Camille, 28: situational vaginismus — why with him and not with someone else

The clinical portraits on this blog are anonymised composites: they combine features from several clients to protect each person’s privacy while remaining faithful to the reality of clinical practice.

Camille came to my practice with a question that often returns, phrased almost identically:

‘Why does my body do this with him, when it has never done it with anyone else?’

Twenty-eight, an engineer, in a relationship with Antoine for three years. Before Antoine, two longer relationships and several shorter encounters. None had ever been painful. None had ever been blocked. Until then, sex had been something simple, enjoyable and free from drama for her.

Then, a year earlier, it had begun. Pain at the entrance at first, which she put down to tiredness. Then avoidance, which crept in without her noticing. Then impossibility — the moment Antoine tried to penetrate her, her body contracted, like a door closing by itself.

Yet whenever she thought about Sasha, her ex from four years earlier, her body responded normally to the memory. She could touch herself. She could reach orgasm. The wall was not in her anatomy. The wall was in the relationship.

Situational vaginismus — the least discussed form

When we say vaginismus, we most often imagine a woman who has never been able to have penetrative sex. Primary vaginismus. Or a woman who lost that ability after a medical event or childbirth. Secondary vaginismus with a physical cause.

Camille is neither. Camille has situational vaginismus: her body closes in a particular relationship, at a particular time, with a particular partner. With others, or at other times in her life, that same body would function without difficulty.

This is the most confusing type of vaginismus for clients — and the most neglected by practitioners, because it does not look anatomical. Yet it is extremely common. In my practice, one consultation in five resembles Camille’s.

What our exploration brought to light

When Camille and I reviewed the previous twelve months — not chronologically, but looking for what had developed in her body — several things emerged:

Antoine wanted a child, and brought it up regularly. Not with harsh pressure. With a gentle, repeated, persistent insistence.
Camille was not sure she wanted that child — not with him, not now, not in the life she had built. She had never expressed that ‘not’. She had always answered ‘we’ll see’.
Antoine had begun drinking a little more after changing jobs six months earlier. Not enough to speak of alcoholism. But Camille did not like the smell in bed in the evening.
Camille’s mother-in-law was going through a difficult period, and Antoine was carrying her through it, making him both indispensable and emotionally absent.
Camille had been promoted four months earlier, which made her more visible professionally, more mobile and — though she had not put it into words — more able to imagine another life.

No single element would have been enough. Together, they formed the context her body had perceived and was responding to.

The dominant mechanism: the body refuses what the mind cannot allow

Camille belongs to what I call women whose bodies speak before their minds. These women read their relationship situation accurately, but do not have the inner permission — cultural, familial or marital — to express what they feel.

Their mind says: ‘I am with a good man, he loves me, we are building something; I cannot break it all over a doubt’. Their body says: ‘I do not want this sperm to fertilise me, I do not want this intimacy, I do not want to be here’. And the body wins, because the body has not learnt to lie.

The pelvic floor contracts. The vagina closes. Sex becomes impossible.

The trap with situational vaginismus is that people first look for causes where none exist. There are examinations. Lubricants are tried. A physiotherapist is consulted. Everything is normal. And everything remains blocked. Because the cause is not in the body — it is in the body’s reading of the context.

The work that made sense

Camille and I worked together for eleven months. The work was not body-based at first. It was cognitive and relational, and only afterwards — because an automatic response had nevertheless developed — body-based.

First phase (three months): allowing Camille to name what she felt. No prescription. No protocol. Individual psychotherapy in which she could put into words things that had been forbidden to her until then — the idea that perhaps she did not want a child; perhaps she no longer wanted this relationship; perhaps she had grown while Antoine had stayed where he was.

Second phase (four months): couples work. Not to ‘save the relationship’, but to find out whether a shared life was possible that respected who Camille had become. Antoine came. He cried a great deal. He listened. They decided to continue together — but differently.

Third phase (four months): gentle body-based work to undo the automatic response. By then, Camille no longer needed to close her body — her mind had said what it needed to say, the relationship had changed and the context was no longer the one that had triggered the closing. But the pelvic floor had acquired the habit. A few sessions of breathing and gradual touch with her partner were enough.

The turning point

Camille wrote to me one evening, three months after our last session:

‘Last night, it worked. No ritual, no protocol. Antoine fell asleep before me, and I watched him sleeping and thought: this is my husband, and I want him. I no longer knew whether that was possible.’

The turning point in situational vaginismus is not a moment when ‘the body opens’. It is a moment when the mind finally permits what the body was asking for — by changing the context, leaving it or accepting what is in it. The body follows. Always.

If you recognise yourself

Perhaps you are Camille. Vaginismus developed within a particular relationship, when you had never experienced it before. And you are exhausting yourself looking for the cause in your anatomy, your psyche or your distant past.

Three avenues to explore:

Assess your current context, not your anatomy. What changed in your relationship, your life or how you related to your partner during the 12 months before vaginismus appeared?
Do not rush towards dilators. In situational vaginismus, they are at best unhelpful and at worst reinforce a false problem (you are treating a symptom whose cause lies elsewhere).
Individual therapy generally comes before couples therapy. You first need to be able to name what you feel for yourself before you can share it.

And then this sentence, which I often repeat to clients like Camille:

Your body is not a safe to force open. It is a witness to your life. Listen to it.