Sylvie and Martin, an attractive couple in their late 20s came to my office for a consultation. On Sylvie’s intake sheet, under “Problem” she had written “Unable to have intercourse because of pain.” Martin had simply written “To have intercourse” as his goal.
They’d been married for several years, but they had not been successful at having intercourse. Sylvie described terrible vaginal pain, which she’d suffered for as long as she had known Martin.
But other than that, they described their marriage as perfect, and reported that they were very happy as a couple.
As it turned out, very negative messages about sex from a teacher and a friend were key to understanding Sylvie’s suffering.
Sylvie had come from a religiously conservative background, so she and Martin were not active sexually until they got married. The first few times they tried, Sylvie had experienced so much pain that she and Martin just decided to stop. They found other ways to be intimate.
Sylvie explained how embarrassed she was by her problem. She wanted to be able to have intercourse because she wanted to feel normal, “like everyone else.” She also wanted to have a child — a huge motivator.
I asked Sylvie how she felt about kissing Martin. There, too, she was very inhibited. She didn’t really like it all that much, she said. She wondered if she just wasn’t a very sexual person.
Because she was presenting a picture of a lot of psychologically based sexual inhibition, I asked Sylvie about if she had heard anything scary about either intercourse or childbirth. Perhaps she heard something negative from her family.
She said no, not in her family. Then I asked her if she had heard anything negative somewhere else. Her eyes opened wide, and she described to me several frightening things she had heard at age 14 or 15 from people outside of her family.
First, one of her teachers at religious school, who recommended abstinence, had told her class several times about how painful intercourse could be. Later on, one of Sylvie’s friends talked about how painful she had heard childbirth is.
Sylvie said that since those incidents, she had always pictured intercourse as painful. So when it was painful on her honeymoon (which she had dreaded), she became more and more frightened of it.
Martin added that Sylvie’s family never talked in a fun or friendly way about anything sexual. (This kind of family environment is often labeled a “sexual vacuum.”) So Sylvie’s had no one to go to talk about the upsetting information she was hearing at school.
It looked to me like Sylvie probably had vaginismus, a condition that is physically and psychologically based. The pain is real, but it is caused by a woman being so fearful (the emotional part of it) that she clenches the muscles at the opening of her vagina (the physical part of it).
Besides vaginismus, Sylvie was not comfortable with sexual feelings in general. Her treatment would have to include a combination of physical work on her muscles and some reprocessing of negative beliefs about female sexuality.
It is always important to get a medical evaluation of vaginal pain, so I sent Sylvie to a gynecologists I know to get a full examination. But assuming that the physician concurred that Sylvie had vaginismus, I set her up ahead of time with a program to work on with dilators.
The gynecologist reported that Sylvie did indeed have vaginismus. So the dilators that I had assigned were appropriate.
Psychologists now have quite a lot of tools to process trauma. We now have ways to transform negative sexual influences. I worked with Sylvie alone for a few sessions, using hypnosis and a treatment called EMDR to work through some of her fearful memories.
After that, Martin, Sylvie, and I worked as a team so that in 14 months of diligent work, Sylvie’s attitude toward sex was more open, and her vaginal pain was gone.
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