There is an enormous difference between discomfort with intercourse and severe debilitating pain with attempted penetration.
Discomfort with intercourse is known as dyspareunia, impossible painful intercourse is diagnostic of vaginismus. Understanding the different degrees of pain is important in reaching the correct diagnosis and is of considerable help when planning treatment.
Dyspareunia or uncomfortable intercourse
Dyspareunia or uncomfortable intercourse lends itself to dilation therapy in that as the vagina is stretched, intercourse becomes more comfortable. Here too there is a range from mild pain to more pain. Menopausal women often report painful intercourse and this too has a range of severity. Many perimenopausal or menopausal women benefit from a topical estrogen replacement such as Estrace cream as an added aid in combination with dilation. The use of dilators is often helpful in women who experience uncomfortable intercourse, progressively dilating every day from smaller dilators to larger ones.
For women with vaginismus, intercourse is extremely painful or impossible
For women with vaginismus, intercourse is extremely painful or impossible as noted in the book “When Sex Seems Impossible. Stories of Vaginismus & How You Can Achieve Intimacy” by Peter T. Pacik, MD, FACS available on Amazon.com. Again patients range from being able to insert tampons to tolerating GYN exams (mostly with difficulty and forced relaxation). The more severe cases are unable to tolerate any form of penetration. A patient described her experience with attempted intercourse as “The pain is blinding and intense. WHITE HOT!! She suffered for eleven years, was ashamed of herself and remained single until age 39. She was even uncomfortable typing in the search terms “uncomfortable sex” and “painful sex”. This is how she first made her own diagnosis of vaginismus despite numerous treatments for “uncomfortable sex”. She noted that intercourse was like “hitting the wall” and this further clinches the diagnosis of vaginismus, indicating the likelihood of spasm of the entry vaginal muscle. When I spoke to her the evening that she sent in her questionnaires she was ecstatic that for the first time in her adult life she finally had a diagnosis for her problem!
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