"Everyone thinks I have the perfect life," said Natalie, 33, an advertising account manager who has been married for seven years. "And in many ways I do. My husband, Brad, and I like our jobs, and we just bought a new house. We vacation in the Caribbean, enjoy a large circle of friends, and have season tickets to our hometown basketball team, the Philadelphia 76ers. We get along great, except for one huge problem: We've never had intercourse. I'm actually still a virgin.
"It's not by choice. It seems my body won't let me have sex. Whenever we attempt it, I experience immediate muscle tightness and an excruciating burning sensation. I don't know what's wrong. It can't be structural, because I don't feel pain during gynecological exams. It's not low sex drive, either. I'm attracted to Brad and have orgasms from other sexual activities.
"As far as I can figure out, nothing in my background can explain this problem. I'm the younger of two children in a middle-class family. My dad was a department-store manager, and Mom was a sales associate there. I never felt particularly close to either of them. Dad was emotionally distant, and my mom was overly sensitive. I often felt neglected because they lavished all their attention on my older sister, who was born with severe cerebral palsy and had to be institutionalized from birth. They spent most of their free time working for an advocacy organization for parents of children with CP. I grew up pretty much on my own. Whenever I'd complain, my mom would tell me to stop whining. 'Be grateful that you're healthy,' she'd snap. 'Your sister has it a lot worse.' She explained the facts of life to me when I was 13 and told me not to have sex until I was much older. That was our only discussion on the subject.
"In high school, I wanted to have sex with my boyfriend, but when he tried to enter me, I felt the same symptoms I feel with Brad, so I asked him to stop. Around this time my best friend, who had just lost her virginity, told me how much sex hurt. This confirmed my own limited experience — and increased my nervousness. A few years later I felt the same intense pain with another boyfriend and we, too, never had sex. Since I enjoyed other sexual activities, I convinced myself that someday I'd be able to have intercourse.
"I met Brad 11 years ago at the advertising agency where we both worked. I was 22; he was 25. I was drawn to him right away — he was handsome and full of energy. And we had common interests — sports, movies, mountain biking. Brad was a true romantic: He'd leave sweet cards on my desk and surprise me with a tape of love songs. Once, for my birthday, he whisked me off to a resort in New England.
"We were madly in love, so after six months I disclosed my secret — and prayed he wouldn't lose interest. Brad, who'd had many sexual experiences, reassured me by saying, 'Maybe you haven't met the right man yet.'
"But history repeated itself. We tried to have intercourse about a dozen times during our four-year courtship, yet each time Brad got close to entering me, I would tense up to the point where my body felt like one giant knot and I couldn't even spread my legs. We tried wine, bubble baths, and full-body massages to help me relax, but I always froze up whenever we progressed beyond touching.
"Soon we were fighting about sex. Naturally, he was angry we weren't having it. When I'd say, 'Let's try on Saturday,' then back out because it hurt too much, he'd grow even more furious. I wasn't leading him on; I really wanted to have intercourse. Once we were engaged, Brad badgered me to get professional help, but I couldn't bear to tell anyone my shameful secret, not even a gynecologist. I just hoped the problem would go away. Two days before our wedding, Brad threatened to call it off, and I swore we'd have sex on our honeymoon. In retrospect, I'm amazed he gave me another chance.
"But on our honeymoon, I had all the same tenseness. On the last day, we still hadn't had sex, and Brad went ballistic. 'I knew I shouldn't have married you until this problem was solved,' he screamed. 'I'm tired of your empty promises.' He stormed out of the room, and I collapsed on the bed in tears. Three hours later, Brad came back and apologized, promising that we'd solve my problem together.
"But we reverted to the same predictable pattern. I would enjoy his kisses and caresses, and then I would pleasure him with oral sex. He always enjoyed it, but he said he craved the emotional connection of intercourse. So did I.
"Three years ago, things really began to deteriorate. After yet another failed attempt at intercourse, Brad called me his 'roommate' and began sleeping in the guest room from time to time. He set deadlines, saying he'd divorce me if we didn't have sex by our anniversary or by his birthday. As the deadlines came and went, Brad would call me a liar, and I'd sob inconsolably. Sometimes he'd spend the night in a hotel.
"Now we're trapped in a vicious cycle: The more bitter and angry Brad becomes, the harder it is for me to become aroused when we do fool around. I live in constant fear that he's going to cheat on me. As emotionally wrenching as that would be, I wouldn't blame him, because I'm not meeting his sexual needs. Sometimes my problem is all I think about. I have migraines, nausea, and insomnia.
"The other day, Brad threatened divorce again unless I see a therapist. I believe this may be my last chance with him, so here I am."
"I don't want a divorce, but I can't stay in an unconsummated marriage any longer," said Brad, 36, a creative director for an advertising agency. "I've been patient over the past 11 years. I believed Natalie when she promised to solve her problem. I surfed the Internet to find out everything I could about her condition and downloaded articles, hoping she'd be inspired by other women who had overcome the same problem. But she refused even to look at those articles, just as she has refused to see a counselor. What more can I do?
"Sometimes I feel like a chump for sticking around. But I love Natalie; we're best friends. Sex is the only thing we've ever fought about. But I'm prepared to leave if she doesn't get cured of whatever is wrong with her. I'm tired of shutting down my sexual side and pretending it doesn't matter that I've never made love to my own wife. Natalie seems to think the answer is oral sex, but that's not enough. I long for the emotional connection — and frankly, the sexual satisfaction — that's comes only with intercourse.
"I had an unremarkable childhood. I got along with my older sister and younger brother, but wasn't especially close to my parents. My dad, a truck driver, was a jokester who behaved more like a buddy than a father. My relationship with my mother, a homemaker, has always been on her terms. For instance, when I went to college an hour away from home, she never once visited, because she won't drive out of her zip code. She hasn't been to our new house for the same reason. I've always wanted Mom to be more involved in my life, but she is emotionally remote. I'm not really surprised Dad left her for another woman when I was in college.
"I was attracted to Natalie from the moment we met. She's petite and pretty, as well as smart, funny, and outgoing. I was disappointed when she said she had a boyfriend, but we became work pals. When her relationship ended a few months later, I immediately asked her out. Our romance was founded on friendship; once we started dating, I fell in love fast.
"When Natalie told me she was still a virgin, I was surprised but not alarmed. We'd had oral sex, so I knew she wasn't asexual. She was only 22, so I assumed she simply hadn't felt ready. I was confident she would soon be ready for me.
"But as time passed, I grew more and more concerned, and as our wedding date grew near, I was filled with dread. In some ways, I'm sorry I didn't call it off. I couldn't understand what was wrong. I even started to wonder if Natalie had been sexually abused as a child. She said she hadn't, which led me to conclude it was in her head and she needed psychological help.
"I'm angry not just because we've never had intercourse but also because Natalie breaks her promises. She claims she hates being a virgin but won't do anything about it. I'm so disgusted that I've withdrawn from her emotionally and physically. I hang out with friends after work because I don't want to be home with her.
"When I gave Natalie the most recent ultimatum, I was shocked that she finally agreed to get treatment — but frankly, I'm skeptical that she'll follow through."
The Counselor's Turn
"Brad was right: Natalie couldn't solve her problem by herself," the counselor said. "She suffered from a psychosomatic disorder called vaginismus, and she needed the help of a certified sex therapist to overcome it. But they also needed couples counseling to repair their broken relationship.
Vaginismus is the involuntary contraction of the muscles surrounding the vagina, which usually makes intercourse impossible. Sufferers have no control over this tightening. Statistics are hard to come by, but research suggests that as many as 17 percent of the women who seek sex therapy suffer from it. There are two types: Women with 'primary vaginismus' cannot be penetrated by anything; those with 'situational vaginismus,' like Natalie, can tolerate tampons and gynecological exams but not intercourse. The cause varies: It may be the result of a rigid religious upbringing that frowns on sex; a traumatic experience, such as sexual abuse or rape; relationship problems, such as infidelity; or anxiety or control issues left over from childhood. Some cases seem to have no explanation at all.
"I've treated a number of patients who suffer from vaginismus, but all of them either had a strict religious upbringing or had suffered sexual abuse — neither of which seemed to be the case with Natalie. Her anger at her parents' preoccupation with her disabled sister and their neglect of her led me to hypothesize that her vaginismus may have resulted from emotional struggles in her family. Plus, her first attempts at intercourse were painful and negative, which likely reinforced her tendencies.
"Her mother's blatant disregard for her feelings of abandonment contributed to Natalie's pleasure inhibition and survivor guilt (a common reaction among healthy siblings of severely disabled children). Since Natalie had no control at home — that is, she couldn't get her parents to take her concerns seriously and make her feel cherished and important — she sought to gain control over herself and her own body. Even though Natalie wanted to have sex with Brad, in order to do it, she would have to relinquish control of her body and give herself permission to feel pleasure. The thought of sex provoked anxiety, which, in turn, caused the physical symptoms to emerge.
"Vaginismus is highly curable. Many sufferers have no sex drive, but because Natalie was able to achieve orgasm, I thought her prognosis was good. Additionally, in my clinical experience, being in an otherwise good relationship — which Natalie and Brad's was — enhances the likelihood of a long-term cure.
"Natalie's treatment was a three part process: Physical exercises that would help prepare her body for intercourse; individual therapeutic sessions to address underlying psychological issues; and joint sessions with Brad to improve their relationship.
"The physical treatment — referred to as a 'desensitization process' — involved stretching Natalie's vaginal muscles with a series of dilators in gradually increasing sizes. Three times a week at home, she was to insert a dilator a little bit at a time until she could get the entire dilator inside of her. The goal was to slowly stretch and relax her tense muscles to the point where she would eventually be able to have intercourse. There was no set time frame for how quickly this process should advance. 'It's vital that you allow Natalie to move at her own pace,' I advised Brad. 'If you pressure her to move too fast, you could sabotage her recovery.'
"Natalie feared she wouldn't be able to use all the dilators, but once she had used the first one for several weeks and then advanced to the second, she gained confidence. Her anxiety subsided and her other symptoms — migraines, nausea, and insomnia — eased up as well. She also found an Internet support group. People who are in unconsummated relationships — and vaginismus is the leading cause — feel tremendous shame, so it has been vital for Natalie to know she is not alone.
"In terms of counseling, I helped Natalie come to terms with her pleasure inhibition and survivor guilt. I told her, 'You deserve to enjoy yourself. What happened to your sister is not your fault. You've paid your dues; it's time to let go.'
"Meanwhile, Brad needed to understand his role in the couple's marital troubles. Unlike most men in sexless marriages, Brad chose to stay, but he actually made things worse by struggling with Natalie, much as he had spent his early life struggling with his mother. People sometimes remain in difficult situations to replicate a battle from their past, and try to conquer in marriage what they couldn't conquer in their original family. Brad has been frustrated all of his life — first because he couldn't get his mother to do loving things, such as visit him, and now because he was unable to establish a full sexual relationship with his wife. But his tactics were counterproductive.
'If you continue to criticize your wife, issue demands, and threaten divorce,' I told him bluntly, 'you will make her more anxious and less likely to risk sexual intimacy.'
"Brad stopped making hurtful comments — even when Natalie's physical treatment didn't progress as quickly as he would have liked — and his patience helped boost her confidence. As she continued using the dilators, Brad grew hopeful. He began to show her more affection, holding her hand and cuddling with her on the sofa. 'Our marriage is so much better because Natalie has put herself on the road to recovery,' Brad said in one session. 'I have always loved her, but now I like her again.'
"Natalie's physical treatment took 18 months to complete. Three days before their ninth wedding anniversary, the couple had intercourse for the first time. Natalie reported some discomfort, but no pain. And the couple's sex life has grown steadily better over the year since then. They now have intercourse twice a week, and she is trying to get pregnant. 'I can hardly believe the extra level of intimacy and sexual fulfillment this has brought to our marriage,' Natalie told me recently. 'Now I understand why Brad wanted it so desperately.' Her only regret was that she had not sought treatment earlier and spared the two of them years of torment. 'But we're looking ahead to a bright future,' she hastened to add. 'And with luck, we'll soon have a baby to complete our happiness.'"
"Can This Marriage Be Saved?" is the most popular, enduring women's magazine feature in the world. This month's case is based on interviews with clients and information from the files of Stephen Betchen, DSW, a licensed marriage counselor and certified sex therapist in Cherry Hill, New Jersey, and author of Intrusive Partners - Elusive Mates: The Persuer-Distancer Dynamic in Couples. The story told here is true, although names and other details have been changed to conceal identities. "Can This Marriage Be Saved?" is a registered trademark of Meredith Corporation.
Originally published in Ladies' Home Journal magazine, June 2005.