Dear Carol,

Reading the letter from the man who wrote in about his girlfriend’s vaginismus gave me the creeps. I didn’t like his attitude about his girlfriend’s vagina. How common is vaginismus, anyway? What literature claims one in three women have it? The description he gives reminds me very much of the situation Joyce Maynard faced in her memoir about life with JD Salinger. Her body was giving her a strong message, one her conscious mind couldn’t articulate. The message was: keep out. Salinger responded by setting off on a pseudo-medical quest to find out "what was wrong" with his woman, without ever once stopping to think that, perhaps, there was an emotional component to the problem. Maybe his girlfriend doesn’t want to have sex with him. If it’s such a problem, why isn’t she the one writing for advice? Maybe she was molested or sexually abused at some time in her past, and isn’t consciously aware of it. Or maybe she is, and hasn’t discussed it with him. Good sex is good stuff, but man, the bad stuff leaves a pain that’s gonna linger. –Skeptical

Dear Skeptical,

While it’s certainly possible that this woman’s vaginismus is the result of a traumatic event, it’s not appropriate to draw the conclusion that she herself is not troubled by the condition, or that she doesn’t want to have intercourse. The letter to which you are responding was an excerpt of a longer one; while the woman herself did not write to me, I did not get the impression from the longer letter that the guy was trying to foist himself on an unwilling woman. They are committed partners and she has been communicating with other women with vaginismus via the Internet.

As to his citation that up to one-third of all women suffer from vaginismus: such a claim may well have been found on the Net, where statistics, some of them spurious, abound. This statement is not correct, unless, perhaps, you count as "vaginismus" any experience of painful intercourse or penetration. I wouldn’t be surprised to hear that a third of all women have lived through this unpleasant event–I’m almost tempted to say, "Haven’t we all?" However, painful penetration is not the definition of vaginismus, and it can be caused by many things, including organic disease and various sources of irritation. Women with vaginismus experience involuntary and often intensely painful spasms in the muscles of the pelvic floor. Typically they can’t have intercourse, but they also can’t even penetrate themselves, insert a tampon, or have a pelvic exam. It’s important to stress that they can’t do these things even when they want to do them–vaginismus is not simply a sign that a woman is not interested in having sex, although forced attempts at penetration could certainly exacerbate or cause vaginismus.

True vaginismus is probably not all that common; I wasn’t able to find statistics specifying its incidence (some sites say it is "rare," but that doesn’t say a lot, and they were medical sites–MDs are not trained especially well in this field, and I’m tempted to say nonholistic information is just as suspect as the inflated statistics to which you object). But–and this is important–it is a real condition and often profoundly distressing to the women who have it. I found an Internet site devoted to vaginismus, posted by a pair of New York doctors who specialize in its treatment. One woman whose story I read there learned she had the condition when she tried to use tampons with a couple of high school friends; the attempt was so unsuccessful that she thought she didn’t have a vagina at all. Others don’t realize there’s an issue until their wedding night; others when they find they can’t have a pelvic exam. Desire for intercourse notwithstanding, regular pelvics are an important facet of women’s preventive health, and severe vaginismus sufferers can’t even accommodate a Pap test swab.

The above-mentioned doctors’ Web site calls vaginismus "the frightened vagina," and it is indeed thought that fear and/or trauma is responsible for many cases of vaginismus: it can be the aftermath of rape or molestation, as you suggest, but it can apparently also be triggered by an intensely sex-phobic upbringing or other nonphysical traumas. It is also sometimes an outcome of painful penetration experiences that in fact trigger ongoing vaginismus. One woman writing on the site had had a difficult hysterectomy and afterwards found intercourse so uncomfortable that she developed vaginismus as a result. It is thought to be triggered in some women by other sources of physical pain with intercourse–the body learns penetration might be painful and, as you put it, says, "Keep out."

This is a clear enough message, yet many women want to let some things in. Overcoming vaginismus means the woman who has it must desire to get past it. Your hunch is correct that a partner forcing her into "getting better" won’t help–there is, or can be, a strong emotional component to this affliction. However, it can mean a great deal to have an understanding partner who wants to be part of the healing process, and many women can’t count on this. Couples and individual women dealing with vaginismus would do well to enlist the help of a good sex-positive therapist. There are a couple of books that may be very useful, including When a Woman’s Body Says No to Sex by Linda Valins and A Woman’s Guide to Overcoming Sexual Fear and Pain. There is a site under construction called www.vaginismus.com, and there is also a closed Internet discussion group about vaginismus (those interested must join the group to participate in discussions) at http://www.egroups.com/group/vaginismus. If abuse recovery issues are involved, there are some sex-positive resources in that community: see Staci Haines’ book, The Survivor’s Guide to Sex.