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Dear Dr. Myrtle,
I have difficulty with vaginal penetration. When I try (for the first time, or again after some time has passed) to have intercourse, it hurts and I just don’t want to try again. Is there anything I can do on my own, or do I need professional help?
 For some, vaginal penetration can be uncomfortable or impossible, and can cause difficulty with intimate sexual penetration or hamper your ability to be examined by your healthcare provider. While there are a variety of causes of difficult penetration, we’ve designed a general plan that you can tailor to your own needs that can help you gain comfortable contact with your vulva and vagina. We suggest progressing over a period of months, and looking for small successive changes to happen without trauma or pain.
Step #1: Vulvar Massage
A thorough massage of the entire vulva (clitoral hood, clitoral head, labia lips, vaginal opening, and the perineium) is important for sexual arousal and comfortable penetration.  Many women who do not have narrowing of the vaginal opening or vaginal atrophy experience discomfort with vaginal penetration because they are not in an adequately aroused state before penetration is attempted. Sexual arousal brings blood to the genitals, and primes the nerves and blood vessels for the state of sexual excitement. A sexual warm-up massage is important for dilation and enlargement of the vulva and vaginal opening, and for some women is the highlight of the sexual experience.
Vulvar massage acts as more than sexual arousal, and to perform a vulvar massage you do not necessarily have to be, or become, aroused. Like other types of massage, touch will increase blood circulation to the area being massaged, and help the skin increase its flexibility. To perform a vulvar massage, you may want to warm your hands with warm water, and make sure you have a moisturizing sexual lubricant available (we recommend Liquid Silk), both to reduce skin friction and to increase the moisture of your vulvar skin.  We recommend a circular motion with the pads of your fingertips, concentrating the pressure on the tissues beneath the skin, rather than pulling at the skin's surface. We also suggest that you spend a minimal amount of time at any one point, lifting and moving your fingers often.
If you find that you are persistently uncomfortably with vulvar touch, you may have a condition called "vulvodynia", or "pain of the vulva". Common causes are allergies, inflammation of the glands of the vulva, or irritation at the vaginal opening. Each cause has a different recuperation path, so see your healthcare provider to learn more about your vulvar health.
Step #2: Do you have a stiff Hymenal Ring?
(If you are wondering whether you have inflammation of the vulva, pelvic floor spasm, or a hymenal ring problem, it is much, much less common to have a thick hymen ring than the other two problems. This information on the hymen is included for completeness, but don't put too much emphasis on this issue, when compared to the other two.)
Early in early fetal development, a ring structure grows as the internal vaginal structure forms. Often this ring is covered by a thin skin membrane called the "hymen", which is easily broken accidently by a fall or rough play, or broken with first penetration. Most women have a fairly thin hymenal outer ring which held the hymen membrane in place and causes no problem with penetration.
However, a small percentage of women struggle with penetration because the outer ring of the hymen is quite thick. Some massage work is successful at slowly relaxing this band, while some women might require surgery to open the ring up. Work with your healthcare provider if you think this might be an issue for you.
Step #3: Working with the Pelvic Floor
Many women with whom we speak have difficulty consciously relaxing their pelvic floor muscles; but comfortable vaginal penetration requires a healthy relationship between you and your pelvic floor. See the Pelvic Floor Strength article (linked in the right sidebar on this page) for more information.
Step #4: Help your Vagina Function Comfortably during Penetration
The walls of the vagina are made of the same skin as the outer part of your vulva. Once you are comfortably able to massage your vulva and the first 2-3 inches into the vagina, the interior portion of your vagina needs gentle massage as well. For this, lots of women use a smooth-surfaced dildo or vibrator, which allow you to reach deep inside no matter what width your current comfort allows. As your needs or desire dictates, you can choose to graduate up a size, and continue internal vaginal massage to what ever width meets your health and pleasure needs.
Dr. Myrtle
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