[Darcy@CSCSNH]

This is a great question and a concern that is not just confined to couples who have been dealing w/ vaginismus. Many couples, who for a variety of reasons have let intimacy take a hiatus in their relationships, often struggle with some level of communication breakdown which leads to hurt feelings and sensitivities around initiation of sex or intimacy. Fear of rejection and feelings of inadequacy are paramount to many who have experienced traumatic episodes with intimacy.

Women who have had pain and trauma with sex, certainly have understandable reasons to hesitate when seeking intimacy. However, for the partners of those women, their own emotional experiences contribute to their receptivity to sex, and certainly towards their initiating it. Many men in my sexuality counseling practice tell me they avoid asking for sex because it brings up so many bad feelings. Fear of rejection being the number one reason. One man explained it “when we tried sex and it was painful for her, I felt bad, like it was my fault.” He expressed feelings of self-doubt around his sexual prowess, and regret, feeling she couldn’t possibly love him after he caused her so much torture. Another clients boyfriend explained that he felt that he just couldn’t go through the stress of being turned down again. He expressed anger, frustration and resentment. And yet another husband didn’t want to make his wife “feel pressured into it.”

The common theme between all these men is the difficulty in bridging the experiences their wives and girlfriends had in the past and finding a new road to intimacy now. You may notice I keep using the term “intimacy” instead of sex. There is a reason for that. People have as many definitions for sex as there are personalities. Some define it as just penis-in-vagina; others include oral sex (mouth on genitals); and still more definitions broaden to include all things sexual: foreplay, kissing, touching, fondling, toys, etc. This is important because when women are asking for their partner to “initiate sex” you both really have to have a working definition of what you are expecting.

Once you clarify what you are expecting, then there has to be the discussion about your desire to have him start asking again. The caveat here is that you also have to talk about ways you can still say no. Just because you are physically ready to begin having penis-in-vagina sex again post procedure, doesn’t mean you will always be in the mood if he asks. Another client of mine explained that “we have sex every time she asks, but when I ask, she only says yes if she feels like it, so I have to guess what days she is likely to be ready” Again, these are difficult conversations to have but being able to have meaningful discussions with your partner are important. I liked the “marble” idea that Nicole mentioned, and I’ve had couples use this type of trigger to ask for sex “without asking.” One couple used a candy cane on the pillow to indicate she would be willing to give oral sex to him at this choosing during the week. He would just have to put it on her pillow when he was ready.

Again, there is not going to be a magic way to get past this juncture of your relationship, but beginning the discussions and taking an honest look at the barriers will be a great start.

[Darcy@CSCSNH]

This is a very common question that I hear from many of my patients. Once the painful penetration has been overcome there is a joy and elation that intercourse has finally become successful. However, the newness of this experience wears off once sex with your partner is “just another moving dilator.” What I mean by that is that sex is much, much more than just penis-in-the-vagina. Intimacy, close contact, sharing of very close and personal parts of ourselves are not something that can be overcome easily. Pleasure and satisfaction drive human behavior to seek out this activity again to find more pleasure and satisfaction. If physical pleasure is missing, it makes the experience less exciting, and less likely to be a behavior we look forward to or to actively seek out. Your description of your preparation for sex is very clinical. With almost 2 hours to “prepare your vagina” you are focusing on only one aspect of what it takes the female body to be ready for sex. I am a huge fan of bottled lubricant. There is nothing better for a woman than good, wet, slippery surfaces. However, there is a lot more to being sexually ready than being wet and having a vaginal opening that is dilated and non-spasming. Foreplay is an essential part of being ready emotionally as well as physically for sex. Your dilator may be able to help you relax the vaginal opening, but stimulation to your skin (arms, lips, legs, breasts, thighs, clitoris, behind-the-ear, etc.) help to build anticipation and arousal. It is during the arousal phase of the sexual response cycle that the vagina elongates and the pelvic organs pull up into the belly, making more room for deeper penetration (which could explain why your boyfriends thrusting is painful). It is also during this phase that blood flows to the vulva, making the area swell and become protective to the bony areas of your pelvis. The walls of the vagina also stretch and relax, also making penetration easier. By the way, the ‘numb’ feelings deeper in the vagina past the opening is normal. There are not a lot of nerve endings deeper in the vagina, its Mother Natures way of making childbirth a bit more tolerable. In addition to the physical changes in our bodies during arousal, our brains begin to release a tremendous amount of hormones and neurochemicals that create feelings of wellbeing. Orgasm is just icing on the cake after that, but can also add to the experience.

Female on top position is a great way to gain back a sense of power. You have control of the depth of penetration, speed of thrust, and the ability to pull out immediately without feeling like you are being trapped underneath your partner. However, unless you are laying out flat against his chest, it is very difficult to have any direct stimulation from his penis. However, if you sit up in this position, it is easy to have self stimulation with your hand, his hand, or a vibrator during sexual penetration. Only 30% of women (with no history of sexual disfunction) are able to have an orgasm without some type of clitoral stimulation. That means 70% of us need some kind of direct stimulation to the clitoris to have enjoyment during sex. Why is all this detail important? Well, intimacy often requires the ability to “lose ourselves” in our partners. Not to just “carry out intercourse to pleasure my boyfriend.”

Many of the people that I counsel have to go back to the beginning in many ways. Learning how to explore each others bodies, and to play, become a vital part of learning how to become sexual. Practicing sexual touch during your daily or weekly dilating exercises, can help to break the cycle. Use a much smaller dilator while stimulating (or having your boyfriend stimulate) your clitoris. This will help you adjust to the feeling of the dilator in your vagina, without feeling overwhelmingly full. Learning how your body reacts with touch for pleasure, not just to dilate, is a very important exercise. Now that you have been able to overcome the barrier of the physical vaginismus block, working with yourself and your partner to overcome the emotional barrier of pleasure is the next step.

[Darcy@CSCSNH]

In addition to 70% of women needing clitoral stimulation to have orgasm, its important to remember that there are a lot of physical and emotional connections that need to take place in order to achieve an orgasm. Women who have been dealing with vaginismus often have very negative past experiences and strong memories of pain. Even with successful treatment helping you to have painless penetration, the brain chemistry that holds these “muscle memories” can still make it difficult to “let go” and cum. Heather did quote a very insightful article above, which had some good recommendations for treatment. But more than anything, for the women that I see in my sex counseling practice, it helps to build positive sex memories and to focus on communication with your partner. Using fantasy and connecting sound, touch, taste, smells, and images to the sexual experience can also aid that “letting go”. The images, smells, etc don’t even have to be sexual. If fresh baked cookies make you smile and feel warm and gooey inside, or an image of green grass swaying in a field relaxes you, focusing on those things during foreplay or while masturbating will help to create new “memories” that will start to elicit those same warm gooey feelings with sexual touch. Before you know it, sex and sexual touch start to bring on those same emotions. Knowing your own body and how it reacts to various touch and stimulation are also very critical to helping to share that experience with someone else.

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