So there I am at my daughter's tumbling tots class and a woman sitting near me overhears me
say that I'm a marriage and family therapist and says 'can I ask your advice?' and I actually
love this question because I get some really interesting questions and this was one of them.
So here was her question, she says 'I have a friend whose son recently got married and
his new wife never wants to have sex again because the first time it was painful' and all the mom's
friends are saying things like 'oh she's so messed up, what's wrong with her?' 'Is she gay?' 'We were like
rabbits after we got married.' And basically the mom of this couple, and to some degree
the couple themselves, are kind of desperately reaching out for help from the family but they're
not getting much help, and this is actually a really common problem that many women have,
but a lot of people don't have good access to good, reliable sources of support or education
on the topic of sex. The other day someone asked me about vaginismus on instagram. So I'm gonna
talk about this, I'm gonna address this and this is a little weird for me because I don't want a
whole bunch of creepers on the internet making comments on this video. So creepers just like
back off- I think is what they say on YouTube. But for all of you out there, all you women out
there who who want resources, this video is about treatment options for painful sex and vaginismus.
I have started a Patreon page. If you'd like to support my mission of helping make
good, short, easily accessible mental health resources then go ahead and click on the
link in the description. You can start by just supporting me for three dollars a month,
check out the link in the description. Okay, back to the video. According to the American College
of Obstetricians and Gynecologists, nearly three out of four women have pain during intercourse
at some point during their lives. For some women pain is only a temporary problem
but for others this is something they struggle with their whole lives,
but there are some treatment options, there are a lot of things that couples can do to decrease or
eliminate pain during intercourse. So let's talk about some really basic treatment approaches.
Now the first thing that needs to be addressed is this couple's ability to talk about the issue
with someone who's educated on the topic, so a marriage therapist, a sex therapist, or a doctor
would be able to help point them in the right direction instead of family members who really
only know about their own experience or options. For many people talking about sex is a really
difficult thing to do and this can be especially hard for people raised in a conservative or
religious culture. So for some people there's almost no education about healthy sexual behavior
prior to marriage and even for people who have a lot of "experience", they might not really know
that much about how to solve these, you know, challenging problems with their sex lives.
So the first thing I'd recommend is seeing someone who can help this couple
discuss sex in a really open, healthy way and receive advice from someone who's educated. It
might feel embarrassing or awkward to you, but to a professional, it's really like no big deal
and there is a lot to be gained from this. So I would say that the majority of problems with sex
can be solved by education or through conversation especially with a, you know, a skilled professional.
Now if you're unwilling or unable to see someone in person there are some other options; The Good
Girl's Guide to Great Sex. This is a good book, it educates couples from a Christian background
on how to improve their sex lives and in addition to skills and techniques, just even just reading a
book about sex together could help a couple open up communication so that they're able to talk
about sex. Okay, so now that I've encouraged you to talk about sex let's do some just really basic
sex education. So women are generally slower to get aroused and lubricated than men are, so intercourse
can be painful just because of this. So just basic education and skills can really increase her
comfort and her enjoyment. So increasing the length of foreplay, spending more time doing non-genital
touching, using lube, and slowing down, and just doing what it takes to let the woman increase
her level of arousal. This is all going to help her be more comfortable during intercourse. Also,
it's important to know that it is normal for someone, for a woman, the first time that they
have sex to have some discomfort. This is a normal normal thing and if you're gentle and gradual
as you go about initiating sex, then over time that's going to decrease. Okay now fourth, there
are some techniques that the couple can try. So for example you can try a different sexual position,
so specifically positions where the woman has a little bit more control or the woman can
pace, you know, the speed of intercourse, that could be helpful for her. You could try a sex
therapy technique, like the sensate focus exercise, and these exercises can really help couples
improve their arousal, their comfort, and their communication. So again, I think that
a lot of people from conservative or religious backgrounds might be really worried about looking
up how to improve their sexual relationship on the internet and that's with good reason
because they might get recommendations that don't really jive with their values.
Recommendations like masturbation or watching porn together. So for some people these are, you know,
appropriate sexual activities and for other people these go against their values. So it's important
to look for resources or work with a professional who respects your cultural or religious background.
Some couples may be open to most everything and other couples are more reserved, but
there are a lot of options and lots of different approaches. So if you're willing to study it out,
you really can solve a lot of problems. So look for resources that work within your framework.
Okay, now let's talk about vaginismus. So vaginismus is when the pelvic floor muscles contract
involuntarily. So for many women this is a reflex, something that happens without their control.
So just like if I were to poke you in the eye with my finger, your eye would clench up, with vaginismus,
women experience that tightness. Whether with a partner or even just trying to put a tampon in
and when they experience that tightness it makes sex or putting a tampon in more painful, which
makes women be more nervous the next time, which makes them tense up more and then this anxiety-pain
cycle develops. Now this anxiety might be caused by a past trauma or a bad experience
or some anxiety within the relationship or other situations that are causing this anxiety,
but the good news is that most of the time, this can be treated with a psychological approach
rather than a medical one. So even though that tightening up isn't on purpose, you can train
yourself to soften those muscles and gradually feel a lot more comfortable during intercourse.
So if you go back to my videos on exposure hierarchy and the anxiety cycle, the basic idea is
that if something makes us feel anxious, but it's actually safe, if we gradually and gently face it,
over time that anxiety will decrease. So with vaginismus there's two basic skills. The first
one is progressive muscle relaxation, and the second one is using an exposure hierarchy.
Okay, so let's talk about progressive muscle relaxation. If you don't know this skill yet learn
it because it is great for all types of anxiety but basically if you just try to force your
muscles to relax or if you try to make yourself calm down it backfires, it makes you more nervous.
So instead, you're going to train yourself with progressive muscle relaxation to tense a set of
muscles and then to release that tension. You can use pmr for any type of relaxation, but
in this case, the muscle group that you're going to be tensing and relaxing, is your pelvic floor.
So I mean basically, you're going to be doing kegels. If you don't know what a kegel is just
google it because there are a lot of great videos on this topic and you're better off
watching, you know, a physical therapist explain this than watching me explain this. And then
the second skill is to use an exposure hierarchy, to gradually increase your skills. An exposure
hierarchy is starting with really simple, easy, more comfortable skills, and then gradually moving up
to slightly more anxiety provoking skills and you stick with those skills until you feel calm
and relaxed at the level you're at and then you move up one more. Ao with vaginismus you're going
to start by getting good at doing kegels. So you can practice them while you're peeing. If you can
stop your urine flow and then start it and then stop it and then start it, then you're probably
doing kegels right. So just do this a couple times to get familiar with what it feels like
to tense and then relax and then you can practice this with vaginal dilators. Now this sounds scary,
but it's basically just a term for putting increasingly larger things into your vagina.
You can go to your doctor to get a medical device, or you can be creative, as long as what you're
using is clean and safe. And then when it comes to sex, you're going to back way off, you're going
to slow way down, and you're just going to move forward with a tiny step at a time and practice
that level for a while and it may take you a while, it may take you a long time until you're able to
make it to the next level and then you're going to move on to the next rung on your ladder. So
now I'm going to just read you two paragraphs from the book The Good Girl's Guide to Great Sex. (Book)
"Then when you start to make love, have him enter you just a little way until it starts to hurt and
try the same thing, tense first and then relax. You may have to spend a few minutes doing this.
Try to treat it like a game and for him it will probably feel pleasurable
anyway because you're squeezing him and eventually you'll find that it doesn't hurt as much."
and then she shares a great story which I'm going to share. (Book) "When Debbie was married
she was afraid she'd have issues because she had never been able to use tampons
and she had been sexually abused as a child. Sure enough she found sex very difficult.
Her husband, Max, was extremely patient with her for the first four months taking time to play
around with her and get them both more relaxed. Then, when they finally did try intercourse again,
she found that the pain had gone away because she felt so accepted and loved. If sex hurts
tell your husband that story. Sure, it's hard to be patient, but his being patient will often be
what helps you to be able to relax and release your real sexuality. For most women, vaginismus is
a head thing, our muscles tense up because we're scared, threatened, or worried, but is completely
involuntary, you can't make yourself stop. If you put pressure on yourself and feel badly about it,
the pain will likely last a lot longer. The only thing you can do is physically train
your body to relax. Emotionally you can learn to feel more comfortable in your relationship."
oh she says one more thing (Book) "Communicate to your husband that you dream of a great sex life too,
if he knows that this is still your goal, even if you don't know how you're going to get there,
it's going to be much easier for him to be patient than if he thinks you're resigned to
staying this way for the rest of your life." to having, you know, a sexless marriage or something.
So the last thing I want to mention on this short video is that there might be
other underlying causes of painful intercourse. So there's a bunch of physical conditions that
can contribute to painful sex. I'll include a link below to an article by the Mayo Clinic on
other causes of painful sex and there's also other causes for a tight pelvic floor than
just anxiety and these might be best addressed by a physical therapist
and there's also a good chance that a woman has experienced some sexual trauma in her life
because you know around one in three women have and that may be affecting her experience. So
if any of these are factors, they can be treated by experts like a gynecologists, doctors, or a therapist
who specialize in trauma work. So regardless of the underlying cause, improving communication
and reaching out to expert resources is going to help this couple work together to solve this
problem. I really think it's absolutely solvable, they just need to find a way to go about it in
the right way. So I hope you guys find this video helpful. Thank you for watching, and take care.