Adjusting to being married- when sex is not working

Adjusting to Being Married: When Sex is “Not Working”  

 

Let’s face it–it’s not all a bed of roses for a newlywed virgin bride. Perhaps it is a combination of her being too nervous and her husband being too keen, but the possibility of sex not being all that pleasurable in the first weeks or month is a normal occurrence.

In his book Sheet Music, Dr. Kevin Leman advises engaged couples to begin medical check-ups three months prior to their wedding day.  Many women have hymen issues,  some women experience vaginismis.

Vaginismus or vaginism is the physical or psychological condition that affects a woman’s ability to engage in any form of vaginal penetration. This may include sexual intercourse, insertion of tampons or menstrual cups, and the penetration involved in pap tests (gynecological examinations). Vaginismus is presumed to be the result of an involuntary vaginal muscle spasm, which makes any kind of vaginal penetration—including sexual intercourse—painful or impossible.

Just to clarify, the woman suffering from vaginismus does not consciously control the spasm. The vaginismic reflex can be compared to the response of the eye shutting when an object comes towards it. The severity of vaginismus, as well as the pain during penetration (including sexual penetration), varies from woman to woman.  If a woman suspects she has vaginismus, sexual penetration is likely to remain painful or truly impossible until her vaginismus is addressed. Within a marriage, the husband may think his wife does not want to engage in penetrative sex at all, which may not be the case. Vaginismus does not mean that a woman does not want intercourse or does not love her partner. Women with vaginismus may be able to engage in a variety of other sexual activities, as long as penetration is avoided. There is currently no indication that vaginismus reduces the sexual drive or arousal of affected women, and as such it is likely that many vaginismic women wish to engage in penetrative sex to the same degree as unaffected women, but are deterred by the pain and emotional distress that accompanies each attempt. Psychological pressure to “perform” sexually or become aroused quickly with a partner can deter the sufferer from future attempts and/or cause her vaginismus to become more severe.

A woman who is interested in having (or, at minimum, willing to have) intercourse, and finds that her vagina responds with a reflex that makes intercourse impossible, is likely to experience a wide range of emotions, from amazement to grief to embarrassment. Some women may already have negative associations with their genitals, including fears that their genitals are ugly, dirty, or sinful.

These associations can lead to negative emotions arising during any kind of sexual expression and these emotions can take time to process. Feelings of shame, inadequacy or a fear of being “defective” can be deeply troubling. If multiple attempts at penetration are made before treating vaginismus, it may lead to fear of sexual intercourse, and worsen the amount of pain experienced with each subsequent attempt. Relaxation, patience and self-acceptance are vital to a pleasurable experience.

For many couples who encounter this situation in the early days of their marriage, the experience can feel very isolating.

 

There are a variety of factors that can contribute to vaginismus. These may be physical or psychological, and the treatment required depends on the individual. As each case is different, an individualized approach to treatment is useful. The condition will not necessarily become more severe if left untreated, unless the woman is continuing to attempt penetration, despite feeling pain. In this case, the condition becomes reinforcing, trapping the woman in the Cycle of Pain.

 

Dr. Leman’s advice to undergo check-ups months before the wedding date is sound advice. If the woman is diagnosed early on, she may have time to physically and psychologically prepare herself. Below are some examples on how this condition can be addressed.

 

A pelvic physiotherapist can assess hypertonic pelvic muscles that often affect and/or cause Vaginismus through the implementation of a multi-modal approach in treatment.

Pelvic physical therapy involves both external and internal modalities. Internal treatment is achieved by the insertion of one finger into the vagina in order to palpate internal muscles, and assess any connective tissue restrictions or “knots” also known as myofascial trigger points. If a vaginal dilator is used as alternative treatment, then no physical intervention is required as the vaginal dilator replaces the need for finger insertion which may be more suited for people with certain religious or cultural beliefs.

Treatment either involves the use of vaginal dilators that are probes which stretch open the tissue. They come in different sizes up to the size of a penis and are used at home.

The three most common contributing factors to vaginismus are fear of painful sex; the belief that sex is wrong or shameful; and traumatic early childhood experiences (not necessarily sexual in nature).

Vaginismus patients are twice as likely to have a history of childhood sexual interference and held less positive attitudes about their sexuality. Note there is no correlation for lack of sexual knowledge or (non-sexual) physical abuse.

For the majority of women with vaginismus, the psychological aspects must be addressed alongside the physical manifestations. There are emotional difficulties associated with vaginismus, even for women whose vaginismus has a purely physical cause, which can include low self-esteem, relationship issues, continuing fear of penetration, and depression.

For many women, there may be an association with pain and arousal from repeated painful encounters which may result in more tension and an inability to relax during intimacy.  This can result in a cycle of arousal followed by the anticipation of pain that could take some time to break. If this is the case, do not despair. See your doctor and/or someone who is able to walk you through the emotional/psychological component of dealing with vaginismus. There is hope. In the meantime, if you are married and are working through this condition, look for other ways to satisfy each other.