Be Bold and Courageous


Diagnosis of 


It is beneficial to seek a diagnosis for any type of sexual pain, including pain due to penetration problems. Some women may have an underlying physical cause to their vaginismus that needs to be determined so that it too may be treated. Diagnosis can be complex, especially when a medical condition is involved. We recommend choosing a doctor who specializes in women’s health issues like a gynecologist. In an informal poll, on our private forum, about 60% of women who responded indicated they had received a diagnosis of vaginismus from their doctors. 


Some women might feel uncomfortable discussing their sexual difficulties with doctors. It’s common to feel embarrassment, shame, or anxiety in such a situation. If that applies to you, try to ease your apprehension as you seek answers. Remind yourself that by sharing these personal details, you are taking care of your health. If you broke your leg today, would you find treatment? We suspect you would. Just because it is not as easy to see your internal anatomy as a broken leg, does not mean it is less important.

Although we have great respect for the multitude of medical professionals involved in women’s health, vaginismus is among the most misdiagnosed and misunderstood of all medical conditions. Not only is the condition poorly understood, frequently misdiagnosed, and confusingly treated, the medical and technical definitions and recommendations are often confusing and contradictory even for physicians.

Uninformed professionals will often alternately wonder:

      “Is she biologically unusually small or tight?”

      “Does she need a surgical procedure?”

      “Does she need physical therapy?”

      “Does she need a psychiatrist?” 

Regrettably, many women have been directed towards unnecessary surgery or ineffective treatment suggestions by well-intending professionals. Physical abnormalities capable of preventing intercourse are extremely rare. In almost all cases, the genital area is completely physically normal and rather it is the limbic system overreaction causing the observation and experience of penetration tightness. 

While it is always recommended to obtain a medical diagnosis, vaginismus is indicated in the vast majority of cases where female penetration is impossible or uncomfortable due to tightness.

Our mission at and Hope and Her is to help as many women as possible with this condition. 

Both websites detail important information about vaginismus and we invite all those suspecting a possible diagnosis to read through the various site topic areas.


Today, there are many wonderful resources to help women learn about vaginismus and treatment. The self-help book offered through our Hope and Her store, go into great detail about the symptoms, causes, and training protocols for successful vaginismus help.

Pelvic Exam as Part of Vaginismus Diagnosis

A typical pelvic exam involves two parts: an external review of your genital area, and an internal exam (with a speculum and/or finger). The exam takes place while you are lying on your back on an exam table with your knees spread apart. Your abdomen and thighs are covered with a paper sheet or blanket.

      External Exam - The doctor will visually inspect the outer genitalia, which includes the clitoris, vaginal opening, urinary outlet, and the labia. Any signs of unusual redness, discharge, irritations, or growths are recorded. She may then take a cotton swab and touch it to several spots around the vaginal area to check to see if there are any sensitive spots of pain.

      Internal Exam - When vaginismus is suspected, doctors will often begin the internal exam by inserting one or two lubricated fingers into the vaginal opening to see if there is any resistance and to check for any tenderness or abnormalities along the vaginal walls.

      Depending on how that goes, she may then move on to inserting a speculum. This tool is used to separate the walls of the vagina so that the vagina and cervix can be visualized and examined. To increase comfort, most doctors lubricate and warm the speculum to body temperature before its inserted. You may feel a slight pressure as it is opened. A small spatula or tiny brush may then be used to collect cells from the cervix for a Pap test. This test screens for any abnormal cervical cells. You may feel a cramping sensation at this point. The collected sample is then sent to a laboratory. Cultures of cervical discharge may also be taken using a swab. The speculum is then removed.

      Depending on how extensive the pelvic exam is, some doctors may then place two fingers into the vagina while pressing down on the uterus. This assesses the shape and or size of the uterus, checking for any fibroid growths or cysts and/or signs of infection. 

      If you are unable to complete the internal exam, the doctor will consider this reality in forming the diagnosis. The results from your pelvic exam and your description of the pain and/or difficulties with penetration will help to eliminate other conditions that could possibly be causing the pain. It is important to note that just because you may be able to complete a pelvic exam successfully does not mean that vaginismus should be ruled out. For some women with vaginismus, penetration only becomes painful or impossible during attempted penis entry.

To assist women in obtaining a reliable diagnosis for their sexual pain, our modifiable script includes helpful tips to

prepare for a physician visit. 

Sample Script

Introduce the Problem

“I have been having problems with pain during sex and hope you will be able to help me.”

Provide a Description of the Pain

It happens when… “my husband tries insert his penis in my vagina” or “once he is inside and starts to move, I feel burning and tighten up,” etc. The pain is located… “at the entrance to my vagina. My vagina is like a wall; he just cannot get it in” or “after he is inside I feel burning around the penis just inside the entrance,’ etc. The pain lasts… “as long as he keeps trying, especially if we try forcing it in. Once he stops, there is no pain.” This has been happening since… “our honeymoon two years ago and it‘s continued to happen every time we try to have sex” (primary vaginismus) or “my hysterectomy eight months ago” (secondary vaginismus), etc. It feels like… “burning” … “stinging” … “like he’s hitting a wall” … “tightness during/on entry,” etc. I have tried to reduce or eliminate the pain by… “using lubricant, changing sexual positions and relaxing more.” I am able/unable to… “insert a tampon or complete a gynecological exam.”

Mention Any Past Problems

Have you previously had any sexually transmitted diseases, yeast infections, bladder problems, or any pelvic pain outside of penetration?

Mention Any Past Sexual Abuse

This may be difficult for you, but remember that the abuse was not your fault.

State What You Think the Problem Is

“I think it may be vaginismus. My symptoms are similar to those outlined in an article I read. However, I have read there are other things that can cause pain during sex and would like to have them ruled out.”


Tips to Ease the Situation

For many women who experience vaginal tightness, gynecological exams can be quite frustrating or difficult. The mere approach of the doctor’s hand or speculum can cause the vaginal muscles to tighten. Here are some tips:

Bring a friend or partner for support.

Request the smallest size of speculum. 

Relaxing is key to reducing the level of discomfort. As much as possible relax your stomach, thigh, and bum muscles. As the exam begins, breathe slowly and deeply. 

Distract yourself by focusing on a picture on the wall, on your plans for that evening, or by talking to your support person. 

Ask your doctor to describe what is being done as it is happening. 

Communicate any discomfort you may feel as the exam is taking place.

Be Bold- Advocate for Yourself

Obtaining an accurate diagnosis can be challenging. Some women have been misdiagnosed, resulting in unnecessary, invasive, and potentially harmful surgeries and medications. Often, women have been ignored and left undiagnosed. In some cases, doctors who see nothing physically wrong and have not received training in diagnosing vaginismus, fail to give due attention to the woman’s concerns and do not consider researching a proper diagnosis. Seek a second opinion if you are not satisfied with the results of your examination. Vaginismus symptoms generally do not resolve on their own. We encourage you to be bold and advocate for your health to receive diagnosis and treatment care.


“Seek a second opinion if you are not satisfied with the results of your examination”

Is My Hymen the Problem?

It is not uncommon for a woman who has never had pain-free penetration to wonder if her hymen is the cause of her problem. This is almost never true. IN NEARLY ALL CASES OF DIFFICULT FEMALE PENETRATION IT IS DUE TO INVOLUNTARY VAGINAL MUSCLE TIGHTENING, not hymen problems. Unfortunately, there have been cases where doctors have mistakenly recommended surgery for removing the hymen when they are unable to penetrate the vaginal opening with a speculum during an exam. Again, the speculum insertion difficulties are nearly always due to the tight constriction of the vaginal muscles—not due to a rigid or thick hymen. Regrettably, some women are unintentionally led by well-meaning but uninformed medical professionals to believe that surgery will cure what is in fact actually vaginismus. Instead, surgery may lead to additional pain, scar tissue, and no resolution of the problem. 


In VERY RARE situations, surgery for an overly thick or rigid hymen may be warranted. However, it is critical to get a second opinion whenever surgery is recommended, to help prevent acting on misdiagnosis, and to ensure a full review of other options for less invasive alternatives. While surgery may resolve a hymen issue (if there truly was one), misdiagnosis is unfortunately only too common.

Other Causes of Painful Intercourse

What is Solution Focused Practice?

Solution-focused practice began as a way of doing therapy and many people who use it are still therapists. We now talk about solution-focused practice because the approach can be used in many more contexts than just in therapy. It is a way of helping that focuses on people’s hopes and preferred futures, movement that is taking place in these desired directions, and on the strengths and resources that can enable this movement to happen. Another way to understand the solution-focused approach is to notice what its practitioners don’t focus on, which includes problems and causes, assessing and diagnosing. Solution- focused practitioners typically don’t give advice, but rather pay attention to and help draw out people’s own ways of resolving difficulties and making progress.
To find out more, listen to this interview with Guy in the very first of the UKASFP podcast series -

What can I expect if I embark on solution-focused brief therapy?

Most importantly, you can expect to be listened to, very closely indeed, and for your hopes from the therapy to be at the centre of what happens. The questions you are asked will come from what you say and from your hopes in particular, rather than from theories the therapist might have. You can expect not to have to retell problem stories you might have told many times before, while at the same time the therapist will give you space and listen attentively whenever you do need to talk about your difficulties. At these and all other times, you will also experience a curiosity about your strengths and resources, and about your hopes and what you want to be happening in your life. The evidence suggests that solution-focused therapy is an effective approach, and that its useful effects can emerge after a small number of sessions - sometimes just a single session can enable a person to make sufficient changes, with between three and five sessions being an average. A small number of people will continue for more sessions, and find this useful.

What do clients say about their experience of solution-focused therapy?

Here are a few typical comments from clients of mine: “I like the way Guy got me to think of ways of helping myself instead of giving me all the answers.”
“You got me to realise that it wasn’t just Matthew who needed help. You showed me that I needed to change my approach to things as well, without making me feel that I wasn’t a good mother.” “We were always given time, never made to feel that we were a nuisance and always came away feeling more positive.”
“Questions were asked of us which made us think about things in a different way.”
“After using this service for a second time, it has given me the confidence to not only make a decision but to believe in that decision, and carry it forward and change the parts of my life I felt out of control in.”

Who can benefit from solution-focused therapy and from solution-focused practice more generally?

The research is positive, with studies consistently suggesting that most people who have solution-focused therapy find it useful, and there is evidence that where it is not effective it does not appear to do any harm. Regarding who can benefit from it, there do not appear to be any client groups or types of problem where a solution-focused approach has not proved useful at some point.
So, given that the research doesn’t indicate a 100% success rate - no therapy could claim that - this could be summed up as: Solution-focused therapy could help anyone, but it won’t help everyone. As it can’t be predicted in advance who it won’t help, it might well be worth giving it a go, especially as when it does help this tends to happen after only a small number of sessions.

What experience does Guy have?

My experience in social care and therapeutic work goes all the way back to 1983, after I left University and spent a year doing full-time voluntary work, to help me decide if this was the sort of work I wanted to do. I qualified as a social worker over 30 years ago, and first trained in solution-focused brief therapy in 1995. I first worked in the field of adult mental health in 1984, and much of my time as a social worker, from 1989 to 2004 was spent working with children and families. Since then I have specialised as a solution-focused therapist and counsellor, working with individuals, families and groups. I also have considerable experience as a supervisor and consultant, with individuals and groups of workers.

Who can attend Guy’s training courses?

My courses are usually aimed at people who are already working in a helping capacity, so that they can gain additional skills to use in what they do.
Anyone who talks or communicates in some way with others, in order to help change to happen, to help resolve problems or achieve goals, is likely to find solution-focused practice a relevant and helpful approach, and so would be welcome to come on one of my courses.

How does Guy approach his training?

I wrote a piece about solution-focused training a few years back, which you can find on my Resources page. It conveys the excitement I still feel about training and supporting people in using this approach. It talks about what is different about solution-focused training, which I believe includes the following: It gets straight on with it! - 5 minutes into my first course and I was already practising a solution-focused conversation. An assumption of competence – We assume that trainees bring lots of abilities in working with people and build on these. Learning by doing – You don’t learn to drive in the passenger’s seat! Solution-focused training is light on presentations of theory and heavy on practice. Appreciative feedback – We focus on what trainees are doing well throughout. Tracking progress – We enable trainees to pay attention to how their skills are developing. Assuming successful application – On follow-up courses, we assume that learners will have made good use of the skills they have developed, and start from there.

What else does Guy offer?

I offer many other skills and services in addition to therapy and training. I am an experienced supervisor and consultant, with teams and groups as well as individual professionals. I am an experienced workshop presenter and keynote speaker, and my facilitation and chairing skills were developed to a high level during my time as Chair of the British Association of Social Workers.

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Phone: 1.619.449.1200

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