Painful sex and vaginismus

I want to say this plainly, because it is the thing that stops people booking: this is an ordinary medical complaint, I hear it often, and there is nothing about it that will embarrass either of us. If saying it out loud is hard, write it down and hand me the paper. Patients do that and it works perfectly well.

Dyspareunia

Pain during or after sex has causes that are findable — infection, hormonal change and vaginal dryness, endometriosis, scarring after childbirth or surgery, or pelvic floor muscle overactivity. Where the pain is deep rather than at the entrance, that points somewhere different again. The assessment is a history and an examination, done gently and stopped whenever you want it stopped.

Vaginismus

Involuntary tightening of the vaginal muscles that makes penetration difficult or impossible. It is not something you are doing on purpose and it is not a failure of will — the body has learned to brace and keeps bracing. Causes include anxiety, previous painful or negative experiences, infection and chronic pain.

Treatment

There is more than one effective route, and which one fits depends on what is driving it: cognitive behavioural therapy where anxiety is significant, gradual manual dilation, botulinum toxin injection to relax the muscle, and surgery in a small minority of cases. Most women improve.