Pain during intercourse: causes, symptoms and solutions

Vaginismus and dyspareunia are sexual dysfunctions in which pain is the protagonist. Poor sex education and ignorance of the body seriously hamper the detection and expression of these two problems.

The result is a permanent warning that keeps the affected person away from intimate relationships, resulting in silent suffering. This week, Yolanda Segovia, psychologist collaborating at the Monthly psychological assistance institute, Tells us about these two dysfunctions and opens a reflection on the importance of their treatment.

What differentiates vaginismus from dyspareunia?

Vaginismus is the inability to achieve vaginal penetration due to the contraction of the muscles surrounding the entrance to the vagina. When a woman is sexually aroused, she experiences relaxation of the vaginal muscles. However, in vaginismus, the muscle contracture is such that it prevents penetration.

In contrast, dyspareunia is the pain that both men and women may experience in the pelvic area during or shortly after intercourse. The pain occurs during penetration, erection or ejaculation.

Focusing on the female gender, the pain factor is the protagonist of both issues. Yet the difference is significant. In the case of women with vaginismus, the reflex response of the muscles makes penetrative sex impossible (or extremely difficult). In the case of women with dyspareunia, the pain seriously interferes with pleasure during penetration but does not prevent intercourse.

In the case of vaginismus, what aspects prevent muscle relaxation?

Women with vaginismus associate penetration with feelings of danger. This creates a fully automatic tension response that materializes in the vaginal muscles. This reaction generates a high level of discomfort as there is a desire to have penetrative sex but the physical reality is very different. An inexplicable body-mind contradiction then appears for the person.

The result is an overwhelming feeling of lack of control and an explosive increase in anxiety. Among the factors that can cause vaginismus are the sexual beliefs and values ​​that create confusion, insecurity and inevitably generate an inappropriate response. On the other hand, this dysfunction usually starts in the past.

Some women report having difficulty during the first period of menstruation when inserting a tampon, irrational ideas about penetration or the possibility of becoming pregnant, and even distorted ideas about perceiving one’s own genitals.

And in the case of dyspareunia, why does it appear?

Among the aspects that can influence the onset of pain, there is insufficient lubrication due to lack of erotic stimulation, vaginal dryness, premature intercourse after surgery or childbirth, genital irritation caused by soaps, allergies to diaphragm latex or condoms, and these specifically medical aspects. nature (phimosis, frenulum, prostatitis, hemorrhoids, genital herpes, etc.).

We would like to emphasize that, in the case of this dysfunction, the pain should be constant and repeated during intercourse.; occasional pain does not mean there is a problem. Either way, there is no doubt that discomfort greatly affects sexuality and can lead to avoiding relationships.

For this reason, in case of doubt, it is advisable to consult a professional.

Do people with vaginismus or dyspareunia talk about their problem?

Most don’t, they make it a taboo subject. In the case of women with vaginismus, educational work is particularly important. Lack of self-awareness (usually no exploration) and social censorship, they make it even more difficult to express and normalize aspects of a sexual nature.

This reality keeps affected people away from different contexts (friends, colleagues, parents, etc.) for fear of being misunderstood and qualified as “rare”. Fear is increasing day by day and vigilance becomes an intrinsic part of the personality.

Of psychotherapy, what work is done in both cases?

In addition to the psychoeducational work and the detection of negative and destructive thoughts that is done from an individual therapy context, the work that is done from couples therapy is important. To solve the problem, it is essential to establish open communication in order to express discomfort and find mutual understanding.

Likewise, the therapeutic work that facilitates change will aim to gradually address deep aspects. The work of introspection, insight and emotional expression will accompany us throughout the process. Feelings of guilt, internal strife, and in some cases unresolved feelings from past traumatic experiences (for example, a history of sexual abuse, abuse, or rape) will be some of the issues that, d ‘a systemic and integrative point of view, we repair.

What advice would you give to people suffering from one of these two dysfunctions?

Especially in the case of vaginismus, the feeling of lack of control contaminates the rest of personal contexts. The discomfort crosses the purely sexual border and translates into a fear that goes far beyond.

The inability to have penetrating sex always feels the desire, Gradually decreases the ability to seek pleasure and meet own needs. Leaving this problem aside can have a serious impact on a woman’s self-esteem. Fear translates into more fear; this is why it is difficult to talk about the problem and consult a professional.

Our recommendation is always to approach the problem from a holistic point of view and, most importantly, to consider possible organic causes. Once ruled out, the work of individual and couple psychotherapy is what will make it easier for the person to regain self-confidence and above all not to live in a continuous struggle, thus taking control of the situation and ceasing to be self-confident. ‘escape”.

In this sense, couple communication is essential to reaffirm the right to express and empty all this accumulation of feelings which, unconsciously, were once reflected in an essential organ.

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