The psychology, biology, and pain science of vaginal penetration pain disorders
Vaginismus is vaginal resistance to penetration. It’s usually painful, sometimes severely, and historically presumed to be muscular in nature — the vagina clamping shut, a kind of cramp. Although surprisingly obscure, this is a major pain topic for women.1
This condition is of particular interest to me and to many regular PainScience.com readers, because of the complex intersection of psychology, pain, and — probably — muscle spasm, or “muscles behaving badly” in some way.2 However, I am a middle-aged white guy, and so after a summary of the basics, I am going to devote the rest of the article to an in-depth interview with Kirsten Loop of UnravelledSelf.com — someone who really knows this topic, inside and out.
There’s also an extensive selection of other resources: articles, books, movies, and more. Many talented people have done a lot to raise public awareness of this issue, fighting an uphill battle against sexism and sex negativity the whole way.
“PubMed has almost five times as many clinical trials on male sexual pleasure as it has on female sexual pain. And why? Because we live in a culture that sees female pain as normal and male pleasure as a right.”
Lili Loofbourow, The female price of male pleasure, The Week
Classifying the unclassifiable: “vaginismus” isn’t even officially a thing anymore
There is much more (understatement) to the world of female sexual dysfunction, which is how vaginal penetration pain disorders are classified, but the focus here is on “Gee-Tripple-Pee-Dee” pain — genito-pelvic pain/penetration disorder (GPPPD).
There’s an endless debate about whether these conditions are physical or psychological or both, and of course there’s also a long, shameful history of stigma and attributing vaginismus to “frigidity” and other according-to-men feminine failings. Sexism and racism in healthcare are bad enough, but that’s nothing compared to what you get when you pile on with the stigmas against both psychosomatic illness and anything to do with sex. It’s hard to imagine a more hopelessly distorted topic in all of pain medicine.
The last major revision to the Diagnostic & Statistical Manual of Mental Disorders (DSM-5)3 actually got rid of the term “vaginismus” and put whatever-it-is into the big GPPPD bucket, still within the Sexual Dysfunctions category.4 All other medically unexplained pain lives in the Somatic Symptoms category.5 Apparently “sexual” pain is different than all other types of pain?6
Regardless of the official classifications, the term vaginismus continues to be used, because it is the traditional term for the specific phenomenon of a spasm that typically causes pain upon attempted penetration. Which is definitely a thing. But there are other closely related conditions.
Vulvodynia, provoked vestibulodynia, and more “regular” chronic pain in the pelvis
Vaginismus is defined by penetration resistance, with pain that is common but not inevitable. There’s also vulvodynia and vestibulodynia are pain alone, with or without penetration resistance. These conditions are more like “regular” chronic pain that just happens to occur in pelvic anatomy, and routinely has nothing to do with sex. They are actually similar to other chronic body pains like back pain or IBS or headaches: puzzling flare-ups, maddeningly difficult to treat, sensitivity to psychological factors, and a lack of a clear cause.
Provoked vestibulodynia (PVD) is the most common form, occurring in about 8% of all women.7 It’s so similar to vaginismus, or goes with it so much, that it’s not clear that they are actually different things, or just different sides of the same coin,8 but there do seem to be two separate experiences: pain without vaginal resistance and painful vaginal resistance. Despite this seemingly clear distinction, vaginismus was dropped from the DSM anyway — prematurely some say.9
Other relevant articles on PainScience.com:
- My general “pain is weird” piece digs into why pain is so capricious in character, and vaginismus certainly qualifies as an example of just how weird pain can be.
- Sensitization is major concept that’s critical to understanding many kinds of chronic pain, and that almost certainly includes several kinds of sexual pain.
- My “mind over pain” article has a very strong focus on trying to be realistic/practical about that challenge.
- While pain as conditioned behaviour (in the classical conditioning sense) is quite speculative, it’s damned interesting, and all to easy to see how it might apply to vaginismus and provoked vestibulodynia especially. Obviously I am extremely cautious about conflating this with “all in your head” (as noted in the intro).
- Is there much overlap between fibromyalgia and vulvodynia? Frustrating regional pain is generally part of fibromyalgia — most fibromyalgia patients have “hot spots.”
The knees of Kirsten Loop — interviewed below — volunteering for a pelvic floor physiotherapy course at Entropy Physiotherapy & Wellness, Chicago, 2019, as she prepares for an internal exam. The arms belong to physiotherapist Sandy Hilton, who also writes about pelvic health.
An interview with Kirsten Loop of UnravelledSelf.com
Kirsten Loop is a writer and advocate for women with pain related to sex. I first noticed Kirsten on Twitter (@Unravelled_Self); she seemed unusually crafty with her words, and passionate about the topic of vulvovaginal pain, a problem I was only dimly aware of. I knew there was “pelvic” pain, but had always thought of sexual/penetrative pain as something secondary to other pain problems in that region, a tragic complication rather than a phenomenon in its own right (a “primary” pain). My own obliviousness was clearly related to systemic sexism in healthcare — a serious problem, for which I want to be part of the solution. The last thing I want is for my female readers to think, “Oh great, another pain ‘expert’ who’s clueless about my experience.”
But, for now, I am still clueless. To learn about this, I really need to learn about it from women. So when I heard that Kirsten was working on a book on the topic, I knew I wanted to help her get the word out — and I couldn’t wait for the book to learn from her experience and expertise, so I asked for an interview. This conversation took place by email in the fall of 2020, in the depths of the COVID-19 pandemic…
Paul — Who the heck are you, Kirsten Loop? How did you end up trying to explain vulvovaginal pain to the internet?
Kirsten — Thanks for bringing some awareness to the topic. It’s hard for me to believe after all these decades that hardly anyone knows about it, including most doctors and physiotherapists.
I’m a Canadian Technical Writer and UX Researcher in the “Silicon Valley of the North” (Waterloo, Ontario). I spent most of my career in Toronto creating huge technical manuals for complex software systems.
I had vaginismus for twenty years in the 80s and 90s. Vaginismus is a vaginal penetration pain disorder, which means it feels like the vagina is completely blocked—as though there’s a “wall” there. Nothing gets in. It’s a rare-ish “psychosomatic” diagnosis but common enough that millions have it worldwide in all cultures. It’s everywhere but no one talks about it.
In 2018, a persistent midlife burnout left me searching deep for some answers. To my astonishment, I found myself face-to-face with the disorder I’d pretty much disavowed after I cured myself in 1998, at age 28.
I now have things to say about it.
Kirsten Loop (@Unravelled_Self), writer & advocate for women with pain related to sex. Her photo disclaimer: “Pandemic hair!”
Paul — You have so much to say that you’re writing a book. Is that your first, and where are you at in that process? How’s it going, from the writing and publishing perspective?
Kirsten — In a lifetime far, far away, I photographed the Naughty Paris series of travel guides that tastefully explored the erotic subculture of Paris, or parts of it anyway. The book won the 2009 Independent Book Publishing Award (Gold Medal, Travel Category), and the project was reprised for New York City. The self-publishing landscape has changed since then and I haven’t yet made firm decisions about this book—which is quite a bit different than a travel guide! It’s more like A Beginner’s Guide to the Research — but not boring. I use my tech writing skills to explain things, and I use my own lived experience to illustrate the research. In essence, I’m creating the book I wish I’d had when I was 20-something.
I’m in that satisfying, maddening phase of a massive information project where the first draft pours out one minute and dries up in the next. I’ve spent two plus years circumambulating the scientific literature and contemplating my own experience to come to a (slight) reconceptualization of vaginismus than what’s popularly known. There’s far more to the condition than what’s found on the internet. Only a book can capture that complexity. Social media sound bites won’t do.
Paul — Writing a book you wish you could give to your past self seems like a clever source of motivation. I might have to imitate that!
It does sound really different than a travel guide. 😉 But obviously you have been on a journey, and I know from my work on PainScience.com that using your own story to “illustrate the research” is an compelling formula. So let’s do a bit of that now and get a little more of that story. You suffered from vaginismus yourself for a long time, and you cured yourself in 1998. So, how are you “face-to-face with it again” now?
Kirsten — I didn’t expect to have to face it. I’d vaguely planned to never revisit that time in my life. I first sought help at age 15. I’d rarely thought about vaginismus since being cured. The experience was lonely, frustrating, infuriating, and damaging.
Flash forward 20 years after cure. Relentless career burnout started to go existential. I’d made admirable attempts to rebuild and redirect my tech career, and I’d scored a few big wins! But something wasn’t right. I’d keep crashing, and I couldn’t identify the cause or solution.
A good therapist finally gave me a great assignment: to write out every single thing I’d ever lost in a “loss list.” I needed to identify what I needed to mourn, where I was “stuck.” After three days of emptying out everything I’d ever cried over, it finally floated up into awareness again and I wrote it down: vaginismus.
The shock! I knew in an instant that was the problem! On the spot, I searched the term in Google Scholar for the first time and fell down a rabbit hole. I discovered good quality research had emerged only in the last 20 years. I didn’t agree with all of it, but it sure did explain a lot!
The time had come for me to incorporate my really weird so-called sexual dysfunction into my self-concept rather than to act as if none of it had ever mattered. I hadn’t forgotten the experience, but I’d minimized it to almost nothing. It was time to honour it.
So here I am.
Paul — All chronic pain is traumatizing to some degree, even when people escape the pain. But I bet that vaginismus and other forms of pelvic and sexual pain are in another league when it comes to their power to cause emotional scarring, thanks to cultural sex negativity.
You’ve obviously been learning both personally and from that surging research. What’s one of the more important things you’ve learned that you wish you could share with a younger you? What did she most need to know that she didn’t?
Kirsten — Vaginismus wreaks havoc on relationships, especially if heterosexual intercourse is a priority. How you do and don’t fit into your peer groups becomes deeply perturbed. In religious families, or as biological time runs out, the pressure to conceive can become an unbearable source of despair. If vaginismus persists over a long time, all these problems compound.
Any mention of pain in the vagina, especially during sexual intercourse, tends to shut people down. It’s a taboo topic. Most people look at you like you have three heads, and some crack uncomfortable jokes, but most laugh as though it’s the most absurd thing they’ve ever heard — and some of these people are doctors! Or best friends. Or potential boyfriends. Or parents. Sufferers learn early not to disclose, they delay seeking help, and years can go by before they get a diagnosis. Meanwhile, their lives pass them by.
The persistent silence around these relatively common conditions bothers me. I’d want my younger self to know that she is not, at all, alone. She is not a freak whose condition is to be kept hidden away for the emotional comfort of everyone else. I’d want her to know there are options for treatments and that the “prying open” of vaginal muscles with dilators is not strictly necessary, though dilation therapy does help many (it’s just not about “prying open” the vagina).
Paul — The squeamishness of partners responding to disclosure is appalling, albeit completely predictable, thanks to that tragic human habit of literally or figuratively pointing and laughing at anything and anyone they don’t understand. I imagine there’s not much that can be done about that except dogged public education to blunt the ignorance. But it seems like a high bar to clear, in a world where sex education is so limited that many countries can barely even teach kids the basics of birth control.
You’ve told me what you wish you could tell your past self. What do you wish you could teach men and boys about vaginismus? Or anyone else who wants to have a sexual relationship with a woman who has vaginismus? What do the partners most need to know and do?
Kirsten — Hook-up culture forces disclosure much earlier now, I think. When she tells you about it, believe her. She’s not lying, coy, obstinate, or lazy. She’s definitely not rejecting you. She wants to have sex!
Intercourse is a central issue in vaginismus, but not everyone who desires penetration is heterosexual, and not everyone desires penetration. Whether or not to try to fix “the problem” depends on personal and interpersonal priorities, what you consider “cure” to be, and how you define the problem.
Partners need to get ultra-clear on whether or not penetrative sex is essential for the relationship. Obviously it is for most, and some couples discover only on their wedding night that it’s impossible. Navigating this self-exploration with brutal honesty can be very difficult. If penetrative vaginal sex is critically important, then they might need to move on from the relationship — with kindness and respect. I suspect betrayals of infidelity cut deeper for guilt-laden women whose own vaginas they feel are responsible for the abandonment.
Partners sometimes open up relationships or arrange hall passes. Many have a rewarding sexual life without vaginal penetration. Others struggle with the seemingly never-ending cycle of avoiding/attempting sex or dilation therapy.
Paul — That sounds like good advice for anything that interferes with typical expectations of how sexual intercourse should go, or whether it is expected to “go” at all. Penetrative sex may be popular 😉 but it’s also just the simple truth that it isn’t everyone’s cup of tea. And even when it is a sacrifice, some partners may be willing to pay that “price of admission” to be with a partner they are otherwise happy with.
Okay, let’s get into the nature of this problem a bit. What is vaginismus? What’s the official definition, and is it a good one from a patient advocacy perspective?
Kirsten — Vaginismus no longer exists in name or definition, but everyone still uses the term anyway. Both vaginismus and dyspareunia (provoked vestibulodynia, that is) have been subsumed under a new term: Genito-Pelvic Pain/Penetration Disorder (GPPPD). Some call it “Gee-Triple-Pee-Dee” — you know, to keep things simple.
Provoked vestibulodynia (PVD) (which used to be called vulvar vestibulitis, VVS), eventually became synonymous with dyspareunia, which, in essence, simply means pain during intercourse (penis-in-vagina sex). Clinicians and researchers used the terms interchangeably for a while to everyone’s confusion.
PVD is an extreme burning, cutting, or scraping sensation at what I sometimes call the “gateway” to the vagina during penetrative attempts—or sometimes even with the “slightest touch of a feather.”10 It’s the most common subtype of vulvodynia. A central issue in the fight over the DSM-5 revision is whether or not vaginismus is a subtype of PVD or a stand-alone condition. Provoked vestibulodynia might be the same as vaginismus or it might provoke some mechanism that blocks penetration. No one knows.
Vaginismus was always said to be caused by a muscle “spasm” in the outer third of the vagina. There was no evidence for this. In 2005, a proposal was made to move vaginismus from the Sexual Dysfunction category of the DSM-5 to the Somatoform Category where it might automatically get better treatment by pain professionals. Having been tuned in to the pain science discussion for a few years, I knew this potential move held significant risk.
Paul — I am going to need a chart! It sounds like there’s a nomenclatural mess, which is typical on the frontiers of medicine. And while I am afraid I know what you mean about the “significant risk” of being labelled as a somatoform disorder, could you elaborate on that? What could possibly go wrong?
Kirsten — I provide a chart in the book. It’s more like a legend, though.
The proposed move to the somatoform category seemed to me like an arbitrary move but also an admirable one. With “sexual” removed from the diagnosis, a reduction in stigma would likely follow. Certainly the Sexual Dysfunction category wasn’t doing us any favours. So that’s the bright side.
The other side of the coin is that most people with somatoform issues come to the DSM from the medical world. When doctors can’t find anything wrong, patients get punted to the shrinks. The problem is deemed to be “psychosocial” in nature — and with that term psycho is generally meant. It was thought that by moving whatever-the-heck-unexplained-vulvar-pain-and-penetration-problems-are to the somatoform category in the DSM-5, patients would automatically get better treatment from pain professionals.
I wasn’t so sure about that.
Paul — It does seem like both classifications risk stigmatization: the stigma of sexual dysfunction versus the stigma of psychosomatic symptoms. Scylla and Charybdis.
Rewinding a bit to your last answer… are you saying the spasm mechanism was just a guess?! I am the last person who should be surprised, but that’s still a bit shocking. I take it there is no widely accepted story about what drives this type of pain. Is that hypothesis still taken seriously by anyone who matters today, or should it be considered an unfortunate myth?
Kirsten — The phenomenon of a clamped shut vagina appeared in medical texts in 1547.11 By 1861 it was described as a spasm and the first wave of sexologists ran with it in the 50s. Vaginismus eventually made it into the DSM-III in 1980 — the version proudly touted as evidence-based — where it remained uninterrogated for 24 years.12
Today there are conflicting ideas about the spasm: whether it exists; whether it matters for diagnosis, treatment, and research; whether it’s something else entirely, like a cramping pelvic floor. Maybe it just feels like a clamped shut vagina, but it isn’t actually? That smacks of the all-too-common “it’s all in your head” narrative. I have strong opinions about the spasm informed by my own lived experience, the emerging research, and researchers who agree and disagree with the original proposal. This is exactly what I unpack in the book.
Kirsten’s wall of pain science sticky notes: “Each of my walls is (still) covered in sticky notes, one for each section of my book that addresses a key question, in this case, Is Vaginismus a Pain Disorder? I borrowed from qualitative research methods to uncover themes — which is how I am arranging the content of my book. I am masochistic this way.
Paul — I have written quite a lot about the mysteriousness of unwanted muscle contractions and the way the concept of “spasm” is hopelessly ambiguous and routinely conflated with non-literal, subjective interpretations. Even as an objective medical phenomenon, unwanted/excessive contraction is surprisingly slippery: we know from some of the more extreme examples that it certainly does occur, but subtler spasms are nearly impossible to measure, and their clinical significance largely unknown. “Spasm” in this context may be the ultimate example! Despite being a sign, not a symptom — the muscle is either contracting excessively or it isn’t — it seems to defy objective validation in practice, even more than many other kinds of spasm.
In the absence of any good light being shone on the phenomenon of vaginal spasm, I assume there is a dark legacy of doctors accusing vaginismus patients of being “frigid”? And even though sexism has declined somewhat in recent decades, no doubt overt accusations have been replaced with plenty of weaselly insinuations, e.g. “I’m not saying you’re frigid… but your vagina is clamped shut.”
Just how badly has the history of vaginismus research and treatment been tainted by sexism, and what’s our status today?
Kirsten — It’s a great question. We’re still told we’re frigid far more often than you’d think! I was told sternly that I’d be a “spinster” as though I didn’t already know that. We’re still constantly instructed to get drunk or high, as though we haven’t already tried that. We’re also told to use more lube or to try this position or that position as though we haven’t already tried all that too! By the time we seek help, we’ve generally tried everything.
The online support forums for vaginismus, vulvodynia, vestibulodynia are filled with complaints about unsupportive and dismissive doctors who suggest we are immature, stubborn, or sometimes even outright lying about the pain or the “wall.” It seems to me not much has changed in the clinical encounter in 30 years despite the advocacy work of organizations like The International Society for the Study of Women’s Sexual Health (ISSWH), the National Vulvodynia Association (NVA), or the Vulval Pain Society (VPS).
In the DSM-5, women who have never had the ability to experience the penetration of sexual intercourse were grouped in with those who experience pain during sexual intercourse. Yet, penetration-related fears, not pain-related fears, seem to significantly differentiate the two groups.13 Research points toward catastrophic cognitions, disgust,14 and harm avoidance as culprits.15
Research has only just shown the vaginal canal is active with many reflexes that can be triggered by penetration. When researchers induced involuntary vaginal contractions, by slowly inflating medical vaginal balloons in a group of women, they noted these autonomic nervous system contractions far exceed the voluntary Kegal-like contractions you might learn in pelvic floor physiotherapy.16
No glass of wine is going to relax that!
Unfortunately, the new GPPPD category severely curtails researchers’ use of formal diagnostic criteria to identify vaginistic women for study. It seems vaginismus has fallen into a diagnostic/research void. So, let’s hope it is indeed a pain disorder. Otherwise, we can consider the scientific study of the condition to be terminated.
Paul — That’s some dark but tragically unsurprising stuff: ignorance exacerbated by sexism and, more specifically, a lot of squeamish denial/avoidance of “lady problems.” Chronic pain patients have a hard time being taken seriously without any sex negativity. This must be quite a bit harder still.
Is there any good news? For this community of patients, has anything happened in the last decade or two that is at least a step in the right direction?
Kirsten — Social media has been the biggest boon for us. Globally, women are now reaching out to each other en masse — once they find the name for the condition. Some of the private support groups are tightly monitored for respect, diversity, and inclusivity by incredibly intelligent and empathetic people. It’s quite gratifying for me to see. Many sufferers who’ve become experts in their own right now offer assistance and programs to help. Public forums can be a bit of a circus, but they still help to counteract the loneliness and isolation of the condition.
If you’ve got the money and time, in-person intensive treatment programs boast great success. And pelvic floor physiotherapy — the go-to treatment these days — is growing quickly.
In terms of future research, a handful of scientists are not giving up on the genito-pelvic reflex hypothesis17 and are determined to contribute to the mini-nascent-rebirth of research on “lifelong” vaginismus (another weird term) for which the spasm is a primary focus.
With respect to the sufferers themselves, when we commit to our own cure, we develop deep research skills, superior self-reflection capabilities, and sharpened interoceptive awareness.18
And the heterosexual men? They become better lovers, learning how to give and receive pleasure that’s not so centred on penis-in-vagina sex.
Paul — All good things! We’ve also seen huge social changes around sex, sexism, and gender. The Me Too movement has had a huge impact on our awareness. It’s impossible to watch a 20-year-old movie these days without cringing at the way men talk to and treat women. The entire idea of “sex negativity” barely existed back then, and concepts like “good, giving, and game” are part of the language now.19
This has all got to be good news for sexual and pelvic pain patients. Obviously the benefit is fairly non-specific, but anything that combats misogyny and sex negativity in healthcare has got to be a good thing. For instance, it’s surely a big part of why pelvic floor physio is growing.
Let’s finish with a reading recommendation or two. Other than your book, when it’s ready, what’s the next best thing someone can read about this topic?
Kirsten — I’ve never heard of GGG. I love it!
I created a little guidebook, How to Create A Structured Diary for Vaginismus Dilation At Home. It’s a research-backed method of self-observation to show you how to uncover unseen clues about your particular expression of vaginismus—whether or not you’re working with a pelvic floor physiotherapist. Everyone’s experience of vaginismus is unique. Regular dilation diaries are great to gain self-insight, but they’re usually only a record of thoughts and accomplishments. Here you learn how to keep a simple diary that’s organized more precisely to identify obstacles, target opportunities, gain deeper self-insight, and stay motivated. You can then tweak your home dilation experience for potentially greater—and—faster success! It’s a simple 3-week project for potentially huge gains in home dilation.
My number one recommendation for further information is the Tight Lipped podcast. Hannah and Noa, two young people who were also bothered by the silence around their vaginismus, decided to do something about it and have put together a creative solution that includes a podcast, workshops, and a gorgeous printed zine called Opening Up that will be sent to you for a donation of $20+ USD.
Debbie Does Dilators is a must-watch, especially for young men. It’s a multi-award-winning 13-minute film by Savannah Magruder about how Sara, a production assistant on porn sets, navigates a sexual encounter with a young man. It beautifully captures the absurdity and nuanced emotional pain and complexity that comes with this condition for young adults.
Living With Sex: The Secret to Solving a Big F*cking Problem by Dr. Julia Reeve is one of the best practical resources I’ve ever seen! Everything from the cover design that captures the frustration of our problem to the sketched infographics filled with statistical tidbits and definitions is gorgeous--and useful. Dr. Julia reveals her own method of achieving penetration, now packaged into a 30-day challenge. A potential cure is a tall promise, but everything including the website has been thoroughly thought through and designed for success. An entire chapter is devoted to dilation strategy! The cherry on top is the online forum where, I presume, you can find support, camaraderie, and accountability in your 30-day challenge alongside others who are in deep with you. Pun intended. 😉
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter., or subscribe:
Although I aspire to publish superb content on every pain-related topic, this is a one-man shop, with emphasis on "man." As just one man, I can never truly do this topic justice, so I have placed a strong emphasis on referring readers to other resources — many (if not most) published by women. (Many were cribbed from the excellent resources page at TightLippedPod.com.)
- The International Society for the Study of Women’s Sexual Health (ISSWH) — Provides accurate information about women’s sexuality and sexual health, and supports related research.
- National Vulvodynia Association (NVA) — Dedicated to improving the health and quality of life for women with chronic vulvar pain.
- Vulval Pain Society (VPS)
Film, Video, Audio, Theatre
- Lorna Meehan is a UK theatre maker and spoken word artist. Her show “No Entry!” about her experience of working through vaginismus is a force. You can watch a monologue from it where she explores the big deal with virginity and why the myths we take as truth can seriously hinder our wellbeing. Just as thought-provoking is her poem “Tight.” To dive deeper into what inspired the show and how its themes of sexual wellbeing and actively challenging social conditioning have informed her creative practice, have a listen to a podcast about why she made the show.
- Tight Lipped Podcast — “We ask big questions about female chronic pain. We explore how gender, race, sexual orientation and class impact women and non-binary folks’ experiences of healthcare and of their own bodies. Our show focuses on conditions that are extremely common (like vestibulodynia, vaginismus and endometriosis), yet carry with them a social stigma and often impact mental health, identity and intimate relationships.” See also Opening Up — A printed zine telling “Stories of Chronic Vulvovaginal and Pelvic Pain.”
- Painful Sex: Endometriosis & Doctors Who Don’t Believe Women — Short video (5 minute) from The Atlantic. When the filmmaker Sindha Agha first went to the doctor about her pain, she experienced a phenomenon familiar to many women—she was not taken seriously. Then, it happened again. And again.
- What It’s Like to Not Be Able to Have Sex — A short animated film (10 minutes) about a woman’s experience with vaginismus and chronic pelvic pain — how health professionals have failed her, guys rejected her, and anger and shame plagued her body.
- Debbie Does Dilators — Short film (13 minutes) about a porn production assistant trying to overcome vaginismus. Humourous!
- You’re Not the Only One Having Painful Sex by Stefanie Groner [Glamour]
- It destroys lives: Why the razor-blade pain of vaginismus is so misunderstood, by Kate Lloyd [The Guardian].
- The Doctor Doesn’t Listen to Her. But the Media is Starting to by Ashley Fetters [The Atlantic]
- The Female Price of Male Pleasure by Lili Loofbourow [The Week]
- "Sex Education" Disrupts Pop Culture’s Silence around Painful Sex by Noa Fleischacker (Bitch Media)
- Sex Hurts. Help! by Jen Gunter [New York Times]
- What to Do When a Doctor’s Visit Is the Cause of Pain? by Jen Gunter [New York Times]
- It’s All in Your Head: The Dangers of Disbelieving Female Pain a series by Caroline Reilly [Bitch Media]
- How ‘Bad Medicine’ Dismisses and Misdiagnoses Women’s Symptoms by Maya Dusenbery [NPR]
- How the Medical Community Undermines Female Pain by Abby Norman [WNYC]
- Pain During Intercourse: There is Help by Bat Sheva Marcus (Better Sex Blog)
- How to Create A Structured Diary for Vaginismus Dilation At Home, by Kirsten Loop. Digital download or a (lovely) printed book. With a video trailer! Regular dilation diaries are great, but they’re usually only a record of thoughts and accomplishments. This guidebook shows you how to keep a simple, research-backed “structured” diary to uncover unseen clues about your dilation experience—whether or not you’re working with a pelvic floor physiotherapist, You can then tweak your home dilation experience for potentially greater—and—faster success!
- Living With Sex: The Secret to Solving a Big F*cking Problem (book), by Julia Reeve. Amazon.com ❐ A book Kirsten Loop says is “one of the best practical resources I’ve ever seen!”
- Better Sex Through Mindfulness: How Women Can Cultivate Desire (book), by Lori A Brotto. While not a book directly about vaginismus, it’s extremely relevant (and well-written — lots of praise from all the right people for this book).
- Female Sexual Pain Disorders: Evaluation and Management (book), by Andrew Goldstein, Caroline F. Pukall, and Irwin Goldstein (book review). The definitive text on female sexual pain disorders for healthcare professionals.
Many if not most of these are mentioned above, but I thought it would be handy to emphasize people who use the Twitter platform well:
- @Unravelled_Self — Kirsten Loop, featured heavily in this here article.
- @ShWomenstore — Sh! Womenstore, the sex toy shop that started
- @SandyHiltonPT — Sandy Hilton is a physical therapist who focusses on pelvic pain and tweets very actively about social justice in healthcare.
- @DrJenGunter — The most obvious doctor to follow if you’re interested in women’s health.
- @LornaEMeehan — Lorna Meehan is a UK theatre artist who did a show about vaginismus, “No Entry!”
- @TightLippedOrg — A podcast and organizing project by/for with sexual/pelvic pain.
- @Things1Learned — Kate LaRocque, publisher of FemaleSexualProblems.ca.
Relevant content here on PainScience.com
- Mind Over Pain — Pain can be profoundly warped by the brain, but does that mean we can think the pain away?
- Chronic Pain and Inequality — The role of racism, sexism, queerphobia, ageism, and poverty in health and chronic pain
- Sensitization in Chronic Pain — Pain itself can change how pain works, resulting in more pain with less provocation
What’s new in this article?
2021 — Several minor improvements for Vaginismus Awareness Day. I added a list of good Twitter accounts to follow, some statistics, a good quote, and some clarifications about the relationship of vaginismus to other kinds of pain (with more links). Lorna Meehan’s work is now included in the resources.
2021 — Publication.
- Women are not the only people with vaginas, and therefore not only women experience vaginismus. However, for the sake of simplicity I will be referring to. All vagina-havers are welcome here.
- Cramps and twitches are the tip of the iceberg — there are many major types of unwanted muscle contractions. There are also many myths about them: dehydration doesn’t cause cramps, “stiffness” isn’t caused by “tight” muscles, and “back spasm” is just a way of saying how back pain feels, not how it works. While many common aches and pains feel crampy, no one knows if there is any such thing as a contraction that can cause pain without being otherwise seen or felt — but it is possible. See Cramps, Spasms, Tremors & Twitches: The biology and treatment of unwanted muscle contractions.
- American Psychiatric Association. Diagnostic & Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
- Binik YM. The DSM diagnostic criteria for vaginismus. Arch Sex Behav. 2010 Apr;39(2):278–91. PubMed 19851855 ❐
- More widely known by its old name, “somatoform” disorders. (It is now the Somatic Symptom and Related Disorders. And yes, all these name changes, jargon, and abbreviations are bewildering.) Somatoform disorders are mental illnesses that cause bodily symptoms, including pain (especially pain). There are several sub-types of somatoform disorder, such as the conversion disorders, in which emotional stress is “converted” into physical disabilities like blindness or trouble swallowing. They are a big deal and an extreme example — maybe the most extreme example — of how pain is weird.
- Problematic penetration doesn’t always involve pain though, so this classification could complicate things for vaginismus diagnosis, treatment, and research.
- Smith KB, Sadownik LA, Dargie E, Albert AYK, Brotto LA. Multidisciplinary Treatment for Provoked Vestibulodynia: Treatment Trajectories, Predictors, and Moderators of Sexual Distress and Pain. Clin J Pain. 2019 04;35(4):335–344. PubMed 30614827 ❐
- Binik YM. Should dyspareunia be retained as a sexual dysfunction in DSM-V? A painful classification decision. Arch Sex Behav. 2005 Feb;34(1):11–21. PubMed 15772767 ❐
- Reissing ED, Borg C, Spoelstra SK, et al. "Throwing the baby out with the bathwater": the demise of vaginismus in favor of genito-pelvic pain/penetration disorder. Arch Sex Behav. 2014 Oct;43(7):1209–13. PubMed 25024064 ❐
- Sims, MJ. On vaginismus. Transactions of the Obstetrics Society of London. 1861; 3, 356–367.
- Binik 2010, op. cit.
- Reissing ED, Binik YM, Khalifé S, Cohen D, Amsel R. Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus. Arch Sex Behav. 2004 Feb;33(1):5–17. PubMed 14739686 ❐
- ter Kuile MM, Reissing ED. “Lifelong Vaginismus.” In Principles and practice of sex therapy. 5th ed., pp. 177–192. New York: Guilford Press; 2014.
- Borg C, de Jong PJ, Schultz WW. Vaginismus and dyspareunia: automatic vs. deliberate disgust responsivity. J Sex Med. 2010 Jun;7(6):2149–2157. PubMed 20367766 ❐
- Borg C, Peters ML, Schultz WW, de Jong PJ. Vaginismus: heightened harm avoidance and pain catastrophizing cognitions. J Sex Med. 2012 Feb;9(2):558–67. PubMed 22024378 ❐
- Broens PMA, Spoelstra SK, Weijmar Schultz WCM. Dynamic clinical measurements of voluntary vaginal contractions and autonomic vaginal reflexes. J Sex Med. 2014 Dec;11(12):2966–75. PubMed 25319815 ❐
- Symen K. Spoelstra, Willibrord C. M. Weijmar Schultz, Elke D. Reissing, Charmaine Borg, Paul M.A. Broens. The distinct impact of voluntary and autonomic pelvic floor muscles on genito-pelvic pain/penetration disorder. Sexual and Relationship Therapy. 2019;34(4):462–472. PainSci Bibliography 51767 ❐
- Aeon.co [Internet]. Arikha N. The interoceptive turn is maturing as a rich science of selfhood; 2021 March 1 [cited 21 Mar 1]. PainSci Bibliography 51764 ❐
“Good, giving, and game,” or just GGG, was coined by sex columnist Dan Savage, to describe the attributes of a good sexual partner, someone who is:
- “Good in bed,” as in skilled, because human sexual behaviour is very complicated.
- “Giving of pleasure without an immediate expectation of return.”
- “Game for anything… within reason.”
Dan defines GGG in his own way in this 4-minute video.