Q&A With Dr. Laurie: Seeking Solutions For Sexual Health Issues

Vaginismus Causes And Treatment

Q: I’m pretty sure I have vaginismus and I don’t know why. I didn’t suffer any sexual trauma, so it’s not that. It began about a year ago, and I was totally fine having penis-in-vagina sex before that—even though I wasn’t doing it often. One day, everything changed. I was seeing someone new and when he went to enter me for the first time, I completely tensed up and had this horrible pain. It hadn’t been a problem with my previous partner, who I last hooked up with a few months before this incident.

Because I can’t figure out why I have it—as in, I never really had a psychological issue before—I’m worried that it’s not just vaginismus and that it’s something a lot scarier. Is it possible that there are other causes for vaginismus? I can’t have penetrative sex or use toys up there, although I can still use vibrators and achieve clitoral orgasm.

Aside from that, if it is vaginismus, is there anything I can do to fix it? I really liked penetrative sex before, and I’d like to experience it again at some point. Are there medications I can take to loosen it up down there? Thanks.

A: The first thing you need to do is get a proper assessment. You may have tensed up because you felt pain. We have to figure out why you experienced pain (penis too big, a small cut, vaginal infection, vestibulitis, to name just a few possible causes). If it is vaginismus, it is absolutely curable. I recommend you see a gynecologist first, then a sex therapist, and also a pelvic floor physiotherapist. The physio will help you regain control of your vaginal muscles and will help you figure out why this is happening. Be patient, follow the exercises that will be given to you and continue to enjoy non-penetrative sex for the time being.

Birth Control & Expiration Dates

Q: I got a Mirena IUD inserted in October of 2014, and I never had any complications or discomfort throughout that time. In fact, I loved it because it made my period completely disappear. For about a year and a half now, my period has come regularly and consistently, it lasts a little less than 5 days at most. The IUD is still inside of me and I know I need to have it removed. Note: prior to my second child I’d worn the Mirena, but had to have it removed surgically because it became lost inside me I’d worn it for a little less than 3 years at that time.

My family doctor retired in 2017 and due to my personal circumstances, access to medical needs has been very difficult for me and usually involves a visit to the ER in order to take care of the problem. With the Covid-19 pandemic ongoing for over two years now, you can imagine how my healthcare access has been incredibly difficult for me. I’ve grown heavily concerned about the Mirena because it should have been removed several years ago. So, I was hoping maybe you could help me find out what I can do? Or who can I contact for assistance? Thank you very much in advance for any advice.

A: It is no surprise that your periods have returned regularly since the Mirena is only effective for up to 7 years and should be changed or removed. Remember that you may not be protected against pregnancy anymore. I don’t know where you live, so it’s difficult for me to suggest where you should go. If possible and you have access in your city, you should probably go to a walk-in clinic. I suppose that if all you have is access to a hospital, then you need to call them and find out the best way to proceed.