotion so that your hands can glide smoothly. 

Check out pjur (pronounced pure). an ultra-slippery lubrication which is latex-condom safe, hypoallergenic and can be used for massage too (www.pjur.com). 

If you are tired or tense, it can be good to start by massaging the face, ears and back of the neck. If you have been standing all day, start with a firm massage of the feet and legs. 

Try touching all the parts of your body that you may not previously have thought sexually sensitive. Try the exercise another time, and now you can move onto the more sexually exciting parts of your body. Don't be afraid. Caress your breasts, your nipples. Explore your genital area. 

Find the clitoris - the peak of sensitive tissue in front of the vagina. 

Women vary in what arouses them to orgasm. Some climax when their nipples or other sensitive parts of their body are touched but for most women stimulation of the clitoris is essential. 

Try stroking or rubbing it or the area around it, in different ways, simply doing what feels more pleasurable or exciting. When you have an orgasm the muscles of the pelvic floor rhythmically contract and relax. 

It may feel like throbbing in the vagina. The intensity varies widely, as I've mentioned but it certainly should feel pleasurable. 

Try slipping a finger into your vagina. If you lie back with your knees apart in the air and bend your forefinger back and up slightly, it should slip in easily, and you may be surprised to find how roomy it is in there. Next time, try two fingers. 

Exercise Two

With your partner, choose a time when you won't be interrupted. Start early enough so that you both have some energy left. Get the room warm. Have a drink or some background music - whatever helps you to relax. Leave a light on. 

Choose one of you to start - you take it in turns to lead. Using a little cream or oil, you massage and stroke one another all over. Don't be afraid to say what feels good and what not so good. Say whether light stroking or firm massage feels good where. Keep your thoughts on how your body feels. Don't worry about looking funny, or whether your partner is getting tired - his turn will come. 

The first time you do this "sensate focus" exercise as it is called, do not touch one another's sexual areas. Don't move to touch these until you are both comfortable doing the exercise. The important thing is not to hurry the stages. 

When the time seems right, then you can begin showing one another how to give the most pleasure by stroking and massaging the penis (he's sharing in this pleasurable learning too!) the breasts, round the back passage if you enjoy that, the clitoris and vagina. Lick one another all over, if that feels good. 

Experiment with kissing and licking one another's sexual parts. Remember the only rule is that you should both enjoy it. You can caress your partner to climax. When you feel ready, your partner can slip a finger into your vagina. Next time, two. If you find it difficult to get into the mood, don't be afraid to use fantasies of whatever seems most sexually exciting to you. 

When you feel you are ready for intercourse, you should take the position on top, so that you can feel in control of what happens, and not risk feeling trapped and helpless underneath. Straddle your partner, and slide his penis into your vagina gently. 

He must resist the temptation to make any thrust upwards. You must feel in control of what happens. At first you may only be able to cope with just the tip of the penis, but as long as your partner does not rush you, you should in time be able to accept more. 

Learning to relax and take life calmly can help you tackle any problem, and is particularly helpful for a difficulty like this which is related to emotional stress. Ask at your local library about yoga or relaxation classes in your area. There is more information and guidance on relaxation in my leaflet Self-help for stress. 

Expert help

Such self-help may work for you, but it really is a good idea to get some expert help, too, for a problem such as vaginismus. 

There are some medical conditions which can lead to painful intercourse, such as ovarian cysts or irritable bowel syndrome, so it makes sense to have a word with your GP to eliminate any possible physical cause in the first place. Of course, the very nature of the problem can make it difficult for the sufferer to talk to anyone about a sex problem, but you risk depriving you and your partner of a key part of your relationship if you don't. In fact, you may risk ending it completely. 

Your local Relate will be able to help you explore the underlying emotional problems which are preventing you from enjoying sex (0300 100 1234, www.relate.org.uk). Counselling can be particularly helpful because there may be something in your relationship which is making this fear of sex worse, and a counsellor can help you work out how you can tackle it. Many branches have counsellors specially trained to help with sexual problems. 

Some GPs are expert at treating sexual difficulties, others not. You can ask your GP to refer you for treatment with a psycho-sexual clinic or member of the Institute of Psychosexual Medicine (020 7580 0631, www.ipm.org.uk). 

If you find you are faced with a lengthy waiting list to see a Relate sex therapist, you may like to think about seeing a sex therapist privately. Contact the British Association for Sexual and Relationship Therapy who can send you a list of sexual and marital therapists in your area (020 8543 2707, www.basrt.org.uk). Make sure you know before you start how much it will cost.