Dear Tend

You ask us your sexual wellness-related questions. We get sex therapist Dr. Terri St. George to answer them.

Tend: What do I do if my anxiety is physically preventing me from having sex?

Terri St. George: Without doing a full assessment, it sounds like what we might be looking at is a condition called vaginismus. Vaginismus is a relatively common condition [in people with vaginas] involving involuntary contraction and tightening of the pelvic floor muscles in anticipation of sex (vaginal penetration). This involuntary reaction occurs if penetration is perceived as or expected to be painful or scary or risky. Fears (sometimes unconscious) of sex being painful, fears of your vagina being too small or whether or not you can “fit” a penis, fears of STD’s or pregnancy, religious or cultural internal conflicts, all can lead to this condition.

Often [people] with vaginismus also describe being unable to use tampons, have a GYN exam, and even insert their own finger into their vaginas. It can feel painful or it can feel tight and closed up, like you’re hitting a brick wall.

The good news is that vaginismus is totally treatable. With the right help and support (GYN, pelvic floor physical therapist, sex therapist), you can learn to relax those pelvic floor muscles and enjoy sex (intercourse), if this is something you want.

It might also be helpful to consider intercourse as just one menu item in a full, satisfying meal. If you can expand your idea of what “sex” is, you can enjoy all the other things you can do (solo or with a partner) to have pleasure and connection.

T: Is it abnormal to use lubricant during sex? How many women need it in order to have a pleasant experience?

TG: It is completely normal to need/want/enjoy/use lubricant during sex! I don’t know how to emphasize that enough. Many [people] regularly use and enjoy lubricant for all sorts of reasons. It makes things feel better and makes condoms work better. If you happen to believe that you “shouldn’t” need it or that you are “too young” to be dry or you “should” be able to go for a third time because your partner is ready, I would suggest you challenge that line of thinking.

If you worry about not lubricating “enough” or losing lubrication during a sexual experience, I would be interested in learning more about your experience. My first question would be: Are you aroused (physically & mentally) enough? Do you know what that takes? For many women, sufficient arousal means 15-20 minutes of “foreplay” type activities (think clitoral stimulation) before they are ready for intercourse. Another thing to consider - is your head in the game (are you mentally aroused – you’re not distracted and able to stay present and focus on your pleasure/sensations/erotic thoughts or fantasies)?

Needing lubrication doesn’t mean you are broken or abnormal. It doesn’t mean you aren’t attracted to your partner; it doesn’t mean you don’t like sex. But it might mean that your body isn’t ready for intercourse at that moment; or you’re not really into it; or you have already climaxed, so you will naturally lubricate less, or using a condom is naturally drying so lube is a must.

As always, if you have concerns about your ability to become aroused and/or lubricate, make sure to check in with your GYN. Sometimes medications like antidepressants and birth control pills or health conditions can negatively impact arousal & natural lubrication levels, so you’d want to rule those factors out.

T: Can it be psychologically impairing to be too dominant or submissive during sex?

TG: I think what this question is getting at is: What is the line between dominance and control? and between submission and victimization? And perhaps what are the risks of each style?

I would imagine that the risks of being “too dominant” during sex would be that one might confuse dominance with (or use the dominant style or label as a cover or excuse for) aggressive, sadistic, entitled, controlling, manipulative or abusive behavior. In this scenario, consent could easily be dismissed and ignored. On the other hand, the potential risks of being “too submissive” or having a passive sexual style would be: being taken advantage of, used, assaulted, abused. Someone who has a more passive sexual style might not know how to say “no,” set boundaries, give consent, or get their needs met.

I’m not sure if this question is also talking about BDSM roles – Dominants & Submissives — and whether or not folks who identify as such can be psychologically harmed by this play? Harm happens when there are consent violations – inside and outside of the BDSM community.

However, to the point above, there is no evidence that folks who are kinky and identify in this way are less psychologically healthy or have more childhood trauma than anyone else. In fact, some studies suggest the contrary – that they have better psychological health and well-being than those who don’t participate in BDSM. [A 2013 Journal of Sexual Medicine study expresses this idea].

T: What creates a fetish?

TG: A fetish, for those who don’t know, is being aroused by a non-sexual object, body part, or bodily secretion. The classic example of a fetish is a foot fetish. But there are a multitude of other less well-known examples. Having a fetish is not a consequence of trauma, and it is not inherently unhealthy or pathological. A fetish may become a problem when it interferes with normal functioning or causes extreme psychological distress or negative consequences.

The most honest answer to the question of where do they come from is - we don’t really know. All we really have are some ideas and theories. One of the most popular theories is that fetishes are learned and originate somewhere in our childhoods when the “object” of arousal (feet, leather, urine, navel) was associated with sex and arousal (the non-sexual object or body part was sexualized). Some people are able to remember and identify this initial experience and others are not.

Tend: What do I do if my anxiety is physically preventing me from having sex?