The clinical portraits you will read on this blog are anonymised composites: they bring together characteristics of several patients to protect each woman’s privacy while remaining faithful to the reality of the practice.
Hélène came to me at 52. It was our first session and she cried for almost the whole hour. Not great sobs — a steady, gentle rain, which she wiped away with the back of her hand, apologising.
“I’m sorry. I never cry. But this is the first time in thirty years that I’ve been able to talk to someone about this.”
Hélène had lived with vaginismus for thirty years. She had never experienced completed penetration. She had married at 23 and divorced at 31 — without ever consummating the marriage, something neither she nor her former husband had ever told anyone. Since then, no sexual relationships at all. She had built her life around that absence, calling it “asexuality”, then “a lifestyle choice”, and then nothing — because eventually, you no longer even have words for what has ceased to be.
Then one Saturday morning, by chance, she had opened a women’s magazine at her hairdresser’s. And read a three-column article about vaginismus. And recognised herself. She had cried all day. She had made an appointment on Monday.
What she had not had
Hélène had not had:
- A diagnosis. At 18, during her first gynaecological examination, she had been told “you’re very tense”. At 22, just before her wedding, she had tried to have sex with her fiancé — impossible. She had told herself it would come. It had not.
- Information. The word vaginismus had never crossed her path. Not at school. Not in her family. Not in books. Not with the doctors she had occasionally consulted for other reasons. They had all seen her, palpated her, examined her — none had named it.
- Support. Her former husband had been patient for eight years, then eventually left, hurt without understanding why. Her family had never known. One friend, when she was in her thirties, had suspected something; Hélène had closed that door.
- A chance to rethink desire. Hélène had given up imagining a life with sexuality. Not because she truly lacked desire — because she had adapted to the impossible. When I asked her, “if it were possible today, would you want it?”, it took four sessions before she could answer.
The work that is not mechanical
With Hélène, I did not begin with dilators. I did not begin with breathing. I did not begin with physiotherapy.
I began with a question, asked in our third session:
“Hélène, for thirty years, you have lived without being able to experience penetration. What you have been through is immense. Before we think about how you might regain that possibility, I need to understand something. What does it mean to you to put a word to something that had no name?”
And that was where the real work began.
Because what Hélène needed to do, above all, was grieve for all the women she might have been: the woman who might have had a child, the woman who might have kept her husband, the woman who might have lived a different life — instead of the one she had been forced to build by systematically avoiding situations where sex might arise. Grieving for closeness as a couple. For spontaneity. For the possibility of passing life on through a woman’s body.
No dilator can do that grieving. It is long, slow psychotherapy, to be undertaken before or alongside any work with the body.
The two years that followed
The work with Hélène lasted two years. And that was little, really, to make up for thirty years.
Phase 1 — Grieving and naming (6 months) Weekly psychotherapy, focused on putting things into words, acknowledging her experience and the anger that rose as she realised what she had been left to carry alone.
Phase 2 — Permission (6 months) Allowing Hélène to reclaim the idea that yes, at 52, she had the right to want a sex life. Not an obligation. A right. And that this right was hers even if no partner was on the horizon.
Phase 3 — Working with the body (12 months) Only then did we introduce body work. Not with a partner — Hélène did not have one and did not want one for this phase. With her own body. Breathing. External touch. Recognising her vulva in a mirror (yes, at 52, this was the first time). Very gradual work with Velvi dilators. Alongside this, work with a physiotherapist trained in hypertonicity and vulval care in mature women.
By the end of the two years, Hélène could insert a size M dilator without pain. She still had not had intercourse — she had no partner and was not looking for one. But something fundamental had changed.
She wrote to me six months after our last session:
“I went to the gynaecologist last week. For the first time in my life, I had an examination without tensing up. She looked. She said, ‘that’s very good’. I came out, sat on a bench and smiled to myself for ten minutes. Thirty years avoiding that moment. And there it was, just an examination. Like everyone else.”
Like everyone else. That was her goal. Not an orgasm. Not a marriage. Not perfect penetration. Being like everyone else in this particular part of a woman’s life — knowing that her body can welcome something inside without danger.
What Hélène’s story teaches us
Three things:
1. It is never too late. Hélène was 52 when she put a name to what had been happening since she was 18. She may be 55 when she first has intercourse, or perhaps she never will — and that is fine too. The goal is not performance. The goal is an end to searching without answers — knowing what you have, what you carry and what you can choose to do about it, or not.
2. Grieving comes before mechanics. When vaginismus has lasted ten, twenty or thirty years, work with the body cannot come first. First, there must be grieving. Naming the loss. Acknowledging the anger. Allowing what has been held in to surface. Without this grief, the body refuses the invitation to open again — because opening again also means acknowledging what has been lost.
3. Society bears responsibility. Hélène went without a diagnosis for thirty years because medicine and culture did not want to see. This is a collective issue, not an individual one. And the first thing to say to a woman like Hélène arriving in the practice is: “this is not your fault. You were left without a name for it and without care for thirty years. That is what is abnormal, not you.”
If you recognise yourself
Perhaps you are Hélène. Or Hélène at 40. Or Hélène at 60. You have lived for a long time with silent vaginismus, sometimes without even having the word.
Three steps to begin, even later in life:
- Name it. Read. Find out more. Recognise yourself. Say out loud, alone at home: “I have vaginismus”. That is already part of the work.
- Find someone to talk to. Not your GP first (statistically, they will not know). A sex therapist trained in vaginismus. Or a psychotherapist willing to take the time. The first appointment is the hardest. Afterwards, it gets less hard.
- Allow time for grief. Do not skip stages. You are not competing with your own life. The body follows, in the end. Always.
Going further
If you would like the full chapter on late-diagnosed vaginismus and grieving as part of repair, I wrote Votre Vaginisme : fini l’errance, dénouer le plaisir selon votre profil.
The book specifically addresses the situation of women who discover their vaginismus after 40, 50 or 60, with protocols adapted to a nervous system that has operated in defence mode for decades.
➜ Receive the free extract + join the early readers’ list (in French)
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