Sex Should Not Be Painful: The Stigma of Vaginismus
Our Summer of Sex is made possible by the sponsorship of Planned Parenthood. With their help, we are able to bring you this thoughtful series delving into the subject of sex and amplify the voices of marginalized people and communities.
Cisgender girls are taught that vaginal sex is supposed to hurt the first time (or first few times) you have penetrative sex. This message proliferates within families and across the media we consume. While we know this is not true—intercourse should absolutely not hurt—talking about unwanted pain during intercourse is still taboo. Dominant culture defines sex between cisgender men and women as an inequitable transaction—women endure discomfort and pain in service of men’s pleasure; pain is viewed as a twisted right of passage that women should expect and bear. However, the pain is supposed to go away after you’re no longer a “novice,” right? But what if it doesn’t go away?
Painful penetration (e.g., sex, using tampons, etc.) is called dyspareunia, and it is not something that “should” happen to anyone during vaginal or anal sex. While sometimes the issue is due to lack of lubrication and/or arousal, sometimes dyspareunia is a sign of something more serious. According to the American Sexual Health Association, there are two types of dyspareunia: primary, and secondary. Primary dyspareunia refers to pain during initial or attempted vaginal penetration (“entry pain”), whereas secondary refers to pain during deeper vaginal penetration (“deep pain”). While there is not always a direct cause of dyspareunia, the ASHA identifies several conditions that could cause primary or secondary dyspareunia, including vaginismus (pain caused by involuntary muscle contractions around the vaginal opening), endometriosis, and fibroids. Some people even experience pain during normal, daily activities like walking and exercising. Some people cannot experience penetration at all. People with primary dyspareunia likely notice a problem early—for many, inserting a tampon is very painful or even impossible. However, some go through life having little to no issues and enter a whirlwind of confusion, shame, and pain when they first begin to have penetrative sex. Although there are various treatment options, there is no guarantee of improvement.
Growing up, I received conflicting messages about pain and bleeding during sex. Even trusted authorities like health teachers drilled it into us that it’s going to hurt when you have sex for the first time, and you might even bleed, too. Just like pain, bleeding is also not a normal thing that should happen to you. Blood represents internal microtears of the skin and while they heal on their own, it can put you at increased risk of infections. I didn’t notice that something was seriously wrong and that I needed medical intervention until well into young adulthood, even though I had been experiencing less severe, intermittent pain since I began using tampons. Dangerous messages around the naturalness of pain during sex led me to ignore the issue for much longer than I should have. “Just use more lubricant,” is something I have repeatedly heard prescribed as a remedy for pain during penetrative sex, but this is not a viable option for dyspareunia; while it can help some, lubricant alone doesn’t address the underlying medical and psychological contributors of dyspareunia. It was only when I was finally seen by a pelvic floor physical therapist that I understood how lubricant was only a temporary alleviator. A part of me had accepted that I would just have to suffer through a certain amount of pain in order to enjoy what I thought was a healthy, adult sexual life. I was wrong, and I wish I would have sought help sooner. The reality is that shame keeps many of us from speaking about this to others.
There is an incredibly cisgender, heterosexual, able-bodied bend to the way we discuss intercourse, and a focus on cis male pleasure.
I encountered minimization and delay in treatment after finally reaching out to women’s health providers. It was almost one year before I was referred to a gynecological pain specialist and started a long, exhausting, and expensive treatment process. This included pelvic physical therapy multiple times a week, dilator treatment, a daily lidocaine cream regimen, and a (very) short trial of a low dose antidepressant to alleviate pain (in reality, all the medication did was make me irritable and cry uncontrollably for a weekend, which scared the hell out of my partner). Before this, though, I felt that my concerns went unheard because I was not in a life-or-death situation, although my quality of life and emotional well-being was certainly suffering. Even medical professionals in the OBGYN arena may not be knowledgeable about this issue or understand the impact it has on quality of life—they will often tell you to “just try kegels,” even though this can actually make the issue worse. It wasn’t until I met with the physical therapist that I learned that, with conditions like vaginismus, the problem is that your muscles are overactive, contracting strongly when they shouldn’t, and they need to be taught to relax as much as possible—they don’t need to be strengthened.
As I slowly began to talk about this with others, I quickly found that I wasn’t alone. Multiple women reached out to me, and to my surprise they were all women of color. Where were our voices in this severely under-addressed health issue? The resources that I found online centered white, cisgender, heterosexual women’s experiences. I realized then that an understanding of the complexities of being both hypersexualized and desexualized as BIPOC was sorely missing from the discourse, of which there was already very little. There is an incredibly cisgender, heterosexual, able-bodied bend to the way we discuss intercourse, and a focus on cis male pleasure. “Real sex” is vaginal penetration (by a penis) and everything else is “just” foreplay. This isn’t true, of course, but this message is so pervasive in society that it alienates people with dyspareunia, as well as those who are disabled or LGBTQ. When society frames sex as something primarily in service of heterosexual penile pleasure, sexual acts that don’t serve this purpose are labeled deviant or less than, and vaginal pain during penetrative sex becomes normalized. Clitoral orgasms are seen as non-essential to sexual intercourse, and intercourse is considered over after penile ejaculation. This rigid view of sexuality at best limits our sexual exploration, and at worst furthers stigma that marginalized people already face.
My experience with dyspareunia has forced me to examine harmful messages I’ve internalized about sex and individual worth. Surely, the emotional pain is equally as stressful and unavoidable as the physical pain. This is an important issue that many people are living with under a shroud of shame and secrecy. The first step to addressing this stigma is to become better educated about our bodies and to reevaluate our conceptualization of what it means to have a healthy, enjoyable sex life.
AT is a writer across multiple genres, including poetry, fiction, personal essay, academic research, and social criticism. Her work primarily focuses on issues affecting Black women and other women of color, such as gendered racism and sexual violence.
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