Tell Me About It: I have fallen in love but I can’t have sex

Q I am now in my late 50s and I want to tackle a problem that has haunted me for many years. I'm in a relationship with a man, and I think that I might want to spend the rest of my life with him. But I can't have intercourse and I don't know how to tell him. I am so afraid that it might break us up.

I’ve known I’ve had this problem since first trying to have sex about 30 years ago, and I think I understand where it is coming from. My mum got pregnant whenever my dad came home – he worked abroad and came home every year for a few months. I think I picked up her fear of pregnancy, and my body just won’t let any penetration happen.

I’ve always had flirtations, but backed off when it felt like things were getting serious. Now I am so afraid that I might lose my one chance at happiness.

A What you are describing is vaginismus, a condition that affects many women. There are many reasons why this happens, from the physical to the emotional and psychological. Even if the original problem is physical, the worry and fear that builds around it are often in themselves difficult to tackle.

Sometimes vaginismus can occur even when, at an earlier time, intercourse could happen successfully. Perhaps pain is experienced, and this gets worse over time. The result is often avoidance or withdrawal from a relationship. Of course, this has consequences for relationships and happiness, and the sooner something is done about the problem, the better the chances of a good outcome.

Having a full physical check-up is often the first stage. After that, working with a chartered physiotherapist can help you strengthen muscles and gain confidence in your body. If no physical condition is found, then, as seems to be the case with you, some psychological work is needed.

Very often, the first point at which someone is willing to face the problem is when she finds she has someone in her life that make this huge task worthwhile. It seems you trust the man in your life enough to allow him access to your innermost feelings, and so you now have the motivation to begin.

If two people are working on the problem, the outcome is often faster and more likely to succeed, so it is recommended that both of you attend a professional who deals with these issues.

Your response is multilayered: a habitual physical response, plus an avoidance/ fear psychological response. You must recognise that your body is trying to protect you from danger, even though your mind says it is safe. Working slowly with your body and not demanding that it “fix” itself is the initial step – this will be facilitated by the professional you are working with and will require homework and practice. If we want to achieve anything in our lives, it requires effort, and this is no different.

Making sense

However, you have a partner in this situation, and, if he is willing to participate, then the work might not only be more successful but also more fun.

We are trying to train the body to connect with the senses in the moment, and it is very helpful to have someone to connect you to your body when your mind starts criticising and becoming negative.

Sensate-focus exercises are often recommended – putting intercourse off the agenda for a while and focusing on connecting with the senses in a gradual way, starting with non-sexual touch and gradually moving to more sexual touch.

Working with the history of fear and negativity and the pattern of avoidance is also a huge part of sorting out this problem. Gaining some sense of self-knowledge and control over this pattern is something that will stand to you for life.

This problem also affects young women, and it is vital that they don’t put off dealing with it, as the resultant avoidance becomes a problem in itself. In my experience, young men in a relationship with someone who has vaginismus do not run away but are often very understanding and patient in their willingness to support their partner.

The intimacy that results from a couple opening up to such an extent can only add to a relationship, and says a lot about their capacity for honesty and trust. Accepting the problem and seeking help are the first steps to fun and connection – now is the time to do this.

Trish Murphy is a psychotherapist. For advice, email tellmeaboutit@irishtimes.com. We regret that personal correspondence cannot be entered into