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  • Q&A with Australian Health Practitioners

    Difficulty having sex for the first time, should I see a gynecologist?

    I'm 22 and still a virgin. Have tried everything and I mean everything to have sex but I can't. I'm just so tight I cant even use a tampon.

    I also get really bad period cramps so bad some days that I can't get out of bed.

    Should I see a gynecologist or would it be silly?
  • Find a professional to answer your question

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    Women's Health Queensland Wide provides free health information for Queensland women. View Profile

    Many young women whilst looking forward to sex have some reservations and anxiety re the ‘technical’ component and despite sex being regarded as a natural part of a loving relationship that is not their experience. If sex is associated with pain then this initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. As with any pain in your body, you might start avoiding the activities that you associate with the pain.
    The ‘tightness’ you describe may be due to a condition called Vaginismus.
    Vaginismus is an involuntary contraction, or reflex muscle tightening, of the pelvic floor muscles that generally occur when an attempt is made to insert an object (tampon, penis, speculum used for a Pap test) into the vagina. This muscle tightening causes pain, which can range from mild discomfort to severe burning and aching. Women with vaginismus often think that they’re “too small” and that their vagina needs to be stretched or that their partner is too large. This is not the case at all but rather they need to control the muscles around the vagina. This can be achieved with specific exercises.
    Vaginismus is a learned reflex. A useful way to look at it is to compare it to getting a finger in our eye. We’ve all been poked in the eye at some time in our life and if we see a finger or other object approaching our eyes, we shut them automatically. In the same way, a woman with vaginismus has had an experience of painful intercourse (or other object in the vagina). Later on when she or someone else tries to insert an object in the vagina, the vagina “shuts” to protect itself from pain without the woman even being conscious of it. The muscle spasm is what causes the pain and that is definitely real.
    Vaginismus is a much more common problem than you may realize. Women with vaginismus tend to be very embarrassed about it and not mention it to anyone The good news is that there is a cure for vaginismus; it simply involves learning how to control and relax the muscles that are tightening involuntarily.
    It would be helpful if you could see a female GP with an interest/experience in Womens Health. She can guide you with treatment options/ exercises etc. and if necessary refer you to a specialist. Many women find consulting a Sex Therapist very helpful. In time this may involve your partner. Because treatment can take some time, partner understanding and participation in the process can decrease frustration and anxiety. Understanding your reproductive anatomy and physiology is very helpful, and I recommend The V book
    The V Book: Vital Facts About the Vulva, Vestibule, Vagina and More


    This book offers frank and useful information and advice on all aspects of vaginal health.
    Brenda
    Women’s Health Educator
    Health Information Line, Women’s Health Queensland Wide

    Women living in Queensland can also call our Health Information Line - a free information and referral service for Queensland women - on 3839 9988 or 1800 017 676 (toll free outside Brisbane).

    Please note that all health information provided by Women’s Health Queensland Wide is subject to this disclaimer

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    I am a Melbourne Relationship Counsellor and Family Lawyer who is skilful in helping people get out of the pain of relationship distress and create … View Profile

    I agree with the above answer and would simply add that regarding period pains that are so debilitating it may help you to see a Chiropracotor and/or a Chinese Medicine /Acupuncturist. These health practioners help because they work on regulating the nervous sytem. Also, learning to relax and let go of stress in your life can really assist.

    Good luck!

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    Dr Margaret Redelman

    GP (General Practitioner)

    I come from a general practice background and have over 30 years experience in sexual health. I am an accredited Clinical Psychosexual Therapist with the … View Profile

    Hello,

    You have not provided much information with your question, such as age, sexual experperience, masturbation experience and practice, relationship status or sexual experience of your partner. All these and others are important.

    If you are in your first sexual relationship with a young inexperienced partner, I would recomend that you explore “outercourse” first. That is, learn to pleasure each other through all avenues other than intercourse, to learn each other's bodies and how to give each other pleasure in a much less pressured setting.

    During this phase gentle insertion of your own and then your partner's well lubricated index finger into the vagina will develop an understanding of how the vagina is built, how it feels and what feels comfortable. When you are comfortable with one finger then your partner can try 2 fingers. This is usually about the same width as a penis and the next step is then not so strange. In order to relax you must trust yourself and your partner. Bending the legs up can help ease of penetration. Always use lubricant to prevent friction and increase ease of penetration.

    If the situation persists you should definitely see someone as the sooner you are helped, usually the easier it is.  It is not uncommon to have difficulty with getting sex right at the beginning so try not to feel that you are the only one or odd.

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    Matty Silver

    Counsellor, Sex Therapist

    I am a Sexual Health Therapist. I work with people to identify and overcome a range of physical and mental sexual health problems and help … View Profile

    I agree with Brenda, as you are still a virgin and only 22 years old, you are suffering from vaginismus. I am a sex therapist specialising in vaginismus. Over the past year I have written two “blogs” about vaginismus in the Fairax on-line papers and was contacted by more than 60 women with this condition, most of them telling me “horror stories when they consulted their GP or even sometimes their gynaecologist.

    My clients were told ”there is nothing wrong with you“ - it's all in your head - keep trying, you will get used to it - use an anaesthetic cream - drink some alcohol to be more relaxed - or the worst of all ”your vagina is too small"! They were sometimes traumatised by having a papsmear performed by a GP who kept trying to insert..

    Most of the women come from a backgound where it's importnt to be a virgin before marriage and were often told sex will be painful and their will be blood.

    Vaginismus is easily treated by counselling,education, anxiety reduction and retraining of the pelvic floor muscles. Post counselling I refer my clients to a pevic floor physio therapist who specialises in vaginismus.

    If you live in Sydney I can refer you to one and if not I have contacts in most of the larger cities.

    An infomative website is www.vaginismus.com which explains the conditon in great detail, but as it is a self-help book, please igore the pelvic floor exercies for most women they are too difficult to do on your own.

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    Karen Brown

    HealthShare Member

    I would hope that those who have answered the above question were fully aware that not all pain in the pelvis is  vaginismus.  For those of us who have chronic pain,in that area  it is conmen for people to stereotype
     
    The attitude that most of the women come from a background where it's important to be a virgin before marriage and were often told sex will be painful and their will be blood is a misconception yet again, and then makes it for may of us to get treated
     
    For those of us who suffer, I can safely say I would find a Dr that you feel comfortable with  an then seek testing if  pain occurs out side of sex.  Far too often chronic pains suffers especially in the pelvic area  are type

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    Matty Silver

    Counsellor

    Sexual Health Therapist Relationship Counsellor View Profile

    Dear member,
    The question asked was made by a 22 year old virgin, who tried to have intercourse and was not able to. She does not complain about pelvic pain, therefore you can’t compare your condition with hers. There is no doubt in my mind that she suffers from vaginismus.
    The attitude “that most women who come from a background where it is important to be a virgin, and are told that sex will be painful and there will be blood” - is not a misconception!
    You will be surprised how many medicial practioners know very little about the condition.

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    Dr Yogesh Nikam

    Gynaecologist, Laparoscopic Surgeon, Obstetrician

    Dr Yogesh A Nikam is a Specialist Gynaecologist, Laparoscopic and Robotic Surgeon who understands that no woman’s body or experiences are the same, which is … View Profile

    Hi there

    I have read through all the answers provided. While I agree that difficulty having sex can be a condition related to vaginismus, however, Vaginismus is diagnosed when all the other pathologies have been ruled out. There is no specific test for vaginismus.

    Breifly, Vaginismus is a condition that happens when the muscles around the opening to the vagina tighten up. The muscles tighten when something is about to be put in the vagina, such as a penis, tampon, or medical device. Vaginismus causes pain during sex. 

    As you also have severe period pains (dysmenorrhoea), that you can't get out of bed, then its likely that you may have a condition called as endometriosis. Women who have Endometriosis will complain of pelvic pain, dysmenorrhea ( period pain), dyspareunia ( pain during sex) and or dyschezia ( pain with opening bowels). It is a very debilitating condition and on an average, the delay in diagnosis can be 8.5 years.

    If you get a moment please read my blog ' Endometriosis a Diagnostic Delay'. Here is the link

    http://aevafem.com.au/gynaecology/endometriosis-a-diagnostic-delay

    I would suggest, you see your GP and ask him /her to refer you to a Gynaecologist, who is an Endometriosis expert. Once local and pelvic conditions have been ruled out, vaginismus may be the cause. 

    Hope this helps. Good luck
    Dr Yogesh A Nikam
    www.aevafem.com.au

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    Matty Silver

    Counsellor

    Sexual Health Therapist Relationship Counsellor View Profile

    Dear Yogash,

    I am a sex therapist and have seen about 150 women over the last 4 years with primary vaginismus. Only 1 percent would have been referred by a health professional. They all contacted me because I have written two articles about the condition, this is one of them. http://www.smh.com.au/lifestyle/life/lets-talk-about-vaginismus-20130702-2p8nr.html

    They read the article and realise they may have vaginismus. As you explain, the involuntary contraction or spasm makes the pelvic floor muscles contract tightly around the vagina, shutting down the vaginal opening, which makes it impossible to put a finger, tampon, penis or medical device into the vagina.

    Some of women I have seen, were traumatised by a GP or gynaecologist who insisted to use a speculum to just ‘make sure’.

    You are just wrong to believe that vaginismus needs ‘pathologies to be ruled out first’ to make a diagnosis. Vaginismus is foremost a psychological condition, any medical professional who would take a proper sexual history first, and knows about the condition, could diagnose it very quickly. A woman with primary vaginismus can’t have penetration at all.

    Some of my clients also suffer from endometriosis. But women who suffer from endometriosis CAN have intercourse, which may be painful.

    I’m not a medical person but I assume a woman needs an internal examination to find out? So why would you send our patient , who is only 22, who’s main issue is that she can’t have penetration - to a specialist to have an internal examination?

    Unfortunately many in the medical profession have never heard of the condition or how to treat it.

    Dr Rosie King – one of Australia’s most respected and well known sex therapists and who is also a medical doctor, believes that vaginismus is a common sexual problem that is treated by counselling, education, anxiety reduction, pelvic floor exercises and retraining of pelvic floor muscles.

    Years ago, when she “taught me” about vaginismus she gave me an excellent Vaginismus Information sheet with all the information needed to understand the condition.

    I only have it in PDF format, anyone who would like to receive it – just email me. mattysilver@optusnet.com.au

     

     

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    Dr Yogesh Nikam

    Gynaecologist, Laparoscopic Surgeon, Obstetrician

    Dr Yogesh A Nikam is a Specialist Gynaecologist, Laparoscopic and Robotic Surgeon who understands that no woman’s body or experiences are the same, which is … View Profile

    Hi Matty

    Thank you for your response.

    I am sorry to say but it seems that you are misinformed about Endometriosis. A proper clinical history itself will identify patients with endometriosis, this can be followed by a transabdominal ultrasound in specialised centres that can detect the presence of endometriosis. Not all patients require internal examinations.

    On one hand you want this young girl NOT to go to a specialist for the fear of an internal examination. However, you seem to be ok to let her suffer from her period pains. Even if she does not have endoemtriosis, she could have a potnetial congenital anomaly ( high/low vaginal septum, MRKH syndrome - blind vagina,  etc.) which will make penetration impossible!

    Not all pelvic pain and or difficulty having sex is due to vaginismus.

    Again, I also find it hard to believe that Gynaecologist are not aware of this condition. Most of my colleagues are aware of what 'vaginismus' is and how to treat it. We have major debates at our conferences about ideal ways of dealing with it. I personally do have patients which I manage with other psychologist and counsellors.

    I am not debating your knowledge about vaginismus and thank you for your important role in the community. I also do agree that if it is vaginismus, then it has to be dealt with counselling, education, pelvic floor exercises and retraining of pelvic floor muscles.

    However, it is important for me that the treatment is in its entirety, not just isolated attempts.

    Hope this provides clarity from a Gynaecologist point of view. 

    Good Day

    Dr Yogesh Nikam 

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    Matty Silver

    Counsellor

    Sexual Health Therapist Relationship Counsellor View Profile

    REPLY:

    Dear Yogesh,

     

    Just a quick response.

    I clearly wrote: “I’m not a medical person but I assume a woman needs an internal examination to find out?”

    I didn’t have much time to research it – but most of the articles I read – mention an internal examination.

    My comments were mainly made for this particular patient – who only gives us little information. But her main problem is that she still is a virgin – she can’t have intercourse and is not able to use a tampon.

    Her main concern was her inability to have intercourse – which is a traumatic experience.

    Any medical practitioner – who knows about vaginismus – could try to find out him or herself or sent the patient on to a gynaecologist who knows about the condition and can check if there can be any other reasons.

    You may believe that most gynaecologists or GP’s know about the condition but how do you explain that almost all the clients I see went to see a GP or specialist and were told – there is nothing wrong you and the word vaginismus was NEVER mentioned.

    Can you imagine how upset and frustrated my clients felt when they were told?

    ,

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