Photo: Corbis

Vaginismus is an involuntary tightening of the pelvic floor muscles when a woman attempts to insert something into her vagina. It causes an intense burning pain and can make penetration impossible: The vagina may completely clamp up, blocking entry, as if it were a brick wall. There’s no single cause, and it can be psychological as well as physical. Factors that can cause or exacerbate vaginismus include anxiety, past sexual trauma, or a fear of intercourse (sometimes stemming from inadequate or nonexistent sex ed). There can also be physical explanations, like complications from pelvic trauma or cysts.

This embarrassing and little-discussed condition — which Jezebel recently described as the female version of erectile dysfunction (it’s common to hear men say they couldn’t get it “up,” but how often do you hear a woman bemoan that she couldn’t get it “in”?) — is generally thought to affect about 2 in every 1,000 women. However, these statistics are fuzzy because sufferers are often too scared to seek treatment or are misdiagnosed when they do. Melissa Ferrara, a nurse practitioner at New York’s Center for Female Sexuality, estimates that about 25 percent of her patients are seeking treatment for vaginismus, and they tend to be in their 20s or 30s.

Here, a 50-year-old banker from Connecticut talks about her life with vaginismus.

Have you always experienced this, or did it start later on in life?

I think I’ve probably always had it. However, I didn’t know because I was a “good girl” who didn’t do anything until I got married. During college, when I was still a virgin, I went to see a male ob-gyn. He didn’t believe me when I told him that I was 21 and I had never had any “relations.” That was my first experience having an internal check-up, and it was terrible.

Was he able to perform the exam?

It was very painful. He did the swab, but it took a lot longer than it normally would. I backed up against the table about a thousand times, and he ended up using the child-size speculum. It was quite uncomfortable, and it really didn’t help that he was so unsympathetic.

Is that the first time you realized that putting things in your vagina was difficult and painful?

Yes, but also I didn’t know what to expect, or if that was normal, because I was a virgin. As you can imagine, I avoided going to doctors for years after that.

When you started menstruating, did you try to use a tampon and experience pain?

We didn’t use tampons in my house. Maybe if they had been introduced to me it would have helped, but they just weren’t an option — I have never used one.

What about masturbation, or “self-exploration”?

Oh, no. I didn’t know anything about the M word. When my mother was discussing the birds and the bees, she just handed me a book. Masturbation was not part of my repertoire; I didn’t even know about it until I was in college.

So, when did you first try to have penetrative sex?

I got married at 24 and discovered my problem on my honeymoon.

What happened?

We’d had a big wedding and I was all prepared, with the requisite little light pink gown that you couldn’t possibly “sleep” in (I prefer T-shirts, thank you very much). We tried to have sex but it didn’t happen. However, it wasn’t really a big deal because we were so tired and there was so much pressure, anyway, because we were both virgins. There was some disappointment but it wasn’t like, Oh my God, this is horrible.

How did you meet your husband?

At a high school graduation party when I was 18. And we got married seven years later.

Had you had any relationships or any sexual activity before him?

I had a boyfriend in high school, but we didn’t really do anything. I didn’t want to cross that line before I was married. When my husband went to college, he sowed his wild oats, to some extent. He’s told me that he was also a virgin when we got married; I’m assuming that he’s telling the truth, but I’m sure he also did some other things, too. He was 19 years old and at college — need I say more?

Were you aware that you didn’t want anything to go into your vagina, and did you actively avoid it, whether it was a penis or a finger?

I really did try to avoid it completely. I may have used “waiting for marriage” as an excuse.

So going back to that first attempt, how would you describe the pain? What was the moment like when your husband tried to insert his penis?

It’s like you are trying to pound your fist against the palm of your hand. It’s just not going in. There’s absolutely no give. And as for the pain, it’s a combination of the fear of how much it could hurt and a burning sensation. We both felt like I was a brick wall. I completely clamped up.

At the time, like your experience with the ob-gyn, did you think maybe it was just painful because you were a virgin?

That’s exactly right, and we were so tired from the whole day, I thought, Well, maybe I’m just exhausted. And then going forward, I think my husband was afraid of hurting me. We went on and it sort of became the new normal, even though it really wasn’t normal. My husband always told me it wasn’t a big deal because we were able to be intimate in other ways, but I don’t know what he’d say if you asked him anonymously. Maybe it was very disappointing for him.

I’m curious to know why you waited for marriage to have sex: Was it for religious reasons? Or did you have some sort of mistrust of men, or sex?

I would say the latter, and also I don’t know where I got this morality issue, but I just always thought you shouldn’t. We were Episcopalian, we went to church a few times a month, but I think my mother’s conservatism was more of an influence on me than religion. She would never hug or kiss me. There was no warmth or intimacy. I’ve tried so hard to figure out what happened to cause this. Some people were sexually traumatized when they were younger. To the best of my knowledge, I wasn’t, but I was physically abused and I came from a very conservative household where you really didn’t talk about sex.

Tell me more about your childhood.

I grew up in northern Connecticut. My mother worked long hours and weekends as a nurse, and my father didn’t live with us; he’d come home maybe once or twice a year and that was it. It was not easy for my mom — she had to support three kids on her own. I had two older brothers and we had to get ourselves up and go to school and then come home alone.

That’s where reading saved me. I lived my life through books — they were my escape. Each week, I’d borrow five or six from the library. At the weekend, I would hide in my room and spend the whole day reading. I dreaded being home alone with my brothers.

What did they do to you?

The oldest was particularly violent, and I think he cajoled the other one to participate. Because we were alone, I had no protection. I was free game to get beat up on, and if I told my mom, I’d get just even more the next time. It was a very abusive situation, both physically and emotionally.

I had no voice. I remember one day I was hiding in my room and my brother was standing outside the door tearing pages out of my favorite book — a biography about a Russian gymnast. He tore each page one by one and then he’d slip them under my door. He wanted to antagonize me. He wanted me to come out so he could pummel me some more. That kind of thing went on for years, from as early as I can remember. My mother never acknowledged it.

Did you try to talk to her about it?

I told her a few times and she dismissed it. She was dealing with her own stuff — I think she had depression and OCD. She ignored things and hoped they’d go away. She was very good at avoidance. I remember a few years ago, my middle brother said he doesn’t have any memories from when we were younger. He blocked stuff. Maybe I blocked things, too, but in a different way …

Do you think it’s possible that there was sexual abuse that you’ve repressed?

I asked my therapist about that, but she thinks if I had been sexually abused, it would have come up by now. If you want to psychoanalyze it, I think it was probably the impact of abuse from a male coupled with an absent father figure. And who knows, maybe that traumatic first ob-gyn visit also played a part?

So, back to you and your husband — did you continue to try? Did you talk about it?

It was swept under the carpet. But it wasn’t as though we were walking around completely frustrated; our sexual relations were pretty frequent and satisfying. But I wanted to know what was wrong with me, and I did go looking for help. This was before the internet, so I went to the library. I read everything, and there was nothing out there that described what I had. Unless you knew the word, it was hard to research. It was incredibly isolating.

Did you ever think that your husband’s size was an issue?

Of course, but everything I read told me that the vagina expands to accommodate just about anything, so I knew it wasn’t that. And if you can believe it, I became pregnant without having penetrative sex. To me, that was a miracle.

How did that happen!?

There’s actually something called a “splash pregnancy.” My husband had very strong swimmers, so even though we didn’t have full insertion, his sperm was still able to get where it needed to be. I got pregnant twice this way — I have a son and a daughter.

Were you worried about delivering the babies?

You know, when I was pregnant the first time, I thought maybe it could help. You read stories where women complain that things are looser after they have a baby, and I wanted that. I thought I was just too tight. Unfortunately, I ended up having a cesarean.

Was the cesarean related to this at all?

No, apparently I’m really good at hanging on to babies! She kept trying to bang her way out, and my cervix was swelling shut rather than opening.

Was that related to the vaginismus?

I don’t think so, because I don’t have emotional control over my cervix. But there does seem to be this big movement to keep everything out of my vagina!

How did you cope with all the examinations you need to have during and after pregnancy?

When they wanted to do the first internal exam, I had some reaction. The female doctor acknowledged that it was uncomfortable, but she didn’t say anything like, “You know what? I think this is because you may have a condition called vaginismus, and you are not alone and we can deal with this. I have seen this before.” She just backed off and said we can see things without going through your vagina.

And I wasn’t about to tell them that I hadn’t had full intercourse. They would have said, Yeah, right. What land are you living in? You’re pregnant. It would have been nice if they had asked me how uncomfortable it is when I have relations with my husband, but they didn’t. They probably just assumed that I had a normal sex life.

How did you actually find out that you have vaginismus and that other women have this, too?

I just thought I was the most bizarre creature and there couldn’t possibly be anyone else like me. Before I had kids, I came across a book mentioned in a magazine, it was called something like, “when a woman’s body says no to sex.” I was just like, Oh my God, I think this is what I have! I marched off to the ob-gyn, I decided to go to a woman this time.

But I was just too scared to bring it up. We went through the whole exam, and she could clearly see that I was having issues and had to use the smallest, child-size speculum, but she didn’t ask what was wrong, even thought I was backing myself up off the examining table towards the wall, clearly petrified. I’m not even sure if they learn about this in medical school. Do they even talk about it? There was a doctor mentioned in the book, but he was in London; there was no way I could afford to travel that far to see a specialist. And then I dismissed it for nearly 25 years.

Did you tell anyone?

Nobody at all. It’s not something that I brought up even with my very close friends, and I didn’t have a sister. I didn’t want to tell my daughter because I didn’t want her to develop any hang-ups around sex, or think that she might have it as well.

I think whenever there were discussions about sex, I would go along with it and just laugh. Like, if I was with a bunch of girls and they are saying something like, Oh, well, my husband attacked me again last night! I could agree with most of what they were saying but I just wouldn’t say what I couldn’t do. Then, in early 2013, I discovered that my husband had been unfaithful.

Oh, gosh. How did you find out?

I had a suspicion that things weren’t right. He’d become less affectionate, and then I got a phone call from the woman’s husband. Infidelity is difficult for any couple, but it was particularly devastating because he was able to do something with someone else that I couldn’t do with him. It tore me to the core. But let me tell you, it was a great way to lose weight.

Yeah, the “someone just treated me like shit” diet is very effective.

Exactly! Forget going Paleo, forget the Zone diet: This will make you lose your appetite for everything.

Did you stay together?

We did. He lived in a hotel for a week and then we had a talk. The woman was someone he worked with, so I told him one of them had to leave. He went into work that Monday and resigned. We went into therapy, but I didn’t do anything to address the vaginismus right away because I wasn’t even sure if I was going to stay married to him. So, I waited another nine months trying to get my head together. I wondered if he did this because of the fact that here he was getting older and he’d never actually had sex. Maybe he wanted to know what he was missing.

Did it drag it out in the open, and prompt you to discuss it?

Yes. We really hadn’t talked about it before, and during all the crying and screaming, I asked if this happened because I couldn’t do it. He said no, but part of me didn’t believe him. I told him that I had found a doctor who could treat my condition and I was going to start going. He said that’s not why this happened. He told me that it was not my fault. And I told him it didn’t matter because I wanted to do it for me.

How’d you get help?

I went online and found a clinic — the Medical Center for Female Sexuality — in Westchester and made an appointment. I met with a nurse practitioner and a social worker and we discussed my history and why I was seeking treatment. And then they laid out a plan for what they were going to do to help heal me. It was pretty intense.

Was that the first time you had talked about it out loud to anyone other than your husband?

Yes.

How did it feel?

I cried. Not only did I cry about the affair, I was finally able to tell someone my story and hear that I’m not crazy. I’m not alone and they could help. That was huge.

Tell me about your treatment.

It’s like having an ob-gyn exam every single week for three months, and each time they’d introduce a different size dilator.

How big are we talking?

The first one was smaller than a tampon, but to me it was the most giant thing I ever saw. There are eight different sizes and the largest is 39 mm, which the clinic says is slightly bigger than the average penis.

Was it painful?

The first dilator was only 13 mm, but it was still terrifying having this little teeny-tiny thing coming at me. My body wouldn’t allow itself to expand at all. There’s a burning sensation and it’s scary and painful all at once.

It was traumatic, but once I got through the discomfort, it was okay — the nurse was holding my hand. Before you leave, you have to demonstrate that you can do it by yourself. And then your “homework” is to do that every night and keep it in for ten minutes. Whenever you go back, you get a slightly bigger one. She’ll insert it the first time, and then you have to demonstrate that you can do it, too. At that point, I was pretty determined. I thought if I could survive what I’d been through in the last year, I can handle anything.

On the drive home from that first visit, I felt so joyful — like something had really opened for me. I was normal. I could finally be like everybody else. Someone was going to help me get through this. I wasn’t on my own anymore.

Does that mean it wasn’t until you were almost 50 that you were actually able to insert something in your vagina?

Yes, that little dilator was the first thing that went into my vagina that wasn’t a child-size speculum administered by a doctor.

Did you graduate to the largest size?

I did. And I came out feeling great. It was an important hurdle. It wasn’t the most comfortable thing on the planet, and it’s not like I can go home and just pop that sucker right in — I still have to work up to it incrementally — but at least I know my body is capable of it. But, I have to say, the best feeling was when I managed the smallest one that first time.

Was your husband involved in the therapy? Did you do your homework together?

No, but they have encouraged that. I’d use a code, “I’m going to go upstairs to read a book,” and I would disappear for 10 or 15 minutes.

So, have you been able to have vaginal sex with your husband?

Yes, but only in those cases where I have prepared beforehand. I’m not petrified anymore. I still have to start with a smaller dilator and work up to a larger one. The spontaneity isn’t there, but knowing that I have that ability is just huge.

What was it like the first time?

Probably like most people’s. It wasn’t like, Oh, this is fabulous! It was like, Hey, I did this, and I thought that was so cool. We lay together for a while afterwards. It was so overdue — 25 years is a long time to wait. The fireworks weren’t sexual but a great feeling of Wow, I can do this. I’m normal.

Do you think that’s a part of losing your virginity when you’re a girl? Maybe we don’t talk about it, but there is that sense of, “yeah, I did it. Look at me!” And you really don’t care so much about the quality of the experience *212; it’s actually this physical triumph because you always wonder if your body can actually do it?

That’s exactly what it felt like. It was not all hearts and flowers. I wanted to do it so I could say to myself that I did.

Do you regularly have penetrative sex these days?

It really depends. My preparation is important. If we are both fairly rested and if I think it might be a good night, then I will disappear for about ten minutes to prepare, but when it’s spontaneous we usually do other things.

Have you been able to have an orgasm while your husband is inside you?

No, but it’s something I aspire to. However, I would say I’m probably close to normal here, too, because from what I’ve read, it seems like a lot of women don’t. It’s not going to kill me if I don’t because I know that I can through other stimulation. But I have to say, when my husband has one inside me, it’s very satisfying. It’s like, Wow! That’s something else I can do …

It’s interesting because your story sort of raises the issue of the importance that society places on heterosexual penetrative sex. Despite the obvious distress it has caused you, do you think we could read your condition subversively: It’s not the most important thing?

It would be interesting to compare me to a woman who has only experienced penetrative sex and hasn’t had an orgasm, which I wouldn’t wish on anybody either because the level of satisfaction isn’t as good. I expect that’s a reality for a lot of women and girls. However, whether it’s the whole stigma of virginity or if it’s about having children, I wanted to do it.

What was the environment like at the clinic, and what did the doctors do to help you relax?

It was wonderful. The last time I was there, I brought the receptionist flowers because she was the first face that I saw, and if she had not been welcoming and kind, I probably would have run. And I told her that. At the clinic, it was good having the combination of the nurse, who is very clinical, and a social worker.

The nurse would talk you through it, tell you how small it is, hold your hand and offer encouragement but also be very firm at the same time. She has to be because she’s getting you to do something that every ounce of your body is telling you not to. She has to convince you that you are strong enough to go ahead and do it. So it’s that combination of empathy and firm encouragement that was really helpful. After the first time, I was joking with the nurse that everyone wants to get jacked and buff, how come I’m most ripped in muscles that I can’t even see?

Ha! So in a way, your vagina isn’t passive, it’s too strong?!

That’s right! These are the strongest muscles I have and I don’t want them to be that way.

When you were working things out with your husband, after his affair, did you ever worry about being single and having vaginismus? Was that a deciding factor in staying with him?

It was somewhere at the back of my mind. There were mixed thoughts. Obviously I felt like if this is what caused or contributed to it, I wanted to fix it, but also I wanted to fix it so that I could be “open” to have other relationships and know what I was capable of if I wasn’t with him in the future. So it wasn’t just done for the marriage, it was done for me. At my ripe old age, I finally decided to take control.

Did you have anyone you could talk to for support?

As soon as my husband confessed to the affair, I called my girlfriend. Everyone needs someone like her. She immediately left work, got on a bus, and came to me. Then I found an old cognitive-behavioral therapist I’d seen back in my 20s when I was having some anxiety issues. She was still practicing even though she’s 80. She’s like the mother I never had. I will never give her up, ever. I’ll be 80 and she’ll be 110 and we will still be talking.

We don’t just discuss the affair or the vaginismus — it’s more about being strong and, I know it sounds trite, but after all these years, learning to find my voice and speak up for myself. Maybe this is where my body holds tension and memories from my childhood. It’s amazing to think that you can carry that repressed trauma in your body for so long.

How do you feel like this has shaped your life? And what do you think has been the hardest part about it?

I always felt like I was damaged goods. I looked normal on the outside, but I didn’t feel worthy because I couldn’t do the most basic thing that everyone else could do. Because it’s not something that’s all over the newspapers, I just had no idea where to get help. I just blamed myself. If I was a guy, I’d know what was wrong. We all talk about their erectile problems; we know there are pills for it. When I hear couples say that they can’t have kids, I often wonder if this is why. It’s not something you can ask someone.

When you leave the office where I was treated, you’re given this little magical pink bag, which had our “homework” assignments in it. I remember in the waiting room, whenever I would see a woman come out with one, I’d wonder: Does she have what I have? But nobody would speak up. There was such a taboo around it even though it was clear we are all suffering from the same thing. I wonder if those other women wanted to talk to each other as much as I did.