Vaginismus, vulvodynia: why your partner is part of the treatment (and not just part of the scenery)

This article is based on a review of recent scientific literature concerning genito-pelvic pain and its relational dimension, as well as on my academic research on the flexibility of dyadic sexual scripts.

"It hurts every time I try to penetrate." "My body shuts down, I can't do it." "I was told it's all in my head." And almost always, in consultations, the same scenario unfolds: the woman comes alone . Alone with her pain, alone with her guilt, alone with the implicit mission of "fixing her problem" before returning to her partner. Sometimes, it's even the partner who explicitly expects her to "get better." Yet it is precisely this scenario that research over the last fifteen years has dismantled piece by piece: in vaginismus and vulvodynia , the pain manifests in the body of only one person—but its intensity, its progression, and its chances of recovery depend on both. Studies show that the partner's reactions to the pain measurably modify its intensity. This isn't a metaphor: it's physiology.

The pain is in her body. But its intensity, progression, and healing depend on two people. A woman who consults a doctor alone for vaginismus means the couple is depriving themselves of half the treatment.

Une femme en couple qui consulte seule pour un vaginisme, c'est un couple qui se prive de la moitié du traitement.

Vulvodynia, vaginismus, GPPPD: what exactly are we talking about?

Historically, medicine distinguished between two conditions. Vulvodynia —the most common form of which is provoked vestibulodynia—refers to chronic vulvar pain, typically described as a burning or cutting sensation triggered by pressure on the vestibule (the vaginal opening): penetration, tampon use, gynecological examination, or sometimes even simple contact. Vaginismus refers to an involuntary and persistent contraction of the pelvic floor muscles that makes penetration difficult, very painful, or impossible—the body involuntarily "closes up."

Research subsequently revealed considerable overlap between these two presentations: muscle hypertonia, anticipatory fear of penetration, and vestibular hypersensitivity are found in both. In 2013, the DSM-5 therefore merged these diagnoses into a single category: Genitopelvic Pain/Penetration Disorder (GPPPD) . This change in classification marks a paradigm shift: sexual pain is no longer considered an isolated organic abnormality, but rather a multidimensional experience where the biological, emotional, cognitive, and—crucially— interpersonal aspects mutually influence one another.

These pains are common: prevalence studies estimate that approximately 8% of women experience vulvodynia at some point in their lives. And yet, the typical journey remains a medical odyssey lasting several years, marked by missed diagnoses and devastating phrases—"it's all in your head," "relax," "have a glass of wine." We will see later that this medical dismissal is not merely an emotional wound: it directly affects the couple's relationship.

Why is consulting alone not enough?

The answer lies in a simple observation: genito-pelvic pain occurs, in the vast majority of cases, during shared sexual activity . The partner is not a distant spectator of the problem—they are a direct witness to it, every time. And research conducted since the 2010s, notably by the teams of Natalie Rosen and Sophie Bergeron, has established that their reactions—what they say, what they do, what they think at the moment the pain manifests—act as true modulators of their partner's painful experience .

This research program is one of the most robust in contemporary sexology: studies on 191 couples experiencing vestibulodynia (Rosen et al., 2010), on 179 couples (Lemieux et al., 2013), daily diaries kept by couples for eight weeks (Rosen et al., 2014, 2015), and analyses of attachment styles in 125 couples (Charbonneau-Lefebvre et al., 2021). The findings are consistent: the couple's dynamics predict the progression of pain , day after day. Treating the woman alone means treating half the system.

The four reactions of the partner — and their measured effect on pain

This is the most concrete contribution of this research: the reactions of partners fall into four types, the effects of which on pain have been quantified. Some results are profoundly counterintuitive.

• The overprotective reaction : excessive sympathy, worry, constant attention to symptoms, and the suggestion to stop at the slightest sign of pain. This is the quintessential "good partner" reaction—and the most paradoxical finding of all this literature: excessive solicitude is associated with an increase in pain intensity. By constantly validating the threat, it reinforces the woman's hypervigilance to pain signals, encouraging avoidance and passivity. Good intentions are not enough; overprotectiveness can actually worsen the pain.

• The negative (hostile) reaction : frustration, annoyance, reproaches, guilt-tripping, emotional rejection in the face of pain or refusal of intercourse. Its effect is the most damaging: acute relational stress and fear of rejection activate the sympathetic nervous system and trigger a reflexive defensive contraction of the pelvic muscles—precisely the muscles involved in vaginismus. The partner's hostility literally, mechanically, aggravates the disorder.

• The dismissive (invalidating) reaction : minimizing, denying, or labeling the pain as an "excuse" or a "purely psychological" problem. This destroys the emotional security necessary for any sexual vulnerability and pushes the woman toward the worst possible strategy: silent endurance —submitting penetration despite intense pain to preserve the relationship. However, these endured encounters worsen vestibular micro-lesions, perpetuate local inflammation, and reinforce the sensitization of the nervous system: each endured encounter makes the next more painful.

• The facilitative (adaptive) response : validating the reality of the pain while maintaining intimacy—expressing physical affection, encouraging the exploration of painless erotic activities, without making penetration the goal of the encounter. This is the only response associated with a significant decrease in pain and a lasting improvement in sexual function and satisfaction—for both partners.

Daily newspapers confirm this on a detailed level: a woman's sexual function improves on days when her partner is perceived as accommodating, and deteriorates on days of intense solicitude or negativity. The partner does not influence pain "in general"—he influences it on that particular day .

How does the partner's reaction affect physical pain?

Two cognitive mediators explain this transmission. The first is catastrophizing —the tendency to amplify the threat, ruminate on the pain, and feel powerless in the face of it—which is the most robust psychological predictor of the severity of chronic pain. The work of Lemieux et al. (2013) shows that the partner's catastrophizing independently predicts more intense pain in the woman: when he panics internally, she experiences more pain. The second is couple self-efficacy —the shared belief that the couple is capable of managing painful episodes without sacrificing intimacy—which has a documented protective effect: it reduces anticipatory anxiety, limits avoidance, and releases reflex pelvic tension.

Finally, attachment styles explain why each partner reacts the way they do: anxious attachment (fear of abandonment) leads to hyperarousal—demanding behavior, frustration, negative reactions—while avoidant attachment leads to withdrawal and invalidation, with a marked deficit in facilitative responses (Charbonneau-Lefebvre et al., 2021). And when a dismissive doctor has stated that there is "nothing physical," the partner's doubt is validated: they may begin to interpret the pain as a pretext, a sign of disaffection, or manipulation—the vicious cycle of invalidation is complete. This is why the partner's presence during consultations, including the diagnostic examination that objectifies the pain, often changes everything: the pain ceases to be an allegation and becomes a shared experience.

How do we heal ourselves — as a couple?

Modern management of GPPPD is multidisciplinary and, by construction, dyadic.

• Involve the partner from the start : not as a companion, but as an active participant in the treatment. The first step is psychoeducation for both of them: understanding the neurophysiological reality of pain (it is neither imaginary nor a choice), and learning to recognize one's own reaction patterns — reducing overprotection, eliminating hostility and invalidation, developing facilitating responses.

• Deconstructing the penetration-centric script : In most of the couples involved, penetration has become the sole symbol of successful sexuality—a pressure that directly increases reflexive pelvic hypertonicity. Sex therapy works to explicitly suspend, by mutual agreement, all penetration during a phase of treatment, and to reinvest in a repertoire of pain-free intimacy (approaches stemming from sensory focusing). This work has a name in contemporary research: it is the flexibility of dyadic sexual scripts —the capacity of the couple, and not just one partner, to evolve their scripts in the face of a sexual challenge. This detail is far from anecdotal: this construct originated precisely in the field of sexual pain—the first flexibility scale (Gauvin & Pukall, 2018) was developed to understand why some couples facing vulvar pain maintain a satisfying intimate life while others collapse. The answer: the former loosen their script, the latter cling to it. Recent dyadic studies (Hunker, 2025) confirm that this flexibility, measured at the couple level, is associated with less sexual distress in both partners.

• Re-educating the body : specialized pelvic-perineal physiotherapy (muscle tone re-education, biofeedback, progressive use of dilators at the patient's pace) addresses the muscular component and sensitization. It is all the more effective when the relational climate has ceased to activate the defense reflex it seeks to reprogram—this is how the work between the couple and the bodywork enhance each other.

• Addressing attachment and communication : When negative reactions or silent resistance take hold, couples therapy can defuse one partner's fear of abandonment and the other's withdrawal, restoring communication where pain can be expressed without justification. This relational aspect lends itself very well to online consultations—including for couples where one partner is reluctant to "go to therapy": the screen often makes things easier.

Conclusion: it's not up to her to fix herself.

Vaginismus and vulvodynia are not women's problems that women should resolve alone before returning to their relationship. These are disorders where the pain resides in the body, but whose intensity, trajectory, and healing are determined by the relationship—research has established this with remarkable rigor, supported by dyadic studies and daily diaries. A partner can, unknowingly and with the best intentions, perpetuate the pain; he can also, once equipped, become the most powerful factor in the healing process.

So if you experience pain during penetration and are planning to seek help, come with a partner if possible. And if your partner believes "it's your problem"—that might be where therapy should begin.

Sabrina Beloufa, Clinical Psychologist, Couple Therapist & Sexologist, Specialist in erotic flexibility for French speakers worldwide.

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Sources:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). (The fusion of vaginismus and dyspareunia in GPPPD.)

Charbonneau-Lefebvre, V., Rosen, NO, Bosisio, M., Vaillancourt-Morel, M.-P., & Bergeron, S. (2021). Attachment and partner responses in couples coping with provoked vestibulodynia. (Study of 125 couples: attachment styles and partner responses.)

Gauvin, SEM, & Pukall, CF (2018). The SexFlex Scale: A measure of sexual script flexibility when approaching sexual problems. Journal of Sex & Marital Therapy, 44 (4), 382-397. (The emergence of the construct of flexibility in the field of sexual pain.)

Harlow, B.L., et al. (2014). Prevalence of symptoms consistent with a diagnosis of vulvodynia. American Journal of Obstetrics and Gynecology, 210 (1). (On the prevalence of vulvodynia.)

Hunker, K. (2025). The Sexual Script Flexibility Scale – Dyadic (SFS-D). (Flexibility measured at the couple level in a population with vulvar lichen sclerosus.)

Lemieux, AJ, Bergeron, S., Steben, M., & Lambert, B. (2013). Do romantic partners' responses to entry dyspareunia affect women's experience of pain? The roles of catastrophizing and self-efficacy. The Journal of Sexual Medicine, 10 (9), 2274-2284. (Study of 179 couples: catastrophizing and partner self-efficacy.)

Rosen, NO, Bergeron, S., Leclerc, B., Lambert, B., & Steben, M. (2010). Woman and partner-perceived partner responses predict pain and sexual satisfaction in provoked vestibulodynia couples. The Journal of Sexual Medicine, 7 (11), 3715-3724. (The seminal study of 191 couples: the paradox of solicitude.)

Rosen, NO, Bergeron, S., Glowacka, M., Delisle, I., & Baxter, ML (2012). Harmful or helpful: Perceived solicitous and facilitative partner responses are differentially associated with pain and sexual satisfaction in women with provoked vestibulodynia. The Journal of Sexual Medicine, 9 (9), 2351-2360.

Rosen, NO, Bergeron, S., Sadikaj, G., Glowacka, M., Baxter, ML, & Delisle, I. (2014). Relationship satisfaction moderates the associations between male partner responses and depression in women with vulvodynia: A dyadic daily experience study. (Daily journals over 8 weeks: the day-by-day effect of partner responses.)

Rosen, NO, Bergeron, S., Sadikaj, G., & Delisle, I. (2015). Daily associations among male partner responses, pain during intercourse, and anxiety in women with vulvodynia and their partners. The Journal of Pain, 16 (12), 1312-1320.

Simon, W., & Gagnon, J. H. (1986). Sexual scripts: Permanence and change. Archives of Sexual Behavior, 15 (2), 97-120.

Weeks, GR, Gambescia, N., & Hertlein, KM (2016). A Clinician's Guide to Systemic Sex Therapy . Routledge. (The intersystemic approach to sexual dysfunctions.)

Weiner, L., & Avery-Clark, C. (2017). Sensate Focus in Sex Therapy: The Illustrated Manual . Routledge.

Keywords: Vaginismus, vulvodynia, GPPPD, pain during intercourse, dyspareunia, vestibulodynia, partner reactions, couples and vaginismus, flexibility of dyadic sexual scripts, sex therapy, perineal physiotherapy