Why Does Penetration Hurt During Sex for Some People?

They were in his hotel room with others when he told everyone to leave, locked the door, and raped her. “He kept trying really hard and forcing it,” Sarah says now. “There was so much blood. It was so painful. It felt as if it would never end.”

That was how Sarah had her first kiss and how she lost her virginity—forced and involuntarily. She thought the pain was down to her first time, and the fact it was not consensual.

But a year later, when she tried sleeping with a guy she was dating, she found herself unable to go through with it. “It just wouldn’t go in, and I was in this awful pain—I thought there was something wrong with me.”

Sarah has vaginismus, defined by the UK National Health Service as “when muscles in or around the vagina go into spasm, making sexual intercourse painful or impossible.” In the US, one in 500 women are said to have vaginismus. There are no official figures for the UK, but it isn’t uncommon, says Dr. Virginia Beckett from the Royal College of Obstetricians and Gynecologists.

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“It’s not just something that’s in women’s heads,” she emphasizes. Beckett explains that the vaginal muscles contract when memories of psychological or physical discomfort are triggered. Vaginismus does not just affect rape or sexual assault survivors, and in many cases there is no discernable trigger. “It’s complex, and needs quite a lot of unravelling.”

How someone considers sex plays a big part in it, too. If you associate it with pain or trauma, for example, that may be a notion you internalize—consciously or not. Zara, 22, from London, grew up in a conservative Muslim family. The importance of keeping your hymen intact and remaining a virgin until marriage was drummed into her from a young age. (Zara requested a pseudonym as she does not want her family to find out she has had sex.)

Tampons, swab tests, guys trying to go to second base—all produced the same result: excruciating pain for the days to come. At the age of 14, Zara was also sexually assaulted by a family friend. “I remember a lot of pain, and not wanting it to happen. After that I just stopped trying to put anything inside.”

Embracing strict religious values was a way of hiding her symptoms, she explains. “I believed in no sex before marriage for a long time, but I think I did because I knew no one would question it. I felt guilty considering it because of my family, and I didn’t want to try because of the pain.”

When confronted with these cases, it is important for doctors to consider issues surrounding cultural and social expectations surrounding virginity. They are “a self-fulfilling prophecy,” Beckett confirms. If someone believes the myth that a tampon will make them lose their virginity—and that this would be undesirable or even shameful—the vagina will contract and it won’t go in.

Both Sarah and Zara said they withdrew themselves from situations where they thought sexual intercourse might happen, and for a long time thought they were defective in some way.

Sarah, now 19, and a film student at Kings College London, recalled how she didn’t want to get close to anyone after a failed second attempt: “I just thought, I’m never going to do it again.” It was only after a friend’s mom mentioned vaginismus that she came across the condition and received a diagnosis. “I was so happy to discover it's a real thing and it happens to other women. I reckon a lot of people go through it without even realizing.”

Current sex education teaches women about menstruation, pregnancy, and how to put a condom on; it is centred on male pleasure. “We are taught that women should endure sex, and men should enjoy it. Sex is not meant to be pressured and painful,” said Sarah, who believes her own lack of sex education contributed to her anxiety regarding sex.

Beckett stresses vaginismus is a physical reaction by a woman’s body, rather than purely psychological, as is often the misconception. When Zara went to her doctor for help, she was given dilators—essentially dildos that range in size and are used to try and ease patients into the idea of insertion. “I was told to relax and try them, but for me they were just the same as tampons, or anything else I tried. It didn’t work, and I remember crying and crying. It’s frustrating to think you can’t control your body.”

While there is no definitive solution to vaginismus, relaxation therapy, cognitive behavioural therapy, dilator use under the supervision of a therapist, and adequate foreplay and lubrication are all recommended starting points for treatment.

“Often an experience of comfortable sex is the cure for long-term vaginismus,” said Beckett. “The sense of feeling secure plays a big part in it.”

Sarah was able to have sex with her first boyfriend at the age of 17. “As soon as it happened, I cried and called my best friend saying 'I just had sex and it worked.’”

Similarly, Zara lost her virginity to a guy she dated for more than a year and felt comfortable talking about her past with. “I’d never felt as at ease with anyone before,” she says. “I just knew I could trust him.”

But, despite being able to have positive experiences of sex, and coming to terms with their experiences, they still occasionally experience vaginismus. When Mcintyre tried to sleep with a hook-up buddy, she said her vaginismus flared up. “It feels like my hymen is breaking for the first time all over again.”

“It's like forcing something in when it can’t fit,” echoes Zara, who found herself unable to have sex with an unfaithful ex.

A sense of psychological security plays a big part in it, suggests Beckett. “There is an unconscious element to vaginismus, and even if you think it’s something you want, there is something telling you that it’s not.”

Time, support, and finding the right partner—whether casual or long-term—are all ways to help ease the symptoms of vaginismus. So is talking about it, Sarah suggests. “Don’t ever feel ashamed,” she says confidently. “We have to mainstream these issues and speak up.”

Correction: Sarah’s name has been anonymised to protect her privacy.