Why does it hurt when I have sex? Vaginismus and Vestibulitis; What are the differences?

For many women who suffer from Vaginismus or Vestibulitis, sex is uncomfortable in the least and excruciating in the worst. Although portrayed positively and enjoyable in all medias (movies, TV shows, books, social media etc.) some women are unable to imagine a positive, sexually satisfying experience during intercourse. Sex, therefore, has a dark side for women who suffer from Vaginismus and/or Vestibulitis. These women have to endure the struggles of these conditions affecting their sexual life, love life and even general health. Both Vaginismus and Vestibulitis can cause severe pain during intercourse, one that might even compel the woman not engaging in sexual activity.

Vaginismus and Vestibulitis are two separate issues. According to Wikipedia, the definition of Vaginismus is:

"...a condition that affects a woman's ability to engage in vaginal penetration, including sexual intercourse... This is the result of an involuntary vaginal muscle spasm, which makes any kind of vaginal penetration painful or impossible."

And the definition of Vestibulitis is:

"...characterized by severe pain with attempted penetration of the vaginal orifice...The feelings of irritation and burning can persist for hours or days following sexual activity..."

- Vaginismus is a condition resulting in pain during intercourse because of muscle spasms.
- Vestibulitis results in pain during intercourse due to over sensitivity and over stimulation of nerve ending around the vulvar area.

When trying to diagnose Vaginismus, there would usually be the question about sexual abuse, especially at a young age. It was commonly believed that the muscle spasms happen because of the psychological trauma of such events during childhood. While it could be and is the case on many occasions, Vaginismus doesn't always occur due to psychological issues. Either way, it can be treated.

While Vaginismus has been around as an acceptable diagnosis for decades, it is not the case with Vestibulitis.
Vestibulitis is still quite a new territory, and even many doctors haven't really heard of its existence. It has only started to get recognition in the medical and sexual fields in recent years. Before that it used to be confused or attributed to Vaginismus. Before Vestibulitis became a real thing of its own, the answer doctors would give women complaining about pain during penetration was: "Everything is fine down there, it must be in your head". That response (like in the Vaginismus case) causes women to believe they were traumatized as young children by someone who's sexually abused them, and could not find a real cure besides going to therapy for many years and hopefully get better.

There is no doubt that some women who suffer from Vaginismus had experienced childhood traumas that probably led to the involuntary contraction of their muscles. But, it is not the rule. Not every woman with Vaginismus went through sexual abuse.
Some believe that it is the same case with Vestibulitis. That some sort of trauma caused these hyper sensitive nerve ending in the vulvar area to emerge. On the other hand, it can be a strictly physical issue. Since it is a developing field, and the actual reason for Vestibulitis is still being researched - there is no clear cut answer. Anyway, in both cases of Vaginismus and Vestibulitis, the stress and anxiety that are created because of the inability to sexually function can cause new trauma.

Treatments for Vaginismus come in many shapes and forms but they all have the same notion in mind. Learn to control your muscles better. But, the physiological aspect always takes its toll. Even if the condition is not due to traumatic past history, hurtful experiences that the woman has suffered probably made her pretty anxious and nervous. Now, she knows she's going to experience pain; and that doesn't really help when you're trying to relax as much as possible so the muscles wouldn't contract. The physical part is pretty simple: Kegels and other exercises to strengthen the pelvic floor. If that's all the woman needs, that's fine. If she has been mentally shaken due to the issues that accompany the condition or have previous issues that might make her anxious or nervous during intercourse, therapy is usually recommended. That said, if the issues are not severe, sometimes just a supportive partner goes a long way.

There are many different ways to try to handle Vestibulitis. most of the times there's a need to mix a few of the methods together to completely relieve oneself from the pain.
Here are some of the treatments recommended by doctors.

WARNING: Trying to treat Vestibulitis without consulting a physician can cause severe and possibly irreversible damage to your body!

Change of diet- Some women with vestibulitis are very sensitive to salt crystals that exit the body in the urine we give. Some speculate that these crystals have sharp edges, and so they cause pain and irritation at the entrance to the vagina. If it was decided by the doctor that dietary change is the best course of treatment, the patients would be given a detailed list of food she may and may not consume. The diet can help in many cases if you maintain and follow it strictly, but usually, it is only suggested as an "add-on" that comes with another treatment.

Taking better care and being cautious - Avoiding unneeded simulation of the vulva area like bicycling and horseback riding. Also, washing the exterior vaginal region each time after giving urine with water. And, if using soup burns in the shower, it shouldn't be used.

Medications - Certain drugs for epilepsy dull the nerves. In the case of Vestibulitis, the nerves are overly sensitive. Those medications are taken to balance the hypersensitivity of the nerves by trying to numb them a bit. The medications can be taken orally or use an ointment that is directly applied to the vulvar region. This treatment is long and tedious. The ointment, for example, needs to be applied twice a day, morning and evening for 3 months. This drugs and course of treatment are only accessible through a doctors' approval and under medical supervision.

Surgery - This is the last resort option. It might take a year or more for a physician to decide they want to put a patient under the knife. Different combination of medication would and should be tested before deciding to go through the operation. The actual operation apparently involves scraping or completely removing the over sensitive nerve ending around the vulva area.

Sex should not be painful. There're a number of reasons why intercourse can hurt the woman, and although the social and personal pressure that is put on said woman, there is no need to have painful sex. These issues can and should be addressed and taken care of.