My problem: I can’t seem to have sex. There are both physical and psychological factors. Trying to have sex really hurts. Insertion is extremely painful. Before I started getting naked with my current boyfriend, I hadn’t inserted anything at all, ever. Over the course of my current relationship, I’ve been able to allow painless insertion of his finger (or mine), which is great… but I still have a pretty intense fear reaction if he reaches for my vaginal opening. Fingering is OK for me, as long as I know exactly when and where it’s going to happen, which is really annoying. Even when I do know, it’s still scary for me, even if I’m not experiencing any pain.

As for actual sex… I don’t know, the idea just scares me. And like I said, trying is really painful. I’ve tried SO hard to just “get over the pain” and go for it, but it’s seriously overwhelming and reinforces my fear response every single time I try. It’s the most frustrating thing in the entire world and it makes me feel totally sexually inferior and it just really, really sucks.

So you’re probably thinking that I’ve either experienced some sexual abuse, or I need to go to a doctor. Well, I haven’t been sexually abused, and I’m petrified of going to the doctor, because god knows what they’ll do. I can’t endure a pelvic exam, it simply hurts too much, and I realize that going to a doctor will likely involve a pelvic exam, and I simply can not do that right now. I’m looking for some alternative help.

And yes, I’ve looked into vaginismus. I’m not sure that it’s exactly what I’m dealing with here, but it well could be. If it is, I need a free and confidential way to deal with it because I’m an extremely broke college student, and while I have health insurance, it’s my parents’ plan, and they’re certainly not advocates of sex before marriage but I want to have sex, I’ve wanted to have sex for a while now, because I’m in love and in a healthy relationship and I really think I’m ready… I just can’t seem to do it!

Any advice or resources you can share?

Thanks so much in advance… and for reading all of this. I certainly don’t mean to sound so angry but this is a daily struggle that is really having an adverse affect on my life–and while my boyfriend is extremely supportive, and even encouraged me to write this e-mail, believe me… he’s not a fan of it either! HELP!

A: Thanks for writing with your question. It sounds like a frustrating experience!

The first thing we want to stress is that a visit to your doctor should not result in an automatic (and possibly painful) pelvic exam. Ideally, you would be able to see someone who will be able to deal with your issue appropriately, i.e. by listening to your concerns and proceeding in a way that will help you figure out the problem. As a patient, please do advocate for yourself! You have rights during a doctor’s visit: when something hurts, you can say “stop,” and you can also ask to see a different physician. This can be a hard thing for people to remember, but it’s important!

I doubt that information can get from your doctor’s office to your parents, unless you see a physician your parents know. Health insurance bills aren’t usually detailed. Plus, there are plenty of good and perfectly legitimate reasons for a young woman– sexually active or not– to be visiting a gynecologist. You mentioned that you’re a college student– is there a clinic at your college that you can visit? Can you bring a friend with you to keep you company and to help you remember to self-advocate?

It sounds like you’ve already contemplated quite a few of the possibilities, from the physical to the psychological. The fact that there’s been some “painless” insertion of fingers is a sign that vaginismus might not be what’s going on, although we cannot diagnose that from here!

There’s a long article on the excellent Scarleteen website called “From Ow to Wow! Demystifying Painful Intercourse“, and it mentions a few things that might be useful to you: first, especially, that “any kind of sex shouldn’t be about a lack of pain, but about the presence of pleasure.” Are you “warmed up” or aroused enough when you’re trying to have sex? I understand that the combination of fear of the pain can be a powerful counteracting factor. It’s possible, too, that his penis might be too large for you, or that you need more warm-up (with a finger or two) before trying the insertion of something larger. Points number 5 & 6 ask about sufficient lubrication and anatomy, and number 7 talks about the psychological factors, which I think might be especially important for you. You might want to consider their advice about seeking counseling (again, does your college have a counseling clinic? many of them do) in this case.

A: Good communication is often a key to positive sexual experience. However, you don’t have to spell everything out right away if it makes you feel uncomfortable. You can mention that you are less experienced, and would want your partner’s instructions. It might start an honest dialogue, an opportunity for her to explain to you what she likes. Also, relax, sex is not a marathon. Take it slow, explore each others bodies and minds at a speed and comfort level compatible to you. Pay attention to what you like and she likes, and you will probably start learning very fast.

Many men worry about the size of their cock. However, there are plenty of men of all sizes that have satisfying sexual relationships. Your cock size probably won’t be a big issue, but should this be a problem for your partner, there are alternate sexual positions you can try together. On all fours with a partner entering vagina from behind (doggy style) helps to increase the depth of penetration. You can place a pillow under her abdomen for her comfort. Some people also like to use sex toys, and/or mutual masturbation, and/or oral sex. Some women care about full penetration, others don’t, and prefer foreplay, oral stimulation, or other forms of sex play instead. Communicating about it is the only way to know for sure!

A: First times can be a lot of pressure and stress. For most men having one orgasm by masturbation or oral sex allows them to keep a second erection for a longer period of time. Most men need 10-15 minutes before getting a second erection. Remember, if you do cum once and would like to get another erection there are many activities you can do for and with your partner while you’re waiting to get hard – like oral sex for them or other stimulation.

We recommend that if you know you’re going to have sex in the evening, plan to have an orgasm in the afternoon. That way you’ll be less sensitive for your sexual date and you won’t have to depend on oral sex before intercourse. It will take some of the pressure off.

A: By the age of 21, most women have had their hymen break, and not necessarily through sexual activity. It does sound like it is possible that you could have had some tearing or breaking of your hymen. Sometimes, it will tear partially and some of it will be left intact. It is also possible that the bleeding was unrelated to your hymen. Some women do experience some spotting on occasion that is not their period, especially during times of stress.

A broken hymen does not mean that you have lost your virginity. Many women have their hymens break before having actual intercourse. It can break with regular physical exercise, insertion of tampons, or from masturbation, as well as from intercourse.

Virginity can mean different things to different people. For many people, virginity is connected to having vaginal intercourse, and for others, different sexual activities may also be connected. The definition of virginity can also change over time, as the currently held definitions of virginity might not reflect the same definitions that were true many years ago. We recommend that you identify what feels right for you. If somebody in the future questions your virginity, it may be important to ensure that you are working from the same definition. You can define it for yourself and your relationship.