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.

Léa entered my practice on a Tuesday morning in January. Nineteen years old. In her second year of a law degree. She sat down, clutching her bag against her thighs, and said, before I had time to ask a question:

“I think I have vaginismus. I’ve never had intercourse, but I think I have it.”

And she was right.

How you can know before trying

This is a question older women often ask when they hear Léa’s story. “How can you know you have vaginismus if you’ve never tried?”

You can know because the body gives signs. Léa had had hers for a long time:

  • At 13, she could not insert a tampon. Not one failed attempt — four attempts over two years, then abandoned. Her mother told her “you need to practise”. She practised. Always the same: the tampon stopped at the entrance, as though against a wall. She continued using pads.
  • At 16, her first gynaecological examination. The gynaecologist took out the speculum, Léa tightened, the gynaecologist pushed a little, and Léa screamed. “You’re very contracted”, she was told. No further explanation. No name for it.
  • At 17, her first experiences of masturbation. No difficulty reaching orgasm through external stimulation. But when she tried a finger inside — stopped. Blocked. Painful. She gave up.
  • At 18, her first boyfriend. They kissed and touched each other, a lot. Every time the conversation moved towards “what if we tried?”, Léa felt her body stiffen, her lower belly contract and her desire disappear. She told her boyfriend “not yet”. Three times. Four times. Eventually she admitted that she did not know whether she would ever be able to.

Then she did something half the women of her generation do in that situation: she typed “I can’t put a tampon in” into Google. And in three clicks, Google led her to the word vaginismus.

What she did that most people do not

At this point, many young women do two things:

  1. They tell themselves “I have time; it will pass”
  2. They hide the problem from their partner and the people close to them

Léa did the opposite. She told herself “I don’t have time — I’m 19 and I want to be able to choose”. And she came for a consultation.

That is rare. It is precious. And it is precisely why her therapeutic work was shorter than average.

The clinical profile

At assessment, this is what we established together:

  • Type: primary vaginismus (no completed penetration, ever)
  • Dominant mechanisms: reflex contraction of the pelvic floor (mechanism 1) + anticipatory fear (mechanism 2) — no relational or medical mechanism
  • Identified aggravating factors: the traumatic gynaecological examination at 16 (no intentional violence, but no explanation and real pain), anxiety-provoking messages from her mother about sexuality (“be careful, it hurts the first time”), and a complete absence of credible sex education at school
  • Favourable factors: no major traumatic history, real family support, a patient and cooperative partner, strong capacity for self-reflection and desire present

What worked

The work lasted nine months. Three strands in parallel:

Strand 1 — Gentle body work at home. Daily diaphragmatic breathing (10 minutes a day). Gradual external touch with her hand (thighs → belly → vulva), without any aim of penetration for the first six weeks. Then introduction of a size XS Velvi dilator, held still for 15 minutes, with breathing. No timetable — her own pace.

Strand 2 — Pelvic health physiotherapy. Two sessions a month with a physiotherapist trained in hypertonicity. Manual touch allowed Léa to locate precisely where her pelvic floor was contracting. Crucial information: before that, she thought “everything was tightening everywhere”. In reality, it was two specific points in the levator ani.

Strand 3 — Brief trauma-focused psychotherapy. Six sessions of gentle EMDR on the memory of the gynaecological examination at 16. That was enough to deactivate the association “something entering my vagina means danger”. No need for lengthy psychotherapy; Léa did not have structural trauma, but an isolated procedural memory.

The turning point

Eight months after starting, Léa could insert a size M dilator without pain. Three weeks later, she had intercourse with her boyfriend for the first time. Without pain. Without a dilator the day before to “prepare”. Without an anxiety-provoking ritual.

She came back once more to review things. She told me:

“I didn’t think it would be so simple in the end. I mean — it was hard, nine months is a long time, but on the day, it was as if my body had simply forgotten to defend itself.”

Her body had forgotten to defend itself.

That is exactly what we are looking for. Not to “force it open”. Not to “defeat the reflex”. But to allow the nervous system to unlearn the defence it had learnt.

If you recognise yourself

Perhaps you are Léa. Or you were Léa ten or twenty years ago. And you wonder whether it is still possible at your age.

It is still possible. The work is different — sometimes longer, sometimes structured differently, sometimes with a relational component that was not present for Léa. But the principle remains: a body that has learnt to close can learn to open again. Provided it is offered the right conversation, not the right command.

If you recognise yourself in Léa’s profile — primary vaginismus, young, no completed penetration, few aggravating factors — and you want to act now rather than wait, know that:

  1. You are not too young to seek help. At 19, 20 or 22, you are actually in the best window — automatic responses are less deeply established.
  2. You do not need to wait until you have a partner to begin. Working on your own beforehand spares you the pressure of a partner who is waiting.
  3. Three to nine months are enough in most primary cases without associated complications.

Going further

If you would like to explore the 8 complete clinical portraits and identify your own, I wrote Votre Vaginisme : fini l’errance, dénouer le plaisir selon votre profil.

Léa appears in Part I of the book — alongside seven other portraits covering the full range of situations.

➜ Receive the free extract + join the early readers’ list (in French)

Articles in the same series:

📖 Going further — Scarlett Kaplan’s book, Votre Vaginisme: the most comprehensive French-language reference on vaginismus.