Dr. Aditya Oswal, Dr. Chaitanya Kalra and Dr. Harshita Pathak
Painful Sex: It’s Not “All in Your Head”
Introduction: The Myth That Hurts More Than the Pain
“Just relax.”
“It will get better after marriage.”
“You’re thinking too much.”
In Indian society, pain with penetration is often dismissed as anxiety, inexperience, or fear something a woman is expected to push through. This misconception keeps many women silent for years, feeling broken, ashamed, or at fault.
Here’s the clinical truth: Vaginismus (Painful Sex) is a real medical condition caused by involuntary pelvic floor muscle spasms.
It has nothing to do with willpower, desire, or mindset and it is treatable.
What this article holds for you
What vaginismus actually is (and what it is not)
Why pain happens even when you want intimacy
How pelvic floor therapy and dilators work clinically
How vaginismus manifests
Women with vaginismus often experience:
Pain, burning, or sharp discomfort with attempted penetration
Feeling like penetration “hits a wall”
Involuntary tightening despite trying to relax
Difficulty with tampons or gynecological exams
Fear because of repeated pain not fear of sex itself
Emotional distress, avoidance, or relationship strain
Important reminder: Desire can be present. Trust can be present. Pain can still happen.
The physiological explanation
What Is Vaginismus?
Vaginismus involves reflexive contraction of the pelvic floor muscles, especially the muscles surrounding the vaginal opening, when penetration is attempted.
Key points:
The contraction is involuntary
It is mediated by the nervous system
It’s similar to an eye blinking when something comes close
This reflex can develop due to:
Past painful or traumatic experiences
Anticipation of pain
Pelvic floor muscle overactivity (hypertonicity)
Heightened stress response
Clinical studies classify vaginismus as a neuromuscular pain disorder, not a psychological weakness .
Why “Just Relax” Never Works
You cannot consciously override a reflex.
Telling someone with vaginismus to relax is like telling your hand not to pull away from a hot surface.
Treatment works by retraining the muscles and nervous system, not by forcing penetration.
The Fix: Evidence-Based Treatment That Works
1. Pelvic Floor Physical Therapy (Gold Standard)
Pelvic floor physiotherapists help by:
Assessing muscle tone and coordination
Teaching relaxation (down-training) techniques
Improving muscle awareness and control
Gradually reducing pain responses
This therapy is slow, respectful, and always consent-based.
Evidence shows pelvic floor therapy significantly improves pain and penetration tolerance in vaginismus .
2. Vaginal Dilators: Medical Tools, Not Sex Toys
Dilators are used to desensitize and retrain, not stretch forcefully.
How they help:
Gradual exposure without pain
Rebuilds trust between brain and body
Improves confidence and control
How they’re used:
Start with the smallest size
Progress slowly, at your pace
Often guided by a therapist
They address both the muscle spasm and the fear loop.
3. Supporting the Nervous System
Helpful practices:
Diaphragmatic breathing
Gentle pelvic relaxation stretches
Avoiding rushed or high-stress attempts
Cycle syncing insight:
Follicular phase (post-period): muscles are more relaxed ideal for therapy progress
Luteal/PMS phase: go slower; sensitivity is higher
Indian Context: Why Diagnosis Is Delayed
Sexual pain is taboo
Virginity myths and marital pressure
Limited access to pelvic floor therapists
Women blamed instead of evaluated
This isn't a rarity.
It’s underdiagnosed.
A final note to keep in mind
Painful penetration is not normal and not your fault
Vaginismus is caused by involuntary muscle spasms
Desire and pain can coexist
Pelvic floor therapy and dilators are effective
Healing is gradual and that’s normal
Dr. Rove’s Note
Never force penetration through pain.
If sex keeps hurting, a clinician can help identify what’s going on whether it’s vaginismus, an infection, hormonal dryness, or another treatable cause. Getting the right diagnosis early makes treatment gentler and prevents long-term discomfort and distress.
