As I’m leaving the doctor’s office, I text my boyfriend something I hope none of his coworkers see: My vagina has anxiety. He replies “lol,” which is a completely warranted response to something that does, admittedly, sound ridiculous. But it’s true. I’ve been stressed, overworked and suffering from anxiety for years, and all that tension has manifested in an unexpected place—my vagina.
“It’s called dyspareunia,” said my doctor, giving it a more scientifically accurate (and harder to pronounce) name. Dr. Campbell is a pelvic physiotherapist who co-founded Advanced Pelvic Physiotherapy in downtown Toronto, and her office was the third and final stop on my journey to figuring out why sex was causing me so much pain.
The problem started about two years prior, and that alone is an embarrassing thing for me to admit. I’m the type of person who pushes aside pain and powers through, probably from years of competitive dancing, which included jumping on shin splints and tendinitis. But, unlike dance injuries, this pain, which happened anytime anything entered my vagina, wasn’t just affecting me. It was also affecting my relationship.
It’s hard to talk about something you can’t explain
When I started dating Josh eight years ago, I would turn red when my friends asked me anything about our sex life, and I rarely took part in the usual sex-based conversations you’d expect a bunch of 20-something women to be having. Sex isn’t something we talked about in my family a lot, either, and although I was never kept in the dark about things like puberty or spared the awkward “being safe” talk, it was a topic we all managed to avoid for the most part. Josh and I talked about sex, because we were having it, but when it became painful, those conversations went from being super fun to super stressful.
The pain was sporadic at first, which led us to believe that it was just a situational issue—I wasn’t in the right mood, we didn’t clock enough foreplay, the lube we were using had something in it I was allergic to, etc. We’d stop, and try again the next night, and things would be back to normal. But it progressed, and we got to a point where if anything penetrated me, no matter the circumstances, it hurt like hell. That “hurt” is difficult to describe. Stinging or burning were the descriptors I went with, and it lingered even after nothing was inside me. We got to a point where sex would be Josh watching my face, me cringing, him pulling out and me immediately crying from a combination of pain and frustration.
As I’m sure you can imagine, that is not a recipe for a healthy sex life, or a healthy relationship. Even just the mention of sex gave me anxiety, and we were down to attempting it once a month, if that. Luckily, Josh is super patient and he also pushed me to figure out what was going on instead of letting me stick to my stupid plan of waiting to see if it went away—because it was not going away.
Getting diagnosed with dyspareunia wasn’t so straightforward
My first stop was my GP. She referred me to the only gynecologist in Toronto who specialized in vulvar health, and her office informed me that my appointment was for March of the following year. It was February, and I could not keep living the way I was for another 13 months, so I had my GP refer me to a regular gynecologist.
Stop number two. The gynecologist asked me a bunch of questions about my sexual history, my current sex life and what my pain was like. She examined me and prescribed me an antifungal cream that I was required to massage into my inner labia and vagina every day to treat what she deduced was an infection. I did this for two weeks, and nothing changed. After several follow ups with her, I was finally referred to Dr. Campbell.
I had no clue what pelvic physiotherapy was. It sounded kind of hippie-adjacent to me, something that was for people who went for reiki treatments and believe in the healing power of crystals. But I was getting pretty desperate, so I tried to have an open mind. Dr. Campbell immediately made me feel comfortable, explaining that I wasn’t alone, and that we would be able to fix my problem. After examining me digitally (inserting two of her fingers into my vagina and pressing in various spots), she determined that the muscles in there were too tight. She explained that pelvic floor muscles can either be weak, causing you to pee a little when you laugh or cough, or tight, which can cause burning vulvar pain. “Think of a tight muscle in your neck or shoulders,” she said. “This is exactly what’s happening in your pelvic floor muscles.” Then she asked me if I had a stressful life, or if I was prone to anxiety.
Worrying about job security in my role as a fashion and beauty editor, facing things like self-doubt on the daily, and general catastrophizing about the health of my family were business as usual for me. Add that to a relationship situation like not being able to have sex, and you’ve got a solid set up for tons of stress and anxiety. “Some people’s anxiety manifests as migraine tension headaches. For others, it manifests as burning vulvar pain or pain with sex,” Dr. Campbell explained.
She then described exactly what was happening inside my vagina. When the muscles and soft tissues don’t relax properly because of tension, pain can be the outcome. This is because the connective tissue layer that lies superficial to the muscle is tight. For muscles to relax, the tissues supporting them need to stretch. When they can’t, you get that burning sensation. That becomes a vicious circle, because you start to anticipate the pain and you tighten further in that expectation. “That is exactly me,” I told her.
Treating dyspareunia is a lot different than general anxiety
I’ve had muscle pain in the past, and my solution was always to pop a pain killer, like Ibuprofen, to deal with that. Could I do the same for this, I wondered. “Pain is an output of the brain 100% of the time, so if we look at what drives a person’s pain experience, there can be a tissue component that can contribute to that,” explained Dr. Campbell. That means anti-inflammatory drugs can work, and cause an immediate change in symptoms if there is a lot of inflammation. But, when it comes to pain with sex, there is a lot more going on. “[We can treat] it with an anti-inflammatory or a numbing agent, but the person has already had that pain,” she continues. “Even just thinking about it and there’s nothing touching you, you are already experiencing that pain because you’re having that replay of what’s about to happen.” To actually treat this, my overall outlook needed to be adjusted, including getting over the fear and anticipation of pain.
So, no, I couldn’t simply turn to meds to treat my dyspareunia. Instead, my calendar became filled with weekly visits to Dr. Campbell’s office, where she would massage my vaginal muscles, pressing on certain areas inside me to see what hurt, and ask me if my homework was helping. Homework was using a dilator kind of like a Russian doll meets a dildo—the main part of it has a girth of about two inches, and you can layer larger and larger parts on top of it until it reaches a girth of about five inches. My nightly task was to insert the dilator into my vagina, moving it from side to side, in and out, and when I got to a place where that didn’t hurt, I could graduate to a wider girth. Dr. Campbell called this “practising your accommodation techniques,” and, like all homework, it was not fun or sexy. It was stressful, annoying and sometimes painful, and I locked myself alone in the bedroom with Netflix while I did it. We were also barred from having penetrative sex for a month, or until I could get through at least two of my dilator upgrades without pain.
Dr. Campbell also had me doing hip-opening yoga poses, which helped lengthen the muscles and soft tissues in my pelvic floor. She wanted me to focus on the frame-of-mind and restorative parts of yoga that could help me chill out, too. “Deep breathing continues to rank among the top activities one can do to reduce stress and anxiety,” she said. Aside from yoga, I was barred from doing any kind of ab exercises (truly the best part of all this), because you know how your Pilates instructor tells you to squeeze your pelvic floor while doing crunches, Kegel-style? Not so good for an already tight pelvic floor. (On that note, a quick aside: Dr. Campbell shocked me when she pulled back the curtain on Kegels: “Most people do not need to do Kegels. I see far more people who have tight pelvic floors than I do people who have weak pelvic floors.” Moral of the story: Get a pelvic physio exam before you start doing Kegels or buy those Goop-endorsed vagina eggs—actually, just don’t buy those, full-stop. You could be on the road to too-tight pelvic floor muscles, and trust, it is no fun.)
There is not enough open discourse about pelvic tension
Along with the mind-blowing info about Kegels, I learned a hell of a lot from my visits with Dr. Campbell: I learned about my own vagina, I learned about pain, I learned that I’m definitely not alone—one in four women experience this, says Dr. Campbell—and I learned it’s pretty common to mistakenly assume it will “go away on its own.”
“Many women are told ‘there is nothing wrong with you’ or ‘the pain is in your head’ or ‘just relax,’” says Dr. Campbell. “Women then feel like they are imagining their pain.” I get that. While no one told me to just chill out or suggested that I was inventing my pain, I was embarrassed, and I didn’t know what to do.
Dr. Campbell believes that part of the problem is that there’s still a gap in knowledge about pelvic physio, and a lot of people, like me, who hadn’t even heard of it, especially in North America. She told me about all the conferences she attends in Europe where pelvic physiotherapy is much more prevalent than it is in Canada. (Are you really surprised that Europeans are literally way more relaxed about their vaginas?) “I know there are 800 gynecologists in Toronto, and I don’t have 800 different referring doctors,” she told me. She says the bulk of her referrals come from about a dozen sources, and that more gynecologists should be making routine referrals to pelvic physios. “How many [patients] are out there, lost online, have no idea what to do, and are shaming themselves or thinking they’re the only person in the world that has this? I’m scared to think of the number of people who are out there wondering that.”
You don’t have to suffer from dyspareunia in silence
It’s an understatement to say I’m grateful I found pelvic physiotherapy. Without it, I would have spent years suffering or living in a sexless relationship, with no one to validate the pain I was experiencing. After a few months of doing my exercises and seeing Dr. Campbell regularly, sex gradually returned to be something I could look forward to rather than dread. Now that it’s been a little more than a year, the times I’m able to have pain-free sex outweigh the painful ones, something that comes from a combination of regularly doing my ‘homework’ and continuing to better understand the sources of my stress and therefore my pain.
Like any mental wellness treatment, I will always have to work at this. My Russian doll dildos will likely continue living in my bedside table for years to come, and if I’m not always on top of my anxiety, there will be times I won’t be able to have sex. But I’m relieved to have the tools—both literally and figuratively—to deal with this. After initially keeping my dyspareunia to myself, I’m learning how to talk to other women in my life about it, and when I do, I’m surprised by how many of them have experienced something similar, and how many of them didn’t know what to call it or if it was even something that they could get help for. I hope that other people who are dealing with this or any kind of vaginismus find a similar comfort in knowing they’re not alone, because I sure did.
This article was originally published online in May 2020.