Vaginismus: First Time Intercourse

For women who have suffered with vaginismus, the idea of first time intercourse can be an extremely scary thought! Dr. Peter Pacik, MD, FACS, who pioneered the Botox procedure for vaginismus with progressive vaginal dilation, and has trained our staff, shares his insights.

Dr. Pacik writes:

Perhaps one of the most difficult challenges that vaginismus women face is advancing to intercourse during treatment. A variety of treatments are possible. Most involve dilation as part of the treatment program. I have treated many women who did well with dilation, even those with the most severe form of vaginismus, yet transitioning to intercourse was difficult. This is normal during treatment because of the high level of fear and anxiety related to intercourse. When any of us are in a “dangerous” situation it is a normal protective mechanism to have fear and anxiety. This is what appears to hold us back. My patients have often told me that they feel they are progressing well physically with dilation, yet they still have psychological fear holding them back from progressing to intercourse. This is borne out with my statistics in that women make more rapid progress with dilators than advancing to intercourse.

How do we overcome fear and anxiety as it relates to advancing to intercourse? Certainly being comfortable with the larger dilators is a good beginning. Dilating for an hour with the #5 or #6 (#7 for larger partners) is a must and this applies to GYN exams as well. Addressing your anxiety with your partner and perhaps going out for supper and having a glass of wine. Candles, music, showering, bathing and relaxing together can be helpful for reducing anxiety. Knowing that your partner is on board in being gentle and not being aggressive, and backing off if asked to do so. First time minimal penetration, tip only, an agreement of no thrusting can allow a woman to get centered.  For those who experience “leg lock” (thighs close with attempted penetration) try the “spooning ” position or “doggy style”. Gentleness is key. If these trials fail, working with a talk therapist can be helpful.

Keep in mind that difficulty advancing to intercourse is normal during vaginismus treatment. This one thought will help reduce the pressure that is commonly felt in overcoming this condition.