I’ve been working with clients dealing with painful sex for over a decade now, and there’s one question that comes up a lot: “Was it vaginismus, or was I just not into my ex?” It’s such a good question – and honestly, not always easy to answer.

If you’ve ever experienced pain during sex in one relationship but not another, you might have wondered—was it my body or the relationship itself? This question can feel frustrating, but the answer is rarely black and white.

What’s Actually Happening with Vaginismus

Vaginismus is basically when the muscles around the vagina tighten up involuntarily. It’s not something you consciously control – it’s more like a reflex, like when your leg kicks out at the doctor’s office when they tap your knee.

I find it helpful to think about vaginismus in two main ways:

Primary Vaginismus: When someone has never experienced pain-free penetration. Think of it as your body’s default setting being “nope, not today.”

Secondary Vaginismus: This develops after previously having comfortable experiences. That’s often what I see in my practice – someone who was fine, then had some painful experiences, and now their body’s developed this protective response.

This often leads to a pain-fear cycle, where pain triggers fear, causing more muscle tension and leading to further pain.

The confusing part? This can look different depending on what else is going on.

I had one client who was convinced she just wasn’t attracted to her ex-partner. But through our work together, we realized she’d developed vaginismus after several painful encounters where she felt pressured to continue despite discomfort. Her body basically learned: penetration = pain = danger.

It’s Not Just “All in Your Head”

Let me clear something up – vaginismus isn’t imaginary or “just psychological.” It’s a real physical response, even though emotions and relationship dynamics can trigger or worsen it.

Think about it this way: your body is smart. Really smart. It’s constantly trying to protect you, even when you’re not aware of it.

I’ve seen numerous cases where someone’s body essentially says, “Hmm, last time we did this, it hurt. I’m going to tighten these muscles to prevent that happening again.” Then that tightening causes more pain, reinforcing the cycle.

What makes this extra complicated is that stress, feeling unsafe, or being with someone who doesn’t listen to your needs can absolutely make muscle tension worse. So yes – relationship dynamics matter a ton, but that doesn’t mean the vaginismus isn’t real.

So Which Was It: Vaginismus or Incompatibility?

After years of working with clients asking this exact question, I’ve found the answer is often “both.” Here’s what I mean:

Many people I work with developed genuine vaginismus (a physical condition requiring treatment) that was triggered or worsened by relationship dynamics. So both elements are true:

1. Yes, your body developed a real protective response (vaginismus) that caused involuntary muscle tightening
2. Yes, relationship factors likely contributed to it developing or becoming more severe

Think of it this way: If you sprain your ankle because someone pushed you, the injury is real and needs treatment – even though relationship dynamics caused it.

The good news? Understanding this dual nature helps with recovery. By addressing both the physical symptoms and creating safer relationship dynamics, many people find complete relief.

So, does vaginismus simply ‘go away’ with a different partner? Not quite. Vaginismus isn’t usually something that completely disappears just by changing partners. It typically needs some form of treatment. But symptoms might be less intense with someone who makes you feel safer.

When Relationship Dynamics Come Into Play

One thing I’ve noticed over years of practice – our bodies sometimes know before our minds do when something’s off in a relationship.

Sometimes, our bodies pick up on relationship dynamics before we consciously do. A sense of pressure, judgment, or even an unspoken emotional disconnect can manifest physically.

Maybe you were with someone who:

• Made you feel rushed or pressured
• Didn’t really check in about your comfort
• Made you feel judged or inadequate
• Just didn’t create a sense of safety

Under those circumstances, is it any wonder your body might tense up?

I remember struggling to explain this to a client who kept saying, “But I should have been able to just relax!” I asked her if she could “just relax” while sitting in a chair that felt unstable. Of course not – your body stays tense because it’s trying to keep you safe.

Pelvic floor physical therapy is honestly the gold standard. A good PT can help you identify exactly which muscles are tensing and teach you how to relax them. It’s been game-changing for so many of my clients.

Dilator therapy can be really helpful too – it’s basically a way to gradually get your body used to penetration in a controlled, non-threatening environment. You go at your own pace, using progressively larger dilators when you’re ready.

Therapy helps many people, especially if there’s anxiety or past negative experiences feeding into the pain cycle. CBT (cognitive behavioral therapy) approaches tend to work well.

Sexual therapy or coaching is another valuable option many people don’t know about. These specialists focus specifically on sexual function and can bridge the gap between physical treatment and emotional healing.

Relearning Pleasure & Awareness is also crucial – understanding your anatomy and reconnecting with enjoyable sensations can help reprogram those pain pathways.

And yes – finding a partner who’s patient, communicative, and makes you feel emotionally safe can make a huge difference in your treatment journey. But – and this is important – changing partners alone isn’t usually enough to resolve vaginismus completely.

What Actually Helps

If you’re dealing with painful penetration – whether with all partners or just certain ones – here’s what actually works:

If you’re reading this and thinking, “that sounds like what I experienced,” know you’re definitely not alone. Vaginismus is actually pretty common – it’s just not talked about enough.

The most important takeaway? Vaginismus is treatable. Really treatable. I’ve seen so many clients go from painful penetration to comfortable, enjoyable sex.

Don’t let anyone tell you it’s just about finding the right partner, or just about getting therapy, or just about physical exercises. For most people, addressing both the physical and emotional components works best.

And remember – having experienced pain with one partner and not another doesn’t mean you were making it up or that it wasn’t “real” vaginismus. Our bodies respond to our environments in complex ways. Both things can be true: you might have developed vaginismus AND been in a relationship that wasn’t right for you.

Listen to what your body’s telling you. It’s usually trying to protect you for a reason.

By learning to listen to your body with compassion, you reclaim control over your own pleasure and healing. Whether through self-exploration, professional support, or open conversations, you deserve a fulfilling, pain-free intimate life.

About Dr. Martha Tara Lee