People have been having sex since the beginning of humanity--literally, we could not exist without it. For most people today, sex is a way to establish intimacy, or even relieve stress. And although sex may mean a lot of different things to different people, it should never be unpleasant. However, for women with a condition called vaginismus, sex can be painful. Though it is not an uncommon condition, vaginismus is a serious medical condition which is often overlooked, misdiagnosed, or simply ignored.

So what happens when a woman has vaginismus, and why are women so likely to avoid speaking to their gynecologist about it? It may be because women are embarrassed or ashamed about their experiencing pain during intercourse. However, getting diagnosed ultimately opens the door for treatment options that can alleviate or get rid of this pain altogether. For women with vaginismus, the pubococcygeus muscle group involuntarily tightens during or before sexual intercourse, causing physical pain. For that reason, women with vaginismus often adopt a lifestyle pattern that avoids sex and intimacy altogether, ultimately refraining from seeking treatment. Furthermore, vaginismus is often overlooked as a completely different medical issue. “A lot of the times it looks like a chronic pain condition or a yeast infection,” says Dr. Rachel Barr, OB/GYN at Gramercy Gynecology in New York City. According to Dr. Barr, most women who experience pelvic pain aren’t aware that it’s an issue to talk about with their doctor. Furthermore, patients with vaginismus may also experience abnormal pain inserting tampons and may not recognize their pain as serious. As a result, women with the condition tend to avoid routine gynecological check-ups such as yearly pap-smears, making vaginismus extremely difficult to diagnose.

Age of onset makes diagnosis all the more difficult. Women of all ages might believe that pain during sex is normal or expected, therefore reducing the chances of actually speaking to a doctor. The two major types of vaginismus include primary and secondary vaginismus, both of which differ depending on timing of the condition related to experience of pain. Whereas primary vaginismus typically occurs earlier, especially during the teenage or early adulthood years, secondary vaginismus is more likely to occur following post-trauma or infection. Vaginismus may be particularly difficult to live with for younger women who believe the fallacy that sex should be painful. With culturally accepted myths such as “cherry popping,” which refers to the tearing of the hymen after virginity loss, young women tend to accept their pain as normal. Sexually active teenagers with vaginismus often report their sexual encounters as, “hitting a wall,” says Dr. Barr. These women ultimately develop an unhealthy thinking pattern which assumes that sex must be uncomfortable and unenjoyable.

But at what point does pain during sex become abnormal? Considering the subjective nature of pain, it is difficult to draw a definitive line. Dr. Barr suggests the importance of persistence versus isolated, one-time incidents. Although intimate sexual moments may be sometimes awkward and uncomfortable, sex is ultimately meant to be an enjoyable, healthy, and safe experience. Women who experience chronic, persistent pain at any point before, during, or after sex should always contact their gynecologist or primary health care provider.

To treat vaginismus, the first step is to recognize that it is actually happening. Taking ownership as well as autonomy over the body is a central component of understanding the connection between mind and body. Therefore, women who experience any type of persistent vaginal pain should always speak to their OB/GYN. Treatment for vaginismus aims to remove the psychological aversion towards sex, ultimately encouraging women to take control of their bodies and celebrate intimacy rather than fear it. Alternatively, applying topical lignocaine may alleviate pain and discomfort, allowing for more enjoyable sex.

Just like it takes two to tango, vaginismus doesn’t only affect those who experience the condition; vaginismus may also negatively impact sexual and romantic partners. Along with physical complications, emotional and social problems might cause tension in a relationship if one or both partners don’t enjoy the experience of intimacy. So how might both partners learn to cope with the woes and pain of vaginismus? The answer, according to Dr. Barr, is patience and support. Because vaginismus has the opportunity to create shame and guilt, it is critical that partners both discuss and share. Although oftentimes considered chronic, a diagnosis of vaginismus is not a lifelong commitment. With proper diagnosis, social support, medical treatment, and a little bit of self-love, it is absolutely possible to reintroduce all of the exciting parts of sex and intimacy.