"We've Been Married Seven Years -- and We've Never Had Sex"

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The Counselor's Turn

Healing Together

"Brad was right: Natalie couldn't solve her problem by herself," the counselor said. "She suffered from a psychosomatic disorder called vaginismus, and she needed the help of a certified sex therapist to overcome it. But they also needed couples counseling to repair their broken relationship. 

Vaginismus is the involuntary contraction of the muscles surrounding the vagina, which usually makes intercourse impossible. Sufferers have no control over this tightening. Statistics are hard to come by, but research suggests that as many as 17 percent of the women who seek sex therapy suffer from it. There are two types: Women with 'primary vaginismus' cannot be penetrated by anything; those with 'situational vaginismus,' like Natalie, can tolerate tampons and gynecological exams but not intercourse. The cause varies: It may be the result of a rigid religious upbringing that frowns on sex; a traumatic experience, such as sexual abuse or rape; relationship problems, such as infidelity; or anxiety or control issues left over from childhood. Some cases seem to have no explanation at all.

Vaginismus is Highly Curable

"I've treated a number of patients who suffer from vaginismus, but all of them either had a strict religious upbringing or had suffered sexual abuse -- neither of which seemed to be the case with Natalie. Her anger at her parents' preoccupation with her disabled sister and their neglect of her led me to hypothesize that her vaginismus may have resulted from emotional struggles in her family. Plus, her first attempts at intercourse were painful and negative, which likely reinforced her tendencies. 

"Her mother's blatant disregard for her feelings of abandonment contributed to Natalie's pleasure inhibition and survivor guilt (a common reaction among healthy siblings of severely disabled children). Since Natalie had no control at home -- that is, she couldn't get her parents to take her concerns seriously and make her feel cherished and important -- she sought to gain control over herself and her own body. Even though Natalie wanted to have sex with Brad, in order to do it, she would have to relinquish control of her body and give herself permission to feel pleasure. The thought of sex provoked anxiety, which, in turn, caused the physical symptoms to emerge. 

"Vaginismus is highly curable. Many sufferers have no sex drive, but because Natalie was able to achieve orgasm, I thought her prognosis was good. Additionally, in my clinical experience, being in an otherwise good relationship -- which Natalie and Brad's was -- enhances the likelihood of a long-term cure.

Continued on page 6:  The Counselor's Turn, continued


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