When penetration causes pain: ‘I was holding back tears’

When Mariángeles Montero, 33, wanted to have sex for the first time at the age of 20, she found that she couldn’t. Not because she didn’t want to, but because when she was with her boyfriend, she experienced “an intolerable pain” in her vagina. Mar Simón, 25, went through something similar when she was 19, but thought it was normal because her friends had told her that “it always hurt a little” at the beginning. In contrast, Natalia, 25, recalls hitting “a wall” when she had sexual relations with her first partner.

What they were actually experiencing is known as vaginismus, a problem that makes penetration difficult during intercourse due to involuntary spasms of the pelvic floor muscles that surround the vagina. Data on the prevalence of this sexual dysfunction is very scarce and can paint disparate pictures: 0.8% of nearly 25,000 women surveyed in Denmark said they had suffered from vaginismus during sexual intercourse in the past year. That percentage exceeded 68% in a survey of 400 women in Ghana. In countries like Spain, there is a lack of reliable estimates entirely.

“I literally searched on Google, ‘why won’t the penis go in?,’” confesses Montero, a Mexican marketing professional who works for a software company. For years, she tried many solutions and at one point, she thought it was due to a lack of lubrication. She also resorted to sessions meant to supposedly heal the feminine bloodline, out of a belief that she was experiencing something karmic. “Healing the father, the mother, because I couldn’t find answers,” she says. Montero also tried Akashic records [a concept without scientific basis that implies a universal memory of existence] and consulted a tarot card reader.

This search continued “until one day I was on Instagram and a video popped up of a Spanish girl who was talking about it. In that moment, I knew what I had,” she says. Vaginismus can appear at any age and, although it is most common between 18 and 35 years old, can also happen to women during menopause, which usually begins around the age of 45. This latter version is known as secondary vaginismus and can be caused from decreased lubrication and atrophied tissue as the vagina’s skin dries and wrinkles with age.

No tampons, no menstrual cups, not even fingers. With vaginismus, “nothing gets in,” explains Mónica González, head of the Female Sexual Dysfunction Unit at the Puigvert Foundation. “There is considerable pelvic contraction, so there is organic pain,” she says. In the case of dyspareunia, women can experience penetration, but sexual activity can be uncomfortable. Simón, who is an educator and dance student, says that when she was a teenager, she didn’t realize that she had the condition, but she became aware when she began to have intimate relations with boys. “It was an area that I didn’t even want to touch,” she says.

Her first sexual experience was “very painful,” and felt like pins and needles. “I had sex and I didn’t say anything. I also couldn’t enjoy oral sex or masturbation.” Simón also has vulvodynia, which involves hypersensitivity in the genitals, and particularly of the clitoris. That discomfort led the student to seek out a sexologist and then, a physiotherapist. In her sessions with the first specialist, she observed her vulva for the first time. “For me, it was a shocking thing,” she says.

Another great unknown was her pelvic floor. Nuria Díaz from the Goya physiotherapy clinic, says that it is important to work on the pelvic region, which encompasses the vagina, cervix, uterus, fallopian tubes and ovaries. Specialists can help individuals to focus on relaxing and strengthening muscles in the area with radiofrequency treatments, Kegel exercises and perianal massage. “In the consultation, physiotherapists examine the abdomen, ribs, posture and even ask the patient what she does for a living,” says Díaz.

Many patients experience an epistemological gap that can affect treatment response. In a study of more than 1,000 participants carried out by Australia’s University of Western Sydney, it was found that women can have difficulty seeking and receiving help for such issues, even within the healthcare system. Laura López, a specialist in obstetrics and gynecology at the Gómez Roig Institute in Barcelona, points out that it is often a topic that is not talked about openly and that, until recently, was little researched. “It is difficult to estimate its exact prevalence due to individuals’ tendency to hide the problem. The causes of vaginismus are complex and multifactorial and can involve both physical and psychological aspects,” she explains.

Montero and Simón had to consult a range of specialists to understand what was happening to their bodies. Natalia — who is a journalist and chose not to give her full name — also stayed quiet about her pain for a long time. “It was so intense that I was holding back tears,” she says. She went for five years without being able to have “normal” penetrative sex, despite undergoing various treatments.

Experiences like these are why it’s so important to openly discuss the condition and promote the multidisciplinary approaches that can treat it, says López, in order to “improve the quality of life for the women who experience it.” González says that when she began to see patients in Barcelona, she’d largely see “women in their thirties” who had stable partners of more than 15 years and whose goal was to become a mother. Nowadays, that has changed, but the reason women come in is the same: they haven’t been able to have penetrative sex.

Guilty feelings

Thanks to the help of a psychologist, Natalia discovered that the cause of her vaginismus was a trauma she’d experienced as an infant. “I had this memory stored in my head and I didn’t know it had been affecting me the whole time,” she says. Today, Natalia can have penetrative relations, but she doesn’t experience pleasure from them. The psychological aspect of her condition has made recovery a little slower as compared to those whose vaginismus is due to physical causes.

“You feel like a weirdo and I was afraid that no one would believe me. Now, I think it has a lot to do with the trauma from my childhood that I never told anyone about. I had the same defense mechanism,” she says. The duration of psychological treatment various between patients and every women experiences it in a different way. Carla Carulla, a psychologist from the University of Barcelona, says that women with vaginismus can feel “considerable guilt” for suffering from it. “It takes many women time to go to the gynecologist,” she says.

Like López, Carulla believes there is still a great deal of ignorance around vaginismus. Patients often do not know where to turn for help, and there is a lack of coordination between health services when it comes to the condition. In addition, there are a variety of approaches to treat vaginismus: psychological and medical techniques as well as physiotherapy. Natalia says she had to spend $155 a month on a treatment that lasted nearly a year.

The guilt surrounding vaginismus has a lot to do with the value we place on penetrative sex “in a very heteronormative society,” according to Carulla. In Spain, 52% of the population thinks that “real sex” includes penetration, according to a survey by the country’s Sociological Research Center. For example, Carulla finds the practice’s primacy in our concept of virginity to be highly problematic.

Simón uses social media to bring visibility to the condition, and her videos have millions of views. “At first, my TikTok was about dance, not sexuality. I have received messages from girls thanking me for speaking out,” she says. She thinks that women carry heavy baggage when it comes to beliefs and societal stereotypes. “We have been taught that our vagina is dirty,” she says. Carulla agrees, saying that there is a lot of talk about sex, but that much of it is erroneous. “It is the perfect breeding ground for myths and taboos,” she says.

Montero is in a WhatsApp group of more than 80 people that is meant to provide a space to vent, talk openly and support each other. “They’re always asking if anyone has managed to overcome vaginismus,” she says, citing a common concern among women with the condition. “I don’t want anyone else to have to go through this,” she says, visibly emotional. At 33 years old, and after a decade of an intense search for answers, treatment with several physiotherapists and three relationships, Montero says that she is able to live a satisfying sexual life.

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