Yesterday I met Tabitha, an 18 year old who ostensibly came in to talk about abnormal bleeding patterns, but her real issue was vulvar pain, centering around the introitus--the opening to the vagina. There is no visible sign of infection or trauma, but even the light touch of a q-tip elicits pain. She can't use a tampon let alone tolerate sex.
Tabitha denies past or current sexual abuse, but one possibility is aggressive intercourse (not rape per se but an unknowing or insensitive partner who has watched too much porn and an inability--for whatever reason--on her part to say, "it hurts, let's stop.") that if repeated leads to a reflexive tightening of adjacent muscles, making entry even more painful, and so a vicious cycle and chronic pain.
My recommendation is simple: stop. No penetrative intercourse; instead, a slow and progressive self-touching starting at the inner thighs and working in, to unlearn that reflex. Any contact that causes pain means a return to the level of touch that did not cause pain. And the warning that this may take months.
