We think we haven’t written enough about men and vaginismus. In the spirit of our focus on “our menopause” we want to tell you about how men may be helpful in reversing the problem but how, sometimes, they may worsen it.

Our made up couple, Tom and Jane, went through a typical sequence. Due to low estrogen levels after her hysterectomy, Jane’s vagina was barely lubricating even when she felt aroused. In touching Jane, Tom knew she was dry “down there” which he interpreted as her not being aroused, interested, or ready for intercourse – and sometimes that was accurate. But, other times, she did FEEL sexually aroused yet her body wasn’t ready for intercourse.

When Tom tried to insert a finger in her vagina it felt tight. She sometimes winced or flinched or said “ouch.” Not surprisingly, he felt concerned about hurting her and backed off. From then on, he became tense and tentative about touching her genital area.

Tom and Jane didn’t talk about it. Each worried they’d hurt the other’s feelings.

Sometimes a man, encountering his partner’s vaginal dryness and tightness, will lose his erection or ejaculate while trying to enter the vagina. He may then go on to a pattern of impotence or premature ejaculation. Some men feel so much frustration and confusion that they react with anger. Part of that anger is being unable to play the traditional male role of problem solver. Their frustration is understandable but not helpful.

This is a crisis moment for a couple, whether the man feels angry or, like Tom, feels sad and helpless. Unless the couple talks, the situation is likely to spiral downward and, a year later, they’ll realize they no longer have a sex life together.

First you must stop any sexual activity that hurts. Then you must talk about what’s going on and about how you feel. Remember, when talking about a difficult topic like this it’s important not to place blame and to talk about your own feelings, starting your sentences with the word “I.” If you find that you can’t talk, this is a time to see a therapist who specializes in couple’s and/or sex therapy.

If you are able to talk and you think you are ready to work together on a set of helpful steps, here’s how you begin.

You are going to have at least four separate times in which you take turns with genital touching. You agree ahead of time that no matter what happens, intercourse is out-of-bounds.

Jane, you should invite Tom to touch you the first time if you feel interested or at least neutral and are willing to try. With your clothes off you should start with kissing and non-genital touching. Both of you should focus on doing what gives you pleasure and not have the goal of turning on your partner. When you are relaxed and having pleasure, sexual arousal happens naturally. It’s not something you have to work at.

Jane, when you feel ready to include touching Tom’s penis, ask him to lie on his back with his legs apart. Sit between his legs, facing him with his legs over your thighs. You should spend some time touching his genitals for your pleasure.

He may or may not have an erection. His obligation is to let you know if anything you do makes him uncomfortable or hurts. Then ask Tom to show you, by putting his hand on yours, what feels good to him. This kind of non-verbal communication is a lot sexier and more precise than verbal suggestions like, “ A little to the left and softer.” If Tom ejaculates, that’s okay but it shouldn’t be a goal.

Next it’s time for Tom to touch Jane’s genitals. Tom, sit with your back against the wall or headboard, (with pillows as you choose) your legs spread apart. Jane, sit between Tom’s legs with your back against his chest and your legs apart and over his. Tom, begin by touching Jane’s genitals for your pleasure. After a while, Jane, you should put a hand over Tom’s and guide his touching. In this position, little or no penetration of the vagina is possible. With penetration off the menu, you should both feel less anxious and more relaxed.

Four or more times of genital touching should take place before you go on to try treating Jane’s vaginismus as we describe in the article “Treating Your Vaginismus.”

Many women may experience pain during intercourse after they have a hysterectomy. If you have experienced this or want to learn more, read this article.

Read more in Advancing Health After Hysterectomy