Sometimes I inspect my vulva in my phone camera and wonder if I’m doomed to a life of painful sex. I can’t pinpoint the moment my body sealed up to penetration, tensing up at the sight of tampon applicators and specula, at the touch of a doctor’s fingers and my own. But I have theories about what set off the pain: As a child, the only language I had for vagina came from an Indian rhyme that teaches kids to be ashamed about exposing their privates. As an adolescent, I was sexually abused for years by a family friend who assumed he could count on my silence. By the time I was 17, the fear had already sunk in. One day, a teacher at my Catholic girls’ school instructed our ethics class to draw picture associations from verbal prompts that she later explained would reveal our subconscious beliefs about God and sex. One girl shared her drawing, a mountain with a hand reaching out of its peak. In my illustration, an amoeba in a petri dish shied away from a needle.
When I started college, I assumed the sex I had was painful because I simply wasn’t that attracted to the men I was intimate with. But when I couldn’t have sex in my first serious relationship, I turned to an OB/GYN. She couldn’t help me or even examine me — I couldn’t put my legs into the stirrups without my knees snapping shut. She referred me to a specialty doctor who diagnosed me with vaginismus, a disorder in which the muscles surrounding the vagina involuntarily spasm in response to penetration or its anticipation, making sex painful or even impossible.
At first, having language for my condition was invigorating: If I could name it, then surely I could fix it. It relieved me to know nothing was physically wrong with my vagina. Once a week, we worked to retrain my muscles with silicone dilators that ranged from the size of a pinkie finger to a cucumber. More than I wanted to experience the pleasure of penetrative sex, I was desperate to please my then-partner and worried I was in some way deficient to him. I tried fast-tracking my healing by dilating frequently, in the morning and at night, while watching YouTube videos of fitfluencers making zucchini brownies. Intimacy with him was often unpleasant and painful, but in time I could relax enough to enjoy it. After we broke up, I went on to have more pleasurable sex with other partners, easy and painless encounters that made it hard to remember the days my body had rejected a Q-tip. But two years ago, one violent encounter brought it all back.
The American College of Obstetricians and Gynecologists estimates that almost three out of four women experience dyspareunia, or painful intercourse, over their lifetime, but it’s difficult to pin down exact figures since the experience is so frequently underreported. Vaginismus rates are even harder to measure, with some medical literature estimating the disorder affects anywhere from one to 6 percent of people with vaginas; the ratio rises to 5 to 17 percent within clinics treating sexual dysfunction. The condition can have clear causes, like a history of sexual abuse, postpartum pain, lingering hymenal remnants, or growing up with religious or sociocultural stigmas about sexuality. But sometimes, the cause-and-effect relationship is less clear and the fear just is. Whatever little we do know about the condition, the interconnectedness of those mind-body fears is what makes it so hard to treat. How do you fix a fear? Can you?
Dr. Maria Sophocles, an OB/GYN and the director of the women’s health-care clinic in Princeton where I first received my diagnosis, has patients who have no trauma history but for whom the thought of inserting a tampon is a “frightening and impossible no-go.” Popular treatments include pelvic-floor therapy, cognitive behavioral therapy, and even intravaginal Botox, but there’s little data on how effective these are.
A few months after my vaginismus came back in 2021, I tried dilating on my own, but my legs clamped shut before I even started inserting the trainers I had once used with ease. Though I knew I needed professional help, I worried about finding a doctor who knew both what vaginismus was and how to treat it. I had wasted time and money in the past on providers who didn’t — from the pelvic-floor therapist who told me never to sit cross-legged and made me spend 45-minute sessions squatting on her examining table to the well-meaning psychotherapist who, at the onset of my recurrence, suggested I simply drink a glass of wine and assured me I would be fine once I found a partner I trusted. Dr. Elizabeth Kavaler, a urogynecologist and the medical director of a clinic in Manhattan, says vaginismus can become “psychically depressing” for patients. “When you go to doctors and no one seems to know what it is,” she says, “it gets even worse.”
Last spring, I began telehealth appointments with Origin, an L.A.-based, pelvic-health-focused physical-therapy start-up that bills itself as a “safe space” where people with vaginas can “feel good in their bodies.” I quickly trauma-dumped my obligatory sexual history, then the virtual PT held up a plastic pelvis and dove into the anatomy of the clitoris before eventually settling on a plan to reuse my dilators and exercises for visualization, relaxation, and diaphragmatic breathwork. Between sessions, I rolled a tennis ball under my foot and practiced my breathing but slowly tapered off the treatments, exhausted by the near-daily homework and seeming futility of it all. I had a nagging, low-grade anxiety that made it difficult for me to truly relax. I had already spent so much time fixing my body. Why go through the effort again when my mind wouldn’t follow suit?
“A broken ankle can be fixed,” says Dr. Ditza Katz, a clinician who runs her own practice in Long Island. “But vaginismus can be in a loop if it’s not fully addressed from the core.” Along with her colleague Dr. Ross Tabisel, Dr. Katz started the Women’s Therapy Center back in 1996 to address a lack of holistic vaginismus care. Prevailing treatments are often fragmented, tending to a patient’s mental state or body; it’s rare to find a practice that does both. “We do not look at vaginismus as a sexual disorder or a trauma-based disorder. It’s a psychosomatic disorder, a condition that is always a symptom of underlying anxiety,” she says. In other words, you have to treat both the body and the mind.
“Even if you resolve the pelvic pain but you’ve not resolved the emotional issue, the pain will show up somewhere else,” says Heather Mayone, a psychotherapist at Tribeca Therapy. “I always say we don’t want Band-Aid therapy. We don’t want to just fix the symptom. We want to really understand what caused the symptom to begin with.” Sometimes that means digging deep into a patient’s history to look for negative messaging and cultural coding. “Maybe you had a bad experience inserting tampons when you were little that stayed with you,” says Desiree Nazarian, a New York City–based therapist specializing in intimacy, sex, and trauma. “I’m first generation Iranian American, and I had so many cultural scripts within my system, within my community, about what a woman’s body should be. All of these things, all of these messages, impact a woman’s experience.”
The thought of revisiting my own trauma history in therapy is more anxiety inducing than dilating is. I already have so many theories about my pain; it’s frightening to think I could unearth more. After years of raging over my past, I’ve become quietly resigned to the fact that whatever’s happened has happened. That silence has been comforting. It has helped me trundle forward, and I don’t know if I want to let it go.
I do know I want to live without pain. I want to live without rolling tennis balls under my feet, without lubricating silicone trainers, without worrying I will disappoint a partner the moment my legs shut. There has been some improvement: I breathe better from my diaphragm, and I’ve willed my muscles to contract and relax around the silicone of a small dilator, then the next one, then the next. I still can’t insert one in the position of most recent assault, and the disappointment of feeling my own body clench and contract against my will is so disheartening that the pleasure of sex sometimes feels permanently lost to me. But I know that pleasure and healing are in my muscle memory. Maybe they, as my fear did, will also return.
