When I think about my sexual prime, I remember the summer in New York when I was 25, in my first relationship, and on my back screaming as my gynecologist poked around my vagina with a Q-tip.

“Here?” she asked.

I screamed.

“Here?” she asked again.

Another scream.

My whole body was sweating. At one point I briefly blacked out from the pain.

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This was the summer I set out to understand why sex hurts.


It had always been this way: a raw, burning sensation any time anything entered my vagina. Even tampons were unbearable.

I never went to the doctor because I thought maybe I’d grow out of it. I genuinely thought I was cursed (this was not far-fetched in my family’s canon of Mexican folklore). I kept the pain and the curse to myself. I would fake orgasms to get sex over with; I would fake a “haha, yeah” to end conversations about sex quickly. But now that I was entering a promising relationship, I was anxious to solve my intimacy issues.

It turned out that the walls barring me from intimacy were the very literal walls of my vagina. My gynecologist diagnosed me with pelvic floor muscle spasm, a chronic condition where the pelvic floor muscles can become so tight that they are painful to the touch. Basically, the way one might get knots in their back, I get them in my vagina. (But also my back still; I contain multitudes.) I had never heard of this before my diagnosis, and the medical legitimization of my pain dumbfounded me. Even referring to my pain as chronic pain made me uncomfortable; surely my suffering was not bad enough to warrant the term. But as I worked over the course of two years to get better, I realized maybe it wasn’t all in my head.


Here is what treatment for chronic pain looks like: twice a week, a physical therapist’s fingers were inside of my vagina pressing against different trigger points. In no way did this turn me on, because it was painful, and because my physical therapist would go on about her husband’s New Jersey metal band.

At home, my nightstand accumulated a glob of paper towels wet with lube from my nightly dilator work, during which I had to insert dilators into my vagina at 45-degree angles to stretch out the vaginal wall. I often forgot to hide these from guests. I practiced diaphragmatic breathing while watching Keeping up with the Kardashians, certain that hot people must never have to put up with this. I was no longer able to cross my legs when I sat, and when I did, I couldn’t do it longer than 20 minutes. Worst of all, I had to buy a standing desk and, sadly, use it.

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My physical therapist suggested that I have more clitoral orgasms because they relax the vaginal muscles. But in her careful delicateness, she explained this by whispering: “You might want to think about getting a vibrator and turning on a movie, that, maybe has like, a racy scene.” It was basically just a recommendation to watch Top Gun, but I used it as an excuse to buy a new vibrator anyway.

I had to explain this to my new partner, even though I wasn’t sure how to explain it exactly because there isn’t enough medical research to fully articulate my condition. (As one study dryly noted, “pelvic pain is poorly understood.”) Understandably, he became too scared to touch me for fear of hurting me. I wondered if my vagina was ruining my relationship. My worry turned into anxiety that made my pelvic floor muscles clench up even more. The plateau in my new relationship became the plateau in my vagina’s healing. This, among other reasons, lead to a devastating breakup.

I addressed the vaginal plateau by getting Botox injections because, according to pelvic pain researchers, Botulinum toxin A has been shown effective for pelvic floor muscle spasm. Despite research and evidence, my insurance did not cover it. My vehement appeal was denied after my insurance company called it an “experimental treatment.” I cried—a lot; and I wondered what level of brujería hath wrought this.


I explain this not because I want sympathy, but because women’s pain doesn’t fit into the cultural conversation around sex, despite pelvic pain afflicting up to 32 percent of women worldwide. Women are inundated with messages that sex should be wonderful and fulfilling but there’s virtually no baseline information that it shouldn’t be painful, or that sex can be a lot of things besides penetration, or that it’s okay to talk about this. And while we are still in the “experimental treatment” stage of women’s sexual dysfunction, men’s erectile dysfunction is a $4.25 billion industry. The comparison is not exactly a one to one; pain is multifactorial and therefore hard to study, but then, maybe this is me, yet again, lessening my pain and making it accommodating.


The worst type of sexual rejection is the one that comes from your own body. With chronic pain, your nerves fire pain signals so frequently that the brain physically restructures and learns to expect pain. So any little thing, like a Q-tip or a tampon, becomes painful. Chronic pain perpetuates chronic pain, rewiring the brain to experience it as normal.

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I wonder how much of our collective consciousness has done the same thing; that maybe we are so accustomed to women’s pain that we just passively accept it as a way of being. Study after study has shown that while chronic pain is more common in women than in men, health care providers take it less seriously than men’s pain, sometimes even discounting it as fake. The very idea that our pain is insignificant is the experience of many women.

But it’s more than the pain during sex. It’s the pain of resorting to a fantastical explanation of a curse before I thought something was physically wrong. It’s the pain that I only saw my suffering as valid when it inconvenienced someone who wasn’t me.

I am lucky to have had specialized doctors who have helped me. I can finally have pain-free sex, as long as I keep doing my physical therapy and watching Top Gun.

Eliza Cossio is a Mexican American writer and comedian in Brooklyn. She currently writes for Wyatt Cenac’s Problem Areas on HBO.