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The location of pain during intercourse
& Dyspareunia

1. Insertional/At the opening:

If you have vaginismus, this kind of pain ( a sensation of burning, or being pinched there) is quite common because the ring of muscles at the entrance of the vagina is usually the more tense and the one that's harder to dilate, so be patient.
According to Butcher J. 1999, in her study on Dyspareunia and sexual pain, and from our experience, if you have vaginal pain at the entrance it could be caused by lack of lubrication or the hymen could still causing you some problems, or you may have VULVODYNIA or VVS ( Vulvar Vestibulitis Syndrome ) or other vulvar problems such as yeast or a painful inflammation due to some infections or bacteria so you may ask a good gynecologist to make sure there's nothing wrong going on.
It is hard to differentiate between VVS and vaginismus because both women with vag. and women with VVS may experience pain when the cotton-but test is done on them. (Crowley, Tessa et al. 2006 ). If all that is overruled, you can check our explanations of hymens and their myths to see if it could be the hymen after all getting in the way.
If it's none of those things, you may just work on dilating with only the tip of dilators for a while, since once you are past the first ring of muscles at the entrance, you probably wonít have problems sliding them in and thrusting.
A good movement in these cases is the right and left one, which will gently retrain your vagina to stretch. Also you may try and dilate briefly before having intercourse (or as part of foreplay) with a small dilator and then progress to a larger one, especially if you havenít tried intercourse in a long time.

2. Half-way/During thrusting:

pain here could be the result of an inflammation inside the vagina or endometriosis or it could be more simply be caused by some paper-cut tearing that may have been caused while dilating or during sex and that may take time off to heal first, or it could be due to the movements of your partner which may be too rough or his penis quite big, or because of lack of adquate lubrication or arousal.

3. Deep/At the end of the vagina:

According to the study by Butcher quoted before, this kind of deep vaginal pain (which can be accompanied by blood) is usually felt when the penis during thrusting bumps against either the ovary or the cervix, which is whatís at the end of the vagina Ďtunnelí, our door to the uterus.
In some women this area can be very tender and it can even bleed at times. To avoid this you may tell your partner not to go in too deep, you may change positions or you may feel better having a gynaecological exam to make sure that your cervix is healthy.

When painful sex is not caused by Vaginismus: Dyspareunia

Vaginismus is NOT the only condition that can cause painful sex.
Painful sex is medically known as dyspareunia, which is "a symptom of multiple and varied disease states and may have multiple causes with components of both organic and psychiatric dysfunction".

As you can see summed up in the following scientific study on causes of dyspareunia (by Elizabeth Gunther Stewart, MD ), there is a long list of conditions that can cause a woman to experience painful sex.
So you may wonder if the pain you feel is after all caused by vaginismus and whether youíre curing the right problem or wasting a lot of time. Fair enough. Only a doctor, and a good one, will be able to tell you which condition (or combination of conditions) is causing you to have painful intercourse, but one thing seems clear.

Whatever the condition that is causing you painful sex, (letís say you suffer from Interstitial Cystitis for example), it is very likely that your body will then develop vaginismus as a result of the pain your vagina experienced. For the women (and doctors) who donít know about vaginismus, it can be extremely puzzling to treat the original condition and then see that painfree sex is still not possible because their vagina will clamp and cause them pain still.

So even once your original condition is treated, your vagina may still be very defensive towards intercourse, because it will remember that it was painful and will want to protect you by clamping or closing down and not allowing anything in, or not without further pain.
Itís a vicious cycle that can be stopped by treating vaginismus.

See our page on Dyspareunia, Vaginismus, Vulvodynia in our section for Practitioners to find out more about this.

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DISCLAIMER: This site is not designed to provide medical advice. All material is gathered from the experience of hundreds of women who experienced vaginismus but it is for information only and is not intended to be a substitute for professional or medical advice, diagnosis, and treatment. Please review the information contained on vaginismus-awareness-network.org carefully and confer with a health care professional specialized in vaginismus, as needed.