Does sex hurt or feel uncomfortable 'down there'? Sex therapist Amanda Robb offers some advice.

Why does sex hurt? – Vaginismus symptoms & treatment - Women's Health & Fitness

The scenario: A client recounts stories of excruciatingly painful sex and feeling as though she’s “permanently damaged down there”.

The symptoms she describes, which have put a stop to lovemaking sessions with her boyfriend, make me suspect vaginismus – where the muscles surrounding the entrance to the vagina involuntarily contract or reflex, resulting in penetrative difficulty or inability, burning sensations and overall pain and discomfort.

The treatment: Of sexual dysfunctions, vaginismus is considered one of the most successfully treated. Since treatment was coined in 1970, studies have shown treatment success rates of 97 to 100 per cent.

In our session I fully explain vaginismus while asking questions to determine whether she has the primary (has only had painful sex) or secondary (has had enjoyable, pain-free sex in the past) version.

As with any presentation that involves physical symptoms, I encourage a gynaecological assessment to rule out other diagnoses. Assuming this is the cause, we will proceed with a participatory treatment plan with a strong self-help component.

With guidance from a health professional, she will retrain the pelvic floor muscles – particularly the pubococcygeus muscles – to appropriately respond to penetration through a series of physiotherapy-like exercises focusing on pelvic floor muscles.

Other exercises will involve gentle insertion techniques and sensate focus strategies with her partner. A reasonable time frame for treatment is six weeks with appropriate follow-up.

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