The clinical portraits on this blog are anonymised composites. They combine features of several patients to protect each person’s privacy while remaining true to the experiences encountered in my practice.
Yasmina came to my practice at the age of 24, eight months after getting married. Her husband, Karim, came with her. It was their first session, and he spoke first.
‘We don’t know what to do. We love each other. We want to be together. But we haven’t managed it. Not once.’
They had married eight months earlier. It was a marriage they had chosen, not an arranged one: two young adults from the same community, raised in practising religious families. They had met while studying engineering, fallen in love and waited until marriage to have sex, in keeping with their values.
Once they were married, Yasmina’s body said no. Not occasionally, but every time. Penetration had never been possible. Their families, expecting a pregnancy soon after the wedding, had started asking questions.
What can make a body close before it has been touched?
Yasmina described no trauma, assault, rough examination or distressing first intercourse. Karim was exceptionally gentle, and before their marriage she had enjoyed their kisses and touching over clothes.
What made her body close was not one event. It was many different messages that had built up over twenty-four years:
- Her mother bursting into the bathroom when Yasmina was seven and exploring her body, shouting: ‘We don’t do that. It’s dirty.’
- The local imam saying in a sermon about modesty that a woman’s body was a source of fitna — disorder or temptation.
- Her cousin, married at 22, crying on the sofa two weeks after the wedding because she had not known ‘it would hurt that much’.
- The complete silence from her mother, aunts and friends about sexuality: a silence that seemed to say both ‘we do not discuss this’ and ‘this is extremely serious’.
- The unspoken assumption she had absorbed that the first night would hurt, that she would bleed and that she would have to ‘put up with it’.
- The quieter but constant message that desire was immodest, pleasure degrading and wanting something sexually was for men.
When Yasmina found herself naked beside Karim, the patient husband she loved, her body was not only responding to him. It was responding to everything she had been told about what was supposed to happen in that bed. Her pelvic floor clenched like a fist.
Cultural complexity without simplistic conclusions
I want to be clear about this: I see women from many backgrounds, religions and traditions. Anxiety and vaginismus associated with silence around sexuality do not belong to one religion or community. I have encountered them among practising Catholics, Orthodox Jewish women, practising Muslims and secular women from families where sex was simply never discussed.
The pattern can be similar across these settings: when sexuality has been surrounded by silence, it may be difficult for the body to feel safe when intimacy becomes possible or expected. Without information, an internal sense of permission or an understanding of the body, the message ‘this is forbidden’ may remain powerful.
For Yasmina, another challenge was working on this without rejecting her culture. She did not want to leave her religion or cut herself off from her family. She wanted to reconnect with her body within a framework she valued. Therapy needed to respect that.
What we worked on together
The work with Yasmina lasted ten months. Karim joined six couples sessions. There were four strands, developed alongside one another.
1. Understanding the body. Yasmina did not know some basic things: that the hymen does not necessarily tear or bleed, that lubrication is not simply a matter of willpower, or that her pelvic floor could contract without her noticing. Three sessions focused on sex education, using drawings, diagrams and books. For the first time, she had a clearer picture of her own anatomy.
2. Internal permission. We explored the messages she had absorbed. The aim was not to silence them: she experienced them as the loving voices of her mother and grandmother. It was to give them a different place — recognising their meaning without allowing them to govern the body of the adult woman she had become.
3. Changing the conversation as a couple. Karim was a deeply supportive partner, but he had grown up with the same silence. He believed a man was supposed to know what to do automatically and felt ashamed that he did not. In couples sessions they could speak about it together, aloud and without embarrassment. Naming what was happening already reduced the pressure.
4. Gentle physical exploration. Yasmina worked on her own, at her pace, with a Velvi XS dilator, with no obligation towards Karim. This physical work began only in the fourth month, after she had started to feel more psychological room to move.
The moment things changed
It was not successful intercourse, an orgasm or an erotic moment.
It was a conversation during their fifth couples session.
For the first time, Yasmina said to Karim:
‘I want you to know something. When we were engaged, I was afraid you would think I was dirty if I wanted sex. So I pretended not to want it. Now we’re married and you’re waiting for me to want it, and I don’t know how any more.’
Karim cried, with relief rather than sadness. Without realising it, he had been waiting to hear this. He replied:
‘You’re allowed to want it too. I will never think you’re dirty. That’s what I miss. Not you opening up for me. You wanting it.’
Three weeks later, they had penetrative sex for the first time, after using a dilator and with lubricant. There was no drama, bleeding or pain.
Yasmina wrote the next day: ‘I didn’t cry. I don’t know whether it’s normal not to cry, but I didn’t. It was good.’ Those few words meant a great deal.
If you recognise yourself
Perhaps something in Yasmina’s story feels familiar. You grew up in a family, religion or community where sexuality was never discussed, or was surrounded by solemnity, modesty or fear. You are married, or about to marry, and your body resists the intimacy expected of it.
Three things to remember:
- You do not have to choose between your culture and your body. Therapy can respect your values. Look for a practitioner who does not ask you to reject everything you believe.
- Understanding the body can be an important first step. Words, diagrams and clear information may need to come before dilators or other physical exercises.
- Your partner has a role beyond patiently waiting. It includes opening a conversation, making room for things you have never been able to say and speaking honestly about their own experience.
To explore further
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Related articles:
- Léa, 19: primary vaginismus before any attempt at penetration.
- Vaginismus and the wedding night: moving beyond cultural pressure.
- Five common mistakes partners make around vaginismus, and how to talk about them.