East Toronto Therapy

When you can’t have sex

By Sarah Dale, MSc., RP

What happens when you can’t have sex? Some women have difficulty with penetration, both sexual and non-sexual types of penetration, due to a condition commonly referred to as vaginismus. Vaginismus, (also known as pelvic floor dysfunction), may be include pain, worry about pain or other concerns and/or muscle tightening that makes penetration impossible. For some women, their concerns about penetration are so great that they don’t even attempt penetration. Others have tried but found that it didn’t work.

Vaginismus can have a huge impact on a woman. It can lead to avoidance not just of penetrative sex, but even of other sexual activity, out of worry that it might lead to penetrative sex. It can also cause a woman to feel bad about herself, or abnormal, for not being able to have sex the way so many other people are.

But is the inability to have penetrative sex really a problem? Sex doesn’t have to involve penetration. While women and couples impacted by penetration difficulties or vaginismus sometimes say that they can’t have sex or aren’t having “real” sex, there is nothing in the rulebook of life that says that sex needs to involve penetration. There are lots of people who don’t have penetrative sex, either by circumstance or choice, and many have terrific sex lives! If you’re happy with your sex life without penetration, then nothing needs to change. If, on the other hand, you’re interested in adding penetrative sex as one option in your sexual repertoire, there’s help available. A therapist with experience in sex therapy can help you work through penetration difficulties.

When I work with women who have been unable to have penetrative sex due to vaginismus or pelvic floor dysfunction, I talk with them about their goals. Is it to have a great sex life? To get pregnant? To have penetrative sex be an option to them? For some women, it is incredibly reassuring to hear that vaginismus is actually more common than you think, and that penetrative sex isn’t required for a great sex life or happy relationship—knowing that they may be happy to work on developing a full sex life without penetrative sex. If having children or getting pregnant is the goal, we can also work on strategies that don’t include intercourse. Other women may decide it’s really important that their sex life include the option of penetration. If that’s the case, I can work with a woman to overcome vaginismus so that penetration is possible.