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Q: My boyfriend and I have been trying to have sex and we have been struggling. We have tried three times. I have never had sex before and we haven’t been able to get penetration, it’s very painful. I believe I have PTSD because I associate sex with an abusive past relationship. I love my boyfriend and I want to be able to be with him in that way. I just feel like something is wrong with me and I have been struggling.
—M, 19
A: Like many traumas, the aftermath of an abusive relationship can be disorienting, uneven, and at times excruciating. It might last years. Revelations will come in fits and starts, hiding for a while then flooding into your brain unexpectedly. You’ll likely feel relief and even bursts of exhilaration, but flashes of the darkest memories may come back at the most inopportune times…such as when you’re trying to be intimate with a person you love, with whom you very much want to be close.
You have a great self-awareness about the lingering fallout of your relationship, regardless of the root of the physical pain you’re experiencing. While I can’t diagnose you, physical pain can indeed be caused by emotional pain, and your inability to have penetrative sex may very well be connected to your past traumas. This means that your brain might be sending signals to your muscles—including your pelvic floor muscles that control contractions in your vaginal opening—to shut down danger, even if you’re genuinely doing something you want to be doing.
Sex or relationship trauma “can insidiously disrupt one’s boundaries and can create some mental confusion,” says Gretchen Blycker, a licensed mental health counselor who focuses on sexuality and sexual trauma. “When there’s an unhealthy relationship and the dynamics are harmful, it can create hyper-vigilance.” Even after that relationship is over, “the body seeks out signals of harm and can have a triggered reaction.”
But first thing’s first: Have you scheduled a physical exam with your gyno? That’s what Dr. Meera Shah, fellow with Physicians for Reproductive Health, does first when a patient reports this type of pain, “in case it is something physical, to make sure that their external and internal genitalia are healthy,” she says. That means checking for infections or a possible hymen abnormality. During the exam, Dr. Shah will stay attuned to the patient’s reactions while gently trying to insert a finger into the vagina (never a speculum at first!), if the patient agrees.
“If somebody really tenses up or really gets uncomfortable,” she says, “it may be something like vaginismus,” a condition that causes involuntary, often painful contraction of vaginal muscles when penetration is attempted.
Frankly, we don’t understand a whole lot about the causes of vaginismus, but many therapists and medical professionals connect it to emotional trauma. Vaginismus is most often associated with any type of penetration, not just penile, so Dr. Shah will talk to her patient about masturbation: “Are you able to explore your body alone, and if yes, what does that look like for you? Do you use toys or their hands, does it feel good to you, are you able to have pleasure that way?” (Also: Do you use tampons?) This gives clues as to whether any type of penetration causes your pelvic floor to tense up, or whether it’s a reaction that happens most when you’re with a partner.
Regardless of whether you have vaginismus (and again, make an appointment with a doctor before self-diagnosing), it’s definitely a good idea to talk to your boo before any fooling around takes place. You absolutely have the right to set boundaries and establish ground rules. Ask him to listen, to be patient and reassuring, to ask permission during each step. If you haven’t already, it might be a good idea to share your suspicion that your pain is connected to a past relationship.
And be gentle with yourself, too. Remember that there’s nothing “wrong” with you. “Sometimes with an abusive relationship there can be an internalization of a harshness towards oneself,” says Blycker. Writer Carmen Maria Machado’s “vestigial trauma” from a toxic relationship caused her to “catch myself thinking in a way that I could tell [my abuser] was shaping, from the past. Which was really disturbing.” The goal is to recognize that kind of thinking, and reshape it.
When it comes to the actual sex, try slowing down. Think of other ways to explore one another’s bodies before going straight for the p-in-v. “Sex” could really mean anything, from touching each other to using your hands or mouth to masturbating side by side. Maybe put anything vulva-related aside for now. If you’re feeling anxious about sex—whether it’s from past trauma or just overall nerves or some combo of the two—you need to give your body and mind a chance to build up trust with your partner.
There are also things you can try alone. Dr. Shah has suggested vaginal dilators to her vaginismus patients. And it’s a good idea to practice relaxation and being present, even when you’re just touching yourself in private. Blyther recommends closing your eyes during sex or masturbation and imagining a “place where you felt enveloped and warmed and loved.” Or it could be as simple as remembering to breathe.
And even if you do end up being able to have pain-free sex with your boyfriend, I’d still recommend talking to a therapist or counselor about your abusive relationship. Healing and processing is always necessary — whether or not it stands in the way of your sex life.
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