#1299: “Any tips for non-binary people with vaginismus?”

Rae McDaniel is back today, with many expert recommendations for interrupting the body-parts-gone-rogue => pain => anxiety about pain => weird body feelings- cycle.

Hi Rae!

I’m a bisexual agender person [they/them] (probably?) in their mid-20s. I happily present in a butch-androgynous style, but it is also often assumed that I am a woman. As I’ve gone through and methodically questioned my gender identity (a balance of record-keeping, “if-I-didn’t-have-to-deal-with” scenarios, and finding what’s useful in day-to-day life), I’ve become 95% certain that I’m nonbinary. So, yay! Self-knowledge! Unfortunately, there is one notable elephant left in the room.

Okay, there’s no way around this, I have a vagina, and a common condition known as vaginismus. Basically, any kind of “insertion” is horribly painful. I have a hard time getting through pap smears, and most kinds of penetrative sex aren’t possible. For how common it is, it’s also not very widely understood. I’ve had doctors say I should just try again, or imply that I was fake crying during a pap exam.

While I get very specific dysphoria about other stuff, I don’t about penetration. I like the idea, it just hurts. Physically. Just a lot of non-sexy pain. Is vaginismus the cause of the nonbinary feels? Nope, I can trace these feelings back to the pre-discovery days. But, wow, it sure doesn’t help. Especially when a lot of messages about women and sex revolve around penetration in some way. There’s also a swirling cloud of worry about other people’s assumptions and how my experiences could be twisted against me or other nonbinary people that make it very hard to feel confident in my gender identity.**

Also, there’s the deep irony of being treated closer to a non-binary gender when people assume that I’m a lesbian. However, as inconvenient as it is, I am bisexual and it’s possible I could date a dude at some point.

How do you sort through gender identity with a big, painful elephant in the way? Any tips for non-binary people with vaginismus?

Thank you,
More than the Sum of My Parts

Hi Love!

Rae here.

Big congrats on the journey of self-discovery and celebration of your non-binary identity! A lot of folks don’t take the time and energy it requires to really explore their gender and miss out on the freedom that you’ve discovered for yourself. It’s a real gift to understand yourself so deeply.

Let’s dive right into your concerns about vaginismus.

First of all, I’m sorry that you’re having to deal with this. Pain during penetration is not only painful physically. It also brings up a host of big and painful feels.

This is an amazingly common problem and, yet, most people who experience pelvic pain often feel incredibly alone.

It doesn’t help that most doctors (and a lot of gynecologists) don’t truly understand pelvic pain conditions and give advice that ranges from annoying and unhelpful to truly damaging. It is never ok for a doctor to tell you that you are faking pain, especially during any type of pelvic exam, or to dismiss your concerns by telling you the equivalent of “just drink another glass of wine.”

Ewwww. Patriarchy.

I get why experiencing pain with penetration would kick up some of those dysphoria feels. I want to normalize that vaginismus is a common condition for anyone who has a vulva, cisgender and transgender/non-binary folks alike.

Experiencing pain with penetration in no way impacts your validity as a non-binary person or reflects badly on other non-binary people.

Whether or not one particular sexual activity is something that you are able to or want to do has nothing to do with your gender identity or sexual orientation. You can be cisgender and straight as a board and still not like penetrative sex. Or as non-binary and masculine-presenting as you want to be and still love vaginal penetration.

Someone saying otherwise is the equivalent of someone saying “oh, you must be a lesbian because you haven’t slept with the right man yet (No, grandma, that’s not it, I promise).

If someone does turn around your vaginismus on you to try to invalidate your gender identity or sexual orientation, well….fuck ’em.

It’s ok for someone to be wrong about you.

It’s unfortunate that our society has made the image of a non-binary person out to mean Assigned female at birth (AFAB), skinny, white, masculine-of-center human who only dates other AFAB people.

Being non-binary has nothing to do with you who sleep with, your gender presentation, whether you like or want penetrative sex, or who that penetrative sex is with.

It’s simply who you are.

And it can make things a bit more confusing as you are sorting out your gender identity and sexual orientation. I get that. 

I know because I’ve been there.

I grew up in the rural South and got married (to a cis-guy) very young. I found out quickly that I had a pelvic pain disorder that caused sex to be excruciatingly painful.

I remember sitting in the bathtub after sex crying as quietly as I could because I was in so much pain. I remember going to a doctor and a therapist and having both minimize what I was experiencing, give me no clear answers, tell me to “just relax” and make me and my husband have sex right before I came into a doctor’s appointment for a pelvic exam so the doctor could “see where I was in the most pain” as I cried on the table.

It was torture and I felt horribly, horribly alone. 

And it was incompetence and ignorance in action on behalf of the “professionals” who were supposed to be helping me. 

It also made my identity journey to queer and non-binary way more complicated as I was having to also sort out my feelings of something being very wrong in my marriage and wondering where they were coming from. Was it just the pain talking? Did I just need to get over it?

It took a lot of time to work through, but eventually, I did. Both the physical and emotional pieces. And all of that work was worth it. 

The biggest piece of advice I can give you is to get help.

Professional and knowledgeable help.

It might take a little bit of searching to find your dream team, but I promise experts are out there that can help you work through all the aspects of this and it’s worth it to find them.

Get professional support:

Therapist: Find a Certified Sex Therapist (CST) through AASECT, the American Association of Sexuality Educators, Counselors and Therapists. All Certified Sex Therapists have training in helping people work through pelvic pain.

Make sure to also ask about their experience in working with trans/non-binary folks. Depending on where you live, finding a therapist who is both a CST and has experience working with trans/non-binary folks might not be possible, but at least you will know what you are walking into and can see if they are:
(a) non-affirming (avoid)
(b) just need to do more reading (ask them to do more reading).

Even if pelvic pain starts out as purely physical, it never stays that way. In our body’s attempt to protect us, it becomes hypervigilant about the potential for pain with penetration and then tries to avoid it by tensing up our pelvic muscles and developing anticipatory anxiety. Your body is simply trying to be helpful by alerting us that this thing you’re doing caused pain before so maybe don’t do it again. Like touching a hot stove. The problem is that we get stuck in this cycle of pain > anxiety > tense and avoid > pain > “See! I told you to avoid it!”

We get stuck in our heads instead of being able to relax into our bodies.

A sex therapist can work with you to decrease the anxiety, get you out of your head and into your body, and develop skills to help your muscles relax.

Go see a Pelvic floor physical therapist:

Seriously. Do not skip this step. 

Pelvic floor physical therapists are miracle workers. Truly. Most people aren’t familiar with pelvic floor physical therapy, but these professionals have a deep knowledge of the pelvic floor muscles that are causing your pain and a unique skill set to help decrease that pain exponentially (and relatively quickly in many cases.)

The concept of going to a pelvic floor physical therapist might sound intimidating, especially if you’ve had painful experiences with Pap smears in the past. Let me assure you, the notion of “no pain, no gain” does not apply in pelvic floor physical therapy.

Ask about the professional’s approach to pelvic floor physical therapy and pain and talk directly about your fears. If the physical therapist is good, they will assure you that you (a) don’t have to do anything you don’t want to in terms of internal examinations and (b) the pain should always be within your window of tolerance or something is going wrong. It’s a gentle practice with great results.

You can find resources here: https://ptl.womenshealthapta.org/

Find a good gynecologist who understands pelvic pain and is trauma-informed.

It’s likely that there is something physical going on that started or is maintaining the pain. Finding a good gynecologist is an important part of your treatment team. 

Ask questions about their expertise before you go and their trauma-informed practices. In particular, they should give you choices about what types of exams you want, talk you through every step of the way, be gentle, and, for god’s sake, listen to you when you say you’re in pain. If they don’t do all of those things, walk out the fucking door.

I know this can be a scary, isolating, and frustration-inducing concern. Trust me when I say that I know how that feels. And, also trust me when I say that there is help and healing out there.

Hang in there and build your dream team. 

PS-I think you’re magic. Don’t forget it.

Rae McDaniel, MEd, LCPC, CST (They/Them) is a Gender and Certified Sex Therapist and Coach who works with folks feeling anxious and lost about a transition they’re experiencing in sex, gender, sexual identity, or relationships. Find them at www.practicalaudacity.com and