Patient: I have always had problems with my vagina seeming too tight. My hymen broke and was accompanyed by the usual bleeding on multiple occassions: while masturbating, during sex play before I lost my virginity and when I lost my virginity after many failed attempts. After each time it tore, things became a bit more comfortable and the pain and discomfort lessened. The first few times I tried to have sex, it failed and penetration didn’t occur. Eventually it became possible bit by bit. Now, after nearly two years of regular sex, I am able to have normal penetrative sex but still find it painful, especially in certain positions and have to go really slowly and build it up slowly until it gets easier but it is still never completly painless. I have read up a lot on the internet about what can cause painful sex but none of the problems seem to me to be what is causing my pain. I am very aroused and well lubricated before sex both naturally and with personal lubricants, am very relaxed, have a healthy relationship with my partner and am usually hopeful that there will be minimal pain rather than fearful or tense. The pain is in the entrance to the vagina at the bottom and feels like the skin is stretching and is incredibly painful when the penis rubs against this area. I know the pain is not limited to sex alone as I experience the same pain when penetrated digitally. I also have the same problem when using tampons but am able to pull the skin downwards at the bottom so that the tampon does not rub against this area but due to the larger size of a penis, this is not possible during sex. This problem is becoming very frustrating for me and I really want to enjoy normal pain free sex with my partner. I would really like to know what could be causing my pain as I can’t seem to find any information on the internet. Could the problem be related the the problems I had with my hymen as it seems that it tore bit by bit but has never fully broken?
Doctor: I understand your concern about painful intercourse. Most of the women at some point in their lives experience some type of pain related to intercourse. Since you already have ruled out lubrication problems and according to the location of the pain at the bottom of your vagina and especially the description of it as if the skin stretches and becomes tense, a possibility of Vaginismus could be present.Vaginismus is an involuntary spasm of the muscles surrounding the vagina that causes pain and difficult penetration during intercourse. A pelvic exam can confirm the diagnosis of vaginismus. A medical history and complete physical exam is important to rule out other causes of pain with sexual intercourse such as infections or reactions from the skin. Once every other possibility is ruled out and Vaginismus confirmed, exercises like contracting and relaxing your pelvis as well as vaginal dilators might help getting rid of the pain. I wish you the best.